The Truth About Becoming an ‘Enrolled’ Scrub Nurse “Fire up the Theatre!”

Discover what it’s really like to work as a enrolled nurse in theatre – as a scrub nurse in Australia. Brad Ross shares his journey through setbacks, perioperative nursing, theatre life, and why persistence pays off.

💬 If you enjoy articles like this, explore more nursing stories and interviews at:
🌐 www.thenursebreak.org/blog

✍️ Interested in sharing your own nursing journey, specialty, or clinical passion? We’re always looking for nurses, students, educators, and healthcare professionals to contribute. Email us at:
📧 hello@thenursebreak.org

👥 Join thousands of nurses in our private nurse-moderated Facebook community:
🌐 The Nurse Break Facebook Group

About You

I’m an Enrolled Nurse Specialist in Perioperative Nursing in a small regional private hospital in NSW. My nursing (and pre nursing) journey has taken me into so many different roles before settling into the world of Perioperative nursing (specifically instrument and circulating nursing, known as Scrub/Scout.)

Outside of this I was a Level 2 Rugby League Referee for around 13 years and also spent 3 years as a volunteer rescue operator with VRA NSW. This taught me skills in road crash rescue, vertical, industrial and animal rescue as well as domestic rescue skills. Most of all it taught me how to work well under pressure.

Early career and nursing transition

I think those early days, pre actual paid work, showed me how to nurse as opposed to how to be a nurse. I’ve always believed that anybody can BE a nurse but not everyone knows HOW to nurse. Being able to look after family members and then take that experience into looking after other people’s family members, I believe, gave me a really unique insight into being a family member as well as a nurse at the same time. I think it enabled me to build true empathy for people early in my journey and be able to adapt to varying situations. Albeit whilst I was still young.

From Taxi’s to Scrub Nurse

At the time I would often question my choice of careers as for others I would look and see them transition from support worker or assistant in nursing into registered or enrolled nursing and just get it done. I really felt I had an obligation to keep working and earning money as this had been instilled in me for as long as I could remember. I vividly remember the decision to start driving taxis was because I was simply burned out from aged care work but felt an obligation to still earn money and contribute to the household

It was all I’d ever done and whilst I loved the work I’d had a few negative experiences and just couldn’t do it anymore. I remember reading the newspaper and the local taxi service wanted drivers, no experience necessary. At this stage I’d been working for around 6 years and just needed the break.

I’m so glad I did, whilst the money wasn’t fantastic and the hours were long, I enjoyed it and it gave me an opportunity to just work at something different away from the health care system. It also gave me a lot of time to think about where I was going in my career and what I wanted for the future. It was from here I went into disability support worker and then theatre support role and the rest is history. I think you just have to trust and believe that there is an overall plan and that speed bumps/detours along the way are ok.

Rejection didn’t stop you after being rejected from the Bachelor of Nursing

If you’re like me you are your own harshest critic. Even now as a nurse, nobody is harder on me than me but you also have to be kind to yourself at times and give yourself permission to fail. As nurses we put so much pressure on our own kind. Even now I have been told that I shouldn’t be “wasting my time” as an Enrolled Nurse and should be going on as a Registered Nurse. I would be interested to know that any patient who has been looked after by a really good nurse cares in the slightest what rank they are be it Enrolled, Registered or our very valuable Assistants In Nursing.

The rank does not make the nurse. One of the things I love about the perioperative stream is that if you walk into an operating theatre in the middle of a case you can’t tell by looking who is what rank. You see an instrument (scrub) nurse standing next to a surgeon, confidently handing up instruments, anticipating the next movement, the next instrument, the next move, it’s amazing to watch.

Then you watch a good circulating (scout nurse) standing back, listening to the surgical conversation and watching the case, anticipating what their scrub nurse might want/need next and an anesthetic nurse silently but confidently working away with an anaesthetist, as well as theatre assistant who has helped the nursing staff meticulously prepare the theatre for the day. When you see this it really is a wonderful thing to watch a team gel together regardless of the rank of the staff.

Many are surprised when one of those nurses signs their name as an an Enrolled Nurse at the end of the case.

My advice to anybody who cops a knockback or fails a unit, reevaluate your plans and if it’s what you want, go after it. So many people who have been successful in life didn’t succeed the first time. I am really fortunate in that I truly love the discipline of nursing that I’m in. Some people never find that in a job, I’ve been lucky that I’ve always enjoyed the areas I’ve worked in but this is absolutely where I believe I’m meant to end up.

