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

Nurses General Nursing

Published

  1. Do UAPs in the circulating role risk patient safety in the OR?

    • 15
      Yes, patient safety is at risk.
    • 4
      No, patient safety is not at risk when an RN is supervising the UAP.
    • 14
      I don't know enough about the circulating role in the OR to be able to decide.
    • 0
      Who cares anyway?

33 members have participated

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):D

For access to the entire article that I quoted from: http://www.aorn.org/journal/2001/mayhpi.htm

Semstr....Who in that room is the BEST at laying blame on someone else?

Oh, that's right, you already gave me the correct answer. Duh! The surgeon.

Anne

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I would LOVE to give you my opinion. But I've never worked OR, have seen maybe a total of 4 surgeries during nursing rotations, and I just don't know enough.

My gut feeling is with supervision by an RN, a tech would probably work. But then the RN has to do her job AND watch the tech. Plus if the surgeon is uncomfortable with it, he will be watching the Tech AND the RN....

PS I love your Indian legend.

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How is it that an LPN could be "Unlicensed Personnel"?

I'm getting an uneasy feeling about the underlying theme there.

Please clarify that.

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Peeps,

That's not my personal description of "Unlicensed Personnel". That is a quote from an article. Please feel free to access the article yourself. You can locate the address on the original post.

Let's not turn this discussion into something it isn't. I'm not using this in an effort to bash LPNs. My mother is an LPN, thank you very much.

Anne

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KC,

I didn't mean to irritate the sore spot.

I did access the article.

Still don't know exactly what "unlicensed personel" is getting at ,but don't you think it's what I'm thinking it's getting at?

I really want to know. I really don't want to face the possibility that I'll be treated like I have a CNA's education level,but there it is,lumping them together as unlicensed personnel. I'm forced to get my LPN first,for economic reasons,so I thought it would shed some light on why my instructors hesitate when they say "oh.......I thought you were in the RN program. why are you going to get an LPN?"

There's something they can't tell me there. They're biting thier lips over it!:imbar

I'm sorry I brought this into your post. You don't need to justify your feelings,nor should you have to defend the code.

I have only myself to blame for believing that it wasn't true because it made it easier to face.

Ya know,if we could just lay it out there in the open and call it what it is,I probably wouldn't have even considered this option.

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KC,

By the way: I just thought you should explore how you really feel about LPN,s. Maybe you don't see how the way you phrase statements about them would make it appear as if you feel they should be lumped in with techs.

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?

You seem to be questioning the safety of having an LPN(as UAP from the article) performing the same duty as a "licensed RN",as if they could not be comparable at some level.

Just something to think about. The way you phrase things around your loved ones may be hurting them without you realizing it.

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I just don't know enough to have an opinion, which brings me to another real issue I have. How can any of us know if one area of nursing is good for us when we don't even know what goes on there?

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Peeps,

Please comment on the issue at hand. Attack the article if you will, but, stop your attacks on what you think my beliefs are or my character in general.

LPNs are supervised on the floor. If I don't believe that RNs should supervise multiple operating rooms then that would indeed include the supervision of "any" personnel other than a licensed RN. What is wrong with that??

My main concern, however, is with a potentially ill trained "unlicensed" worker circulating in the OR alone. THE ARTICLE mentions LPNs as well as UAPs. I didn't group them together myself. I don't think that an LPN and a UAP are the same, nor do I group them the same.

I say again The ISSUE IS REGARDING AN RN SUPERVISING MULTIPLE ROOMS AT THE SAME TIME. An LPN would be a supervised worker as they are on the floor. End of story.

Anne:D

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OK,the issue at hand is the abillity of a person,that is not an RN to perform autonomously,regardless of thier current training?

Or is the issue that RNs go through some training pertaining to the OR duties in question that would somehow make them not only more competent than someone precepted for a certain responsibility,but also qualified to supervise any of these various duties. If that were the case,then of course they should not be circulating. If that were the case,the other personnel should not be there at all. I don't see anything in an RN's curicculum that would indicate that,but I imagine there's an intership you could get.

No doubt,if I were a supervisor,I would be concerned about the responsibility of knowing everyone's job without the security of having been extensively trained at my own. I would be more concerned of being made to be responsible for a role in which I was utterly unqualified to fulfill.

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