Circulating Nurse

By Sarah Gehrke
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Updated at: November 4, 2025

Inside the surgery room, the patient is powerless; incapable of making a decision on his or her own, and hence, the circulating nurse acts as the patient advocate while the patient is under the influence of anesthesia. The Nurse Circulator ensures safety of patient within the period of operation. Perioperative nursing is a unique type of nursing specialty and an essential member of the surgery team. The circulating nurse works by collaborating with other members of the team including the anesthesiologist, surgeon, surgical technologist, surgical assistant, and other personnel. They render expert pre-, intra- and post-operative nursing service. 

Perioperative nursing is a nursing specialty requiring a distinct set of skills and knowledge through specialized education and training. The RN Circulator plans and performs all nursing care for patients who will undergo surgery and other invasive procedures. They provide nursing care from assessment to outcome evaluation. With this role, the Perioperative RN is usually the single advocate for patient safety during operative procedures. 

What you do before, during, and after surgery

Before surgery

  • Check the patient’s records, vital signs, and consent forms.
  • Help the patient change into a gown and prepare the operative site (for example, shaving and disinfecting).
  • Set up the operating room and test equipment so everything is ready.
  • Gather supplies and specialty items the surgeon might need, such as specific lenses or implants.

During surgery

  • Call and lead the time-out so the team confirms the correct patient, procedure, and site.
  • Provide extra supplies and sterile instruments as needed.
  • Monitor the patient’s level of consciousness and vital signs.
  • Keep track of surgical counts (sponges, needles, instruments) and document events.
  • Help with positioning and with other tasks outside the sterile field.

After surgery

  • Monitor the patient and watch for signs of good or poor outcomes.
  • Give postoperative instructions to the patient before discharge.
  • If general anesthesia was used, watch the patient as they wake and check pain, breathing, and vital signs.
  • Assist with clean-up of the operating room and proper disposal of used supplies.

A perioperative nurse may also work as a scrub nurse (sterile, assisting the surgeon) or split time training, supervising, or doing administrative tasks.

How to become a circulating nurse

  1. Finish a nursing program
  • You can choose a two-year associate degree (ADN) or a four-year Bachelor of Science in Nursing (BSN). Make sure the program is accredited.
  1. Pass the licensure exam
  • After graduation, you must pass the national RN licensure exam and get your RN license in the state where you plan to work.
  1. Start working and build experience
  • New grads can get jobs as circulating nurses. Some outpatient centers may prefer candidates with hospital experience. Ask hiring managers about their expectations.
  1. Consider specialty certification
  • A common certification for circulating nurses is CNOR. The exam can include 200 questions and has a set time limit to complete.

Continuing education and license renewal

  • Continuing education requirements for RNs vary by state.
  • Examples: California and Hawaii require 30 CEUs every two years; Florida and Oklahoma require 24 CEUs every two years; Pennsylvania requires 30 CEUs every two years.
  • Some states do not require CEUs to renew an RN license, including Arizona, Colorado, Connecticut, Maine, Maryland, and Indiana.
  • Other state rules may require training in areas such as HIV/AIDS education or child abuse recognition.
  • Always check your state’s RN credentialing body for exact rules.

Pay and job outlook

  • A May 2024 report lists the median annual income for RNs at $93,600 (about $45.00 per hour). That report did not separate specialties.
  • Another report lists a median salary for circulating nurses at $92,550 per year (about $44.00 per hour).
  • One source notes a typical U.S. circulating nurse salary of about $88,000 per year.
  • States with higher annual pay for circulating nurses include:
    • Washington: about $104,821 per year
    • New York: about $101,252 per year
    • Massachusetts: about $101,076 per year
    • Alaska: about $99,671 per year
    • Vermont: about $98,404 per year

Job growth figures vary across the material. One place reports that nursing of all specialties is expected to grow by about 5% over the coming decade. Other material reports that perioperative nurses numbered over 539,000 and were expected to grow by more than 6% (or more than 12% in another estimate) between 2018 and 2028. The main point is that demand for perioperative and operating room nurses is strong.

How a circulating nurse differs from a scrub nurse

  • Scrub nurse: works inside the sterile field, directly hands instruments to the surgeon, and manages the sterile tray.
  • Circulating nurse: works outside the sterile field, coordinates the room, gets additional supplies, monitors the patient, and handles documentation and communication.

Practical tips for staying organized in the OR

  • Follow a consistent routine for each case. For example:

    1. Check the surgeon’s preference card for needed instruments and supplies.
    2. Visit the patient in pre-op and confirm H&P, labs, and consent.
    3. Pull medications and special implants or devices.
    4. Prepare the room in a “first-used, first prepared” order so you can start quickly if the patient arrives early.
    5. Set up the bed, linens, safety strap, and warming blankets.
    6. Ensure anesthesia supplies such as suction and a clean canister are ready.

  • Prioritize tasks using basic needs: for example, order blood first, reserve an ICU bed second, and then update the family third.

  • Learn the surgeon’s habits and preferences so you can anticipate needs quickly.

A few common questions you might have

  • Can new graduates become circulating nurses? Yes. New graduates can start as circulating nurses after finishing school and passing the licensure exam.

  • How long does it take to become a circulating nurse? Generally 2 to 4 years, depending on whether you complete a two-year or four-year nursing program.

  • What makes a strong perioperative nurse? Patience, teamwork, calmness under pressure, good communication, attention to detail, and the ability to think ahead are all important.

If you want more details about certification, state rules, or salary ranges, check with the RN credentialing body in your state or with perioperative professional organizations for the latest information.

Resources