What does a typical day as a scrub nurse actually look like for you in the private hospital?

Wow I love answering this question, so much goes on behind the scenes that patients and others rarely see. Being full time I generally work mostly early morning starts during the week, (we are fortunate that we rarely work weekends and don’t do on call) however most of those days are 10 hours (sometimes longer) shifts.

I arrive early in the morning (I like to be early as it gives you time up your sleeve)

I will usually check the lists for the day, ensure that no cases have been added on since I last saw the list. I’ll then check my set ups- they are the bundle of disposable items that we need for each case things like sutures, dressings, procedure packs that are specific to each case and each surgeons preference.

Then we remove our sterile trays from our sterile stock room. We always do this the day of surgery as the room is temperature controlled to ensure the integrity of the trays.

I’ll then “fire up the theatre” lol.

Turn the lights on, plug in any equipment and make sure it’s working, organise the room for the day which can be anything from making sure the surgeons desk and chair is in the right place to arranging the garbage bins or checking there’s enough gloves etc. Basically anything that can be forgotten has the potential to mess up our day so I try and be in front of it all.

Being a smaller hospital means that often you have a smaller staff so a lot of the setting up tasks fall on yourself and ultimately, as the scrub nurse, you have the responsibility for everything.

Some theatre lists may go all day and depending on the discipline can be a list of long cases ie only 2 or 3, a list of a lot of short cases or a mix of both.

We then all have a bit of a chat about the day ahead try and work out breaks and talk to the other scrubs about any equipment clashes or things that may affect us all.

Again being a small unit it’s really crucial that you’re across a lot of things. We don’t necessarily have a designated person to do our setups or liaise with companies for products etc we do a lot of this for ourselves. Our theatre suite consists of 3 operating theatres and a procedure room. The procedure room is utilised for pain management every fortnight but it is common that we may have all 3 operating theatres in the morning or even all day. So little things like keeping areas between theatre as de cluttered as possible whilst still having access to everything can de rail your day, particularly during quicker paced lists. I can’t say it enough but being organised is the key.

I’ll then scrub and be ready for when the surgeon walks in so that we are punctual and getting our “knife to skin” time as close as possible to the start of the session time. My rule is that I make sure whenever possible the surgeon/anaesthetist aren’t waiting for me.

Depending on who I’m working with some days I’ll scrub for all the cases and other times I’ll share the scrub scout load with my other nurse.

Once the list finishes, we clean up, put everything away and then I’ll usually check the lists for the next day and if there’s time answer some emails or follow up on any issues.

Being someone who has been working at the hospital for a long period, often things may be passed to me from managers throughout the day or from other staff who may need clarification on something specific to a certain discipline or case which can keep you on your toes throughout the day in between cases.

As well as all of this we need to be across the normal day to day nursing stuff such as mandatory education , product recalls, our in house education and inservicing etc which is really important as things are always changing in a theatre with surgeons preferences, supply chain issues that may lead to product changes and the like.

Then it’s off home and start again the next morning.

I think scrubbing in theatre is very similar in some ways to being in a play in a theatre. You spend a lot of time organising and setting up (almost like a rehearsal) for an operation that is the performance. Sometimes the operation may be quick or lengthy and often the more work you’ve put into it ie the more organised you are and well setup, the better the performance goes.

What are some things people would be surprised to learn about the role of a scrub nurse?

Probably the biggest surprise for me was how much “behind the scenes” work a scrub does

As I said before it’s a bit like rehearsing for a performance. If you see a performance at a theatre you see the end product, you don’t necessarily see all of the rehearsals and the practice and working in small details beforehand. Working in theatre can be similar.

A scrub nurses role is to basically run the theatre. Every single surgeon has individual preferences from equipment to positioning of the room, sequence of surgery, everything you can imagine. The scrub nurse does have access to individual preference sheets for each case that each surgeon does (as well as keeping these updated) so they really have to be across so many things.

They will assemble all of the instruments and consumable items for the case so that the circulating nurse (scout) can open these. The scrub nurse then arranges their trolley (after they have scrubbed, gowned and gloved) to allow easy access to everything during the case. They discuss any issues or plans with the surgeon before the case and during the case. A good scrub nurse anticipates and concentrates as the case is occurring, they have their instruments all arranged, often in order of use and will anticipate unexpected occurrences such as bleeding and react accordingly.

In a regional area our surgeons are not as subspecialised as they may be in a larger urban area.

