Poll and Discussion regarding RNs in the OR. (for research paper )

  1. I am currently in Eng 102 doing research for my paper. The subject I have chosen has some personal interest for me, and others on this board.

    The issue is regarding RNs as circulators in the OR. Should UAPs be allowed to circulate under the direct supervision of an RN??

    "

    The issue of UAP in the circulating role is controversial. In some instances, an institution may loosely interpret the Health Care Financing Administration (HCFA) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) rules, which require an RN to be "immediately available."7 Based on their interpretations, these institutions may have an RN supervise several ORs simultaneously and have UAP function in the scrub and circulator roles."

    Surprisingly, there is no federal statute governing the circulating role within the OR.
    "The current HCFA rule governing surgical services, 482.51, states that

    ORs must be supervised by an experienced RN or a doctor of medicine or osteopathy;
    licensed practical nurses (LPNs) and surgical technologists may serve in the scrub role under the supervision of a RN;
    a qualified RN may perform circulating duties in the OR, and, in accordance with applicable state laws and approved medical staff policies and procedures, LPNs and surgical technologists may assist in circulatory duties under the supervision of a qualified RN, who is immediately available to respond to emergencies; and
    surgical privileges for all practitioners performing surgery must be delineated and specified in a roster, in accordance with the competencies of each practitioner.10"

    Another fact I came across is that only 20 states in the US require RNs to circulate. Therefore, in those states that aren't regulated, the hospitals can interpret guidlines any way they see fit. RNs are required in 37 other states, but the RN is allowed to function in a purely supervisory role. This allows a hospital to implement a UAP in the circulating role. 7 states have no RN staffing requirements regarding the OR.




    What is your opinion regarding this issue? Is this safe? Do you agree or disagree with the cost-saving measure of hiring UAPs to perform a role that used to be performed only by a licensed RN?


    Thank you in advance for your replies,
    Anne (eternal student-seems like it anyway)

    For access to the entire article that I quoted from: http://www.aorn.org/journal/2001/mayhpi.htm
    Last edit by KC CHICK on Sep 25, '02
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  2. Poll: Do UAPs in the circulating role risk patient safety in the OR?

    • Yes, patient safety is at risk.

      45.45% 15
    • No, patient safety is not at risk when an RN is supervising the UAP.

      12.12% 4
    • I don't know enough about the circulating role in the OR to be able to decide.

      42.42% 14
    • Who cares anyway?

      0% 0
    33 Votes
  3. 32 Comments

  4. by   Q.
    Hmmm. Interesting subject Anne.

    I guess the way I look at it is this: in OB, I circulate for C-sections and we have an OB Tech who scrubs, and that seems to work just fine. The tech is highly skilled and is very knowledgeable regarding her instruments.

    If it were reversed, and the "tech" or UAP was circulating and I, as an RN, were scrubbed in, I guess it wouldn't matter who does what so long as there were an RN present in the OR. Why?

    For one: as the circulator, at least in OB, that patient on the table is mine and in my care. I want to/need to/should be present during surgery as it helps to guide my care. Secondly, there has been many situations that have required (I thought) my knowledge as an RN to safely, confidently and effectively intervene, when both surgeons and the tech are sterile. The only two people really available to intervene is the anesthesiologist and myself. I know that the anesthesiologists rely heavily on us to assist him, at least in our OR.
  5. by   KC CHICK
    Guys, please....don't just vote and not add to the discussion. I need to know reasons why you're voting the way you do.

    Thank you,
    Anne
  6. by   Stargazer
    Anne, I voted that I don't know enough to decide. 'Cause, um...I don't know enough.

    I'm perfectly willing to expand on that point for many, many lengthy and pointless paragraphs, but it would turn into a Monty Python sketch and I don't think it would be particularly helpful to you in regards to your paper.

    Good luck w/ your data collection though--should make for an interesting discussion.
  7. by   spineCNOR
    1.) First of all, one has to determine "supervision" - it is one thing for a UAP to perform circulating duties when there is an RN physically present in the room -- quite another when the RN is required to be "immediately available". If the RN is assigned to cover more than one room, s/he is not immediately available.

    For example. what if one RN is responsible for 4 rooms - in one room there is a difficult intubation and the anesthesia provider needs help, in another room there is a patient with special positioning needs, in another one of the rooms a patient has unexpected hemorrhaging, needs the cell saver set up urgently, and there is yet another crisis in the fourth room, perhaps an unresolved count?? How is one nurse going to be in all 4 places at one?? Yet s/he is responsible for all of these patients - legally and ethically.

    2.) On delivering medications to the field-- a tech giving medications to a tech with no supervision from a licensed person that has some knowledge of pharmacolgy is just not safe.

    3.) for the most part there is no quality control with OR techs - I have worked with many techs who are excellent and have knowledge and skills comparable to any RN.
    But- there is no education requirement - at my facility we have many techs who were trained on the job, some who have attended a certificate program and some who were trained in the military. Some techs know what to do, but don't know why they are doing it- I have seen some that have a rote understanding of sterile technique, but don't have any understanding of the principles that they can use in unusual circumstances.
    I am not tech-bashing, just saying that they cannot be substitutes for RN's.

