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
Sep 25, '02
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
Sep 25, '02
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.
Last edit by KC CHICK on Sep 25, '02