For example our general surgeons can cover anything from endoscopy (looking inside the digestive tract) through to colorectal (surgery of the colon) and everything in between.

For a scrub nurse this can mean exposure to a large variety of work but also needing to be competent in endoscopy, laparoscopy as well as open surgery. 

I work across multiple disciplines including general surgery- as above

Gynaecology- surgery of the female reproductive system

Urology surgery of the urinary system including bladder, kidney, prostate etc

Upper limb orthopaedic surgery such as fingers, wrists, elbows and shoulders

Pain management including injections to the joints as well as radio frequency denervation which provides longer term pain relief to the patient

I’ll also sporadically fill in for endoscopy lists, oral and maxillofacial surgery and dental surgery.

There can be multiple surgeons in these disciplines so you have to be focused during the list on the surgeon you’re working with and their individual preferences, personalities and nuances.

A scrub nurse is continuously planning for lists. If you can imagine that a typical 5 day week may involve up to 10 lists of 10 different surgeons across 10 different disciplines (based on a morning session and an afternoon session) that require 10 varying lots of equipment it means being across a lot of different things.

We work on a 4 week roster so some surgeons may only be with us once a month so we have to do a bit of long term planning for them and watch their lists as their cases build and respond to any requests they may have for specialised equipment. This is usually written on the patients consent ie a certain tray or a certain consumable. We get to know this.

Other surgeons may operate with us multiple times in a week or a month so they may require a higher volume of stock or for longer lists managing the order of their lists and avoiding equipment or staff clashes with other theatres. Sometimes it can be quite intense juggling multiple things as well as scrubbing each day.

Again as a smaller hospital often we may only have 1 of a certain piece of equipment so we have to manage list orders to avoid clashes and ultimately delays of lists.

What are some memorable procedures, technologies, or moments that have kept theatre nursing exciting for you?

That is a tough question to answer as I really am excited by it all.

Particularly by being involved in new procedures or technologies is really interesting .

The beauty of working in elective surgery in a private hospital is that your patients have a very clear end goal and you actively participate in that. For example a patient coming to have a diagnostic procedure such as a colonoscopy wants to know whether there is a polyp or a cancer or something causing their symptoms.

A patient who has been struggling with pain from gallstones or kidney stones, gets their gallbladder removed or their kidney stones lasered.

It’s a very unique type of nursing to know that there is usually a definitive end point of their treatment even for larger cases such as joint replacements, you know there will be rehab and treatment postoperatively but there is still that endpoint and end goal to their treatment.

The first time I remember being involved in a new procedure was when I was still a wardsperson in theatre. We had a spinal surgeon who had started and he did the first ever cervical disc replacement (anterior approach). 

This means that they replace a disc in a vertebrae in the cervical area of the spine but they access this through the front of the neck. It was the first one ever done in the hospital or the town. It sticks in my mind as the incision was very minimal so the patient just looked like she’d had a little skin cancer cut off the front of her neck, the dressing was that small LOL!!!

Other memorable first include the change from trans rectal biopsies to trans perineal approach for prostate biopsies and using MRI fusion for this. Basically the transperineal approach significantly reduces infection but the fusion system allows the surgeon to merge the patients MRI and ultrasound together to target biopsies at specific areas of the prostate enabling a much more effective biopsy.

Even just this week we are trialling a new plasma generation system in urology. This is a bipolar energy system (meaning the voltage used goes between the two tips of the instrument). The system uses plasma energy to resect away tumours of the bladder or benign prostate tissue to treat benign prostatic hyperplasia (BPH). It’s believed that the plasma enables a shallower tissue penetration with less charring and sticking of the tissue.

Memorable procedures, that’s tricky. You always remember your first solo procedures, the first time you did a laparoscopic or large open case.

I remember a few cases that didn’t go to plan, often when a case doesn’t go to plan, you remain scrubbed in for a really long period. Mostly with elective surgery it can be unexpected problems like bleeding or unexpected anatomical problems. These are the cases where your attention to preparation and the ability to think on your feet is most valuable. Whilst we aren’t the surgeons performing the procedure, it’s always helpful to be able to offer equipment or instruments to the surgeon as they navigate through the unexpectedness.

Also there are the cases where the anaesthetic or the procedure itself causes an underlying problem such as a cardiac or respiratory event. These are the times where the teamwork within the theatre really comes to the forefront. Those times make me proud to be part of the team that I am.

