Performing both surgical and imaging procedures in a hybrid OR can increase efficiency by reducing the number of patient transfers between departments and the number of patient hand overs between personnel. A hybrid OR is, however, a complex environment that requires integrating the knowledge and skills of personnel from multiple disciplines to create a successful workflow. When magnetic resonance imaging (MRI) equipment is installed in the hybrid OR, additional precautions are required to help ensure the environment is safe for patients and personnel. AORN’s updated “Guideline for minimally invasive surgery” provides guidance for personnel designing and working in hybrid ORs and MRI hybrid ORs. This article focuses on key points of the guideline that address hybrid OR configuration, hybrid OR staffing, and mitigating risks associated with intraoperative MRI. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.