    4.) Hospitals are quick to jump on the band wagon of using a nursing shortage as an excuse to replace positions for licensed people with UAP's, to save money-this is more important to them than is quality, safe patient care. In the area where I live the real shortage is of nurses willing to work full-time in a situation where they deal with disrespect from surgeons and management and where they do not have the support they need to do their jobs in the form adequate support from sterile processing, enough instruments, and enough equipment that is maintained properly, where they are required to work large amounts of mandatory overtime to finish scheduled cases.
    Last edit by spineCNOR on Sep 25, '02
  8. by   KC CHICK
    spineCNOR, the assumption is that the RN would be supervising multiple rooms at one time with a UAP circulating in each room the RN is responsible for. A quote from my first post : "Based on their interpretations, these institutions may have an RN supervise several ORs simultaneously and have UAP function in the scrub and circulator roles."

    Thank you so much for all your input. This is a great start.
    Anne
    Last edit by KC CHICK on Sep 25, '02
  9. by   DelGR
    I was an OR tech in the Navy. We did the circulating and scrub jobs. The RN did the supervision and had only two rooms to supervise at a time. The RN and the tech that circulated did the needle and sponge counts.
    I don't think it takes an RN to scrub or circulate but I do think they should be there for legal and supervisory reasons.
    In the Navy, we were taught how to function as an assistant to the Anesthetist.
  10. by   KC CHICK
    Glad to see a tech perspective here.
    Would you mind telling me what kind of training the Navy put you through to perform your separate scrub and circulating roles? Did you get certified in scrubbing, or circulating, or both? What were you taught in class and how long did you train on the job?

    Thank you,
    Anne
  11. by   semstr
    I didn't put my vote into the poll, because I am not sure you can use my information for your paper.
    So just a statement here from Austria.
    Here there are only RN's working in OR, as scrub- and as circulating nurse. The reason is, we don't have the technician-training here (other European countries have them though), the policy to this is, that our nursingboards and government, want basic-nursing-care in OR too. And only a RN can provide that, also the reason no LVN in OR.
    In some (these are pilot-projects) hospitals the pre-OR-visit is done by the duty-OR-nurse, so the patient knows her and sees a familiar face when he goes into the OR.
    Postop. she visits him too and asks his feedback on the whole procedure.
    I really like this and the patients even better!!
    Take care and good luck with your paper, Renee
  12. by   spineCNOR
    Sound's like our European nurse colleagues have the best program going!

    IN response to DelGR-- the best techs I have ever worked with have been military trained--the best tech I have ever worked with was trained in the Navy.
  13. by   ceecel.dee
    My opinion may not be popular, but here goes.

    I was an OR circulator for 2 years. I did not stay long because of the lack of nursing skills needed for the job. I felt my other 10,000 skills getting rusty. I do not think it takes an RN to count sponges, to position a patient, to accept a specimen and package it up properly for pathology, to tie a tech or surgeon into a gown. Yes, I think a supervisory role is imperative, and an RN needs to be available to double check what an UAP might draw up and add to irrigation or injection, to accept orders and implement them as the procedure progresses or changes, for emergency situations that come up, to supervise positioning, prepping (as we have the anatomy knowledge, but can also teach it), and so on....
    So, an RN presence necessary? Yes
    An RN for all circulating duties? Not necessary.
  14. by   KC CHICK
    Mmmmmm. Over 240 Views and less than ten responses. I've been on this board long enough to know that everyone has opinions to share....give 'em to me.
  15. by   canoehead
    OK, I'm not an OR nurse so I didn't vote, but I have been the baby catcher at a C section so have seen the OR in action. In my opinion you need someone to take ultimate responsibility for everything that goes on in the room. Right now I see the circulator doing that as far as equipment, sterility etc. If the doc was willing to do it (not sure if he/she would want to concentrate on the surgery and watch what everyone else was doing) then fine- UAPs could be used although I predict poorer outcomes the surgeries would get done and probably be less expensive to perform.

    Historically RN's have been the coordinators of care, keeping in mind everything that is going on inside and outside the OR (scheduling, skills, technical duties). RN's do that job in the OR and on the floors, and are trained to watch out for everyone to give the pt the very best final outcome we can offer them. So no, I don't think that UAPs could perform equally as well.

    The thought of having one RN overseeing 4 ORs is insane because an emergency can happen any time. Most importantly the RN watches over the final product and intervenes to prevent the emergency. He/she also have the knowledge and skills to problem solve and call in what is needed. (knowing that if Xproblem happens then we have Y doc in house and the equipment is in that cupboard, and so'n so out in room 3 had this same thing happen twice before so if the 1st thing doesn't work he/she can be covered by Joe and come in and be my helper) Tell me a UAP, not trained in anything but THIS type of surgery with THIS doc will know all this, and be ready...

    Sure the surgery will be cheaper, it will get done, but the outcomes will be worse, and pt stays will go up. If you are judging success by money you might get by, but by pt outcomes the idea is a clunker.

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