One of these situations that always comes to mind was a gentleman who suffered a very brief cardiac arrest during a procedure, our team responded quickly and I supported the anaesthetist by doing chest compressions for around 10-15 seconds when we managed to achieve ROSC (return of spontaneous circulation).

We abandoned the procedure and transferred the patient to recovery.

He awoke in the recovery ward, and the anaesthetist and surgeon explained to him what had happened as I walked out. He said to me “are you the bloke that jumped on my chest” I said

“Yes Sir I am.”

He looked me up and down (I’m quite tall) and said

“Thankyou, but no wonder I’m so bloody sore.”

What are the biggest challenges you see students and junior nurses struggle with in your area?

We regularly have students through the theatre complex and I believe as nurses, sometimes our advice to students is something we get so very very wrong. When I was training I was encouraged strongly to “consolidate my training” in a public hospital. I was also told that staying in Perioperative nursing in a private hospital would “deskill me”

I laugh as students come in with their preceptors having said these same things to me. It seems to be a language on replay that we give the students however many of these preceptors have never practiced in the perioperative space so I’m unsure where the idea that they will be “deskilled” is informed from.

I think what we say to students can have a lasting effect on them. Whether they are Enrolled or Registered nurse students or AIN students, everyone has their own journey to take, they are at all different points in their lives, maybe they have a family or people they need to support at home and certain hours or streams of nursing such as shift work aren’t suitable for them. When talking to them about what sort of nursing they wish to pursue I try and gauge what might suit them but also encourage them to pursue a stream of nursing that interests them, that they are passionate about. If that isn’t perioperative nursing it’s still important to give the student a great perioperative experience and show them what is involved in the roles.

Even though I’m not recognised as a “formal educator” I believe that we all have a role of education to play towards our students to make sure that we are future proofing our industry, particularly less popular specialty areas. So long as we are teaching using evidence based methodology and best practice in line with our standards of practice, this shouldn’t be seen as an issue.

Our students are already completing placements in a regional area in smaller hospitals. Sometimes it’s because the students come from the area and are completing placements closer to home. This can be challenging as potentially they are known to or know the patients they are working with. Also smaller hospitals don’t always have the overarching support that may be available in larger hospitals such as multiple educators, multiple specialities and larger numbers of allied health and ancillary staff.

This can be rewarding for a student giving them a little more independence and encouraging decision making, however it may place the student in a compromised position by others for them to “push” scope of practice and maybe consider doing things they aren’t comfortable with, particularly if their uni/tafe preceptors are not around as much as they may be in a larger public hospital. Whilst it’s important for a nursing student to learn skills and challenge themselves, it’s also important that they speak up when they aren’t comfortable and feel supported enough to do so.

Probably the one real issue I have with nursing as a profession is that we tend to define success by rank and specialty. We’ve all heard the stories of “young and fresh nurses” wanting to gravitate to ICU & ED where “the action is, where you learn so much”

As I said previously, when I graduated, I was told that I would “de skill” if I went to theatre. I challenge nursing preceptors and the entire industry, to walk away from this dialogue. As a profession let’s no longer place somebody’s value as a nurse on rank and specialty and just accept that every area of nursing has a different skill set but universally we are all joined by a desire to nurse. I couldn’t walk into ED right now and know what to do, but I don’t think an ED nurse could walk into theatre and know what to do. Our skill sets vary and each specialty takes time to learn. Let’s rather use the language when we talk to students about their future,

“Whatt do you want to do”

“What area of nursing interests you”

“What pathway do you think you see yourself in”

I have no problems with students or new grad nurses trying different areas of specialty but I think encouraging them to follow their passions and not stereotyping those passions will help curb the attrition rate in newer nurses. Nursing is tough, the system both public and private isn’t easy to navigate and can be confronting but enjoying the job can go a long way to alleviating some of these problems.

Why do you think understanding the “why” behind things is so important in nursing?

Too often the way we deliver our training is to teach the end point but not know why and how we get there. We see with students they know what the monitors do, they know how to use the “fancy” equipment but they may not be looking at their patient or know what they are seeing and how to  interpret the information they are receiving. Being able to know what’s going on with a patient and why it’s happening is so crucial. I’m not saying that nurses need to be doctors, they don’t, but they should always ask why.

I believe that again the way we mentor and precept students can either discourage or encourage their curiosity. We teach children from a young age to be curious of their environment, we’ve all had the toddler that asks why almost every minute of the day LOL!!!! 

Why don’t we encourage this in our adult learners.

I remember when the glutide drugs such as Ozempic etc started becoming more common in our theatre patients. I didn’t know a lot about them and their function but heard a lot of anaesthetists discussing new fasting guidelines and talking about different anaesthetic approaches. I took an anaesthetist aside and asked why these drugs are such an issue and what their mechanism of action is and kept asking the questions. If you are courageous enough to ask, most doctors are accomodating enough to teach. Show interest, if you don’t understand something, ask why. The best scrubs I’ve seen work, understand why they are doing what they are doing and so if trouble arises during a case they offer really good solutions quickly.

What do you wish more people understood about the role, knowledge, and skills of Enrolled Nurses?

Enrolled Nurse training has evolved so much just in the 27 years I’ve been working. I remember when the first medication endorsement ideas came out for ENs and then the advent of diploma training from the old Certificate IV course. When I completed my training, we trained in the exact same anatomy and physiology units as the Bachelor Of Nursing training. So many Bachelor of Nursing students have said that the Enrolled Nurse diploma is assessed a lot harder than the Bachelor. My intention in that statement isn’t to rubbish the Bachelor Of Nursing program but this is the feedback that we often get from students.

The truth is though, if you talk to the average patient in a hospital, they want to be looked after by a competent caring nurse, they aren’t interested in rank, so why should we as an industry obsess over it.

I’m not advocating for everybody to have free range scope of practice or for unregistered practitioners to be handed the drug keys, I’m just saying that when you have worked in a system with multiple levels, sometimes those with the highest rank or academic qualifications aren’t necessarily the ones solving the problems.

When I was an EN student, the clinical coordinator on the ward I was working (in a larger public hospital) was an Enrolled Nurse. I found this out almost at the end of my first shift, I asked my preceptor why this was. Her response was simple  “There isn’t a nurse on this ward who knows more or has more experience than her”. Those words resonated with me and I watched in awe as staff right up to the Nurse Unit Manager liaised with her and she led that ward with precision and professionalism and didn’t skip a beat.

I haven’t forgotten that and have seen Enrolled Nurses passed over, because of their rank, for positions that they could’ve done well. Again rank doesn’t automatically assume competence and it never should. That’s why I think allowing ENs to work as specialists, in a similar way we do to RNs just provides a more enriched workforce, particularly when they are specialising as a team together.

Please tell us about being awarded Nurse of the Year and later being nominated for the ACORN GLUE Awards?

These were both shocks in themselves, the workplace nurse of the year was a few months after I started as a nurse and was nominated by my manager at the time. To have your devotion and passion recognised is nice but certainly not something you look for.

The ACORN glue award nomination was a massive surprise. To be nominated by your peers and seen as the GLUE in your workplace is an honour. Perioperative nursing is so reliant on a team for each and every list. Whether it’s the intraoperative team during a case or the wider perioperative team over an entire day, one link missing can be a disaster so to be seen as a leader in that realm is a true honour and I really am humbled by the people I work with every day, doctors, nurses, technicians, CSSD all bring something to the experience for our patients and that is such a wonderful thing when it all gels together.

I’ve always had the goal to be able to end my career (when I get there) and know that people enjoyed working with me, and that I set an example maybe as the type of Perioperative nurse that people maybe aspire to be. That would be a career well worked.

Looking back over your journey, what moments make you most proud to call yourself a nurse?

I think every small diversion I took along the path to becoming a periop nurse specialist added something to help me get there. I’ve been fortunate to work with thousands of people from all walks of life who each have left some of their knowledge, experiences and stories with me. As well as this, every detour that I took gave me exposure to different pockets of the healthcare system. I believe this can make you a bit more knowledgeable and confident in your daily dealings with everyone.

Being able to now call myself a nurse but also to be able to say that each day I work in an area that I truly enjoy and am passionate about.

I guess what really makes me proud is the work that we all do across the system. Whether private or public, hospital based or community, I’m proud daily to be part of the nursing world. We are always up against it, whether it be not enough staff, resources, space or time, we do our best and work hard with what we have. Moments like that make me proud to be a nurse.

I think we are too quick to tear each other down based on rank, skill and specialty when we should be learning more about each other’s disciplines. That’s why I love forums such as this where everybody tells their story and gives us all an opportunity to learn.

Thankyou for the opportunity to tell my story and hopefully raise the profile of both periop nursing and Enrolled Nursing in general.

The post The Truth About Becoming an ‘Enrolled’ Scrub Nurse “Fire up the Theatre!” first appeared on The Nurse Break.