Can a surg. tech. "circulate" a case -give medications?

  1. At the hospital where I currently practice we sometimes have 2-RNs and 1-Surg. Tech in a room (on good days). In some cases the Surg. Tech. is allowed to "ciculate" the room with one of the RNs. My question is when a surg tech "ciculates" can they spike IV bags or give medications to the scrub RN for the surgical field? I have refused to allow the ST to spike IV bags or give me drugs when I am scrubbed because I think that this exceeds her scope of practice but I am not sure. I have asked this question to AORN without results but I think this question goes beyond AORN into the Board of Nursing Practice Act. Please help me to bring some clarity to this situation.
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  2. 79 Comments

  3. by   maikranz
    Greetings!
    I would check with your state's Board of Nursing practice consultant.
    Be specific. Our consultant was quite helpful with my questions about the scope
    of practice related to unlicensed personnel.
    Good luck and you aren't alone.
  4. by   callbabe
    Quote from Linda J
    At the hospital where I currently practice we sometimes have 2-RNs and 1-Surg. Tech in a room (on good days). In some cases the Surg. Tech. is allowed to "ciculate" the room with one of the RNs. My question is when a surg tech "ciculates" can they spike IV bags or give medications to the scrub RN for the surgical field? I have refused to allow the ST to spike IV bags or give me drugs when I am scrubbed because I think that this exceeds her scope of practice but I am not sure. I have asked this question to AORN without results but I think this question goes beyond AORN into the Board of Nursing Practice Act. Please help me to bring some clarity to this situation.
    Your are absolutely correct, I aggree with you totally. They can read,and they can be taught. But do not have a license or the training and our patients deserve the best. Our techs are not allowed to dispense meds. There should always be an RN in the room anyway. No reason for them to do it.....
  5. by   Marie_LPN, RN
    Techs can't give the meds. Circulating depends ont he state regulations, but where i work at the techs and LPNs are trained to circulate just so they know what it consists of, and in case of emergency (rare) situations.
  6. by   shodobe
    This subject has been brought up before. Go through the search and read prvious posts. As far as I know there is no state that allows STs to circulate for any reason. They have their job to do and I have mine and that is to watch them. Mike
  7. by   Lonman
    This will depend on what your state and hospital allows.

    To answer your question, yes they can. Now, does it happen everywhere or is it expected, no.

    CST's are trained to do this role as part of their accredited program. We do recognize the fact that the CST's primary role is not circulating. Many hospitals utilize RN's for this role and some do utilize the CST. I agree with Mailkrans about checking into what the state allows. Unless it is stated by state law, hospitals can do what they feel is necessary.

    Also what is interesting is the definition of "circulating". Out of all the comments from this topic, not once did anyone have a definition of circulating.

    Where I work, I am glad to say this is not an issue with our staff. We all work together to do what it takes to give out patients the best care. RN or CST. We are a team and we do what needs to be done. Our hospital utilizes an RN for the primary "circulator". This is the one person that will sign off on the many papers involved. I will say that I do not sign off and am not the sole person responsible for this action. I will, however, do any other "circulator" tasks if the need is there.

    When drawing up meds, spiking meds, or giving meds to the field, I do what is hospital policy and I verify the meds with the primary circulator and the person who is receiving them.

    ~Lonman
    Last edit by Lonman on Jul 3, '04
  8. by   Lonman
    This will depend on what your state and hospital allows.

    To answer your question, yes they can. Now, does it happen everywhere or is it expected, no.

    CST's are trained to do this role as part of their accredited program. We do recognize the fact that the CST's primary role is not circulating. Many hospitals utilize RN's for this role and some do utilize the CST. I agree with Mailkrans about checking into what the state allows. Unless it is stated by state law, hospitals can do what they feel is necessary.

    Also what is interesting is the definition of "circulating". Out of all the comments from this topic, not once did anyone have a definition of circulating.

    Where I work, I am glad to say this is not an issue with our staff. We all work together to do what it takes to give out patients the best care. RN or CST. We are a team and we do what needs to be done. Our hospital utilizes an RN for the primary "circulator". This is the one person that will sign off on the many papers involved. I will say that I do not sign off and am not the sole person responsible for this action. I will, however, do any other "circulator" tasks if the need is there.

    When drawing up meds, spiking meds, or giving meds to the field, I do what is hospital policy and I verify the meds with the primary circulator and the person who is receiving them.

    ~Lonman
  9. by   stevierae
    Quote from Lonman
    Also what is interesting is the definition of "circulating". Out of all the comments from this topic, not once did anyone have a definition of circulating.

    ~Lonman
    Lonman, we have had this discussion before. Operating room nurses don't need to define "circulating" for each other--we know what the role involves. Our governing body, AORN, which is also the organization on which operating room policies and procedures are based, requires that the circulator be a Registered Nurse.

    The thread shodobe refers to is entitled "Should surgical technicians circulate?" Here is the link:

    http://allnurses.com/forums/showthre...hs+circulating
    Last edit by stevierae on Jul 4, '04
  10. by   shodobe
    stevierae, I was just about to state exactly what you stated, a seasoned OR RN does not need to define what circulating is. This subject has been brought up to many times to let it linger. If there are states out there that "allow" STs to circulate in any manner, they are the ones I would avoid as a parient. The statement to say that, "we do what is needed to give our patient the best care" is obviouly from an individual that hasn't been in the game long enough and wants to do more than what is "legally" allowed. All ORs that are worth their salt go by AORN standards and as stevierae stated, do not condone the use of NON_LICENSED personel to circulate. It all goes back to the issue of who is responsible for the running of an OR room. It is the RN and not an ST who is in charge and "delegates" what responsibilities are appropriate. The patient is my responsibility, not an ST and believe me when the s**t hits the fan who is going to get raked over the coals, the RN! This also goes back to the question of need, are STs really needed in the OR. Well, if they are going to go beyond their scope of practice in my room, the answer is a resounding NO! I really don't care if an ST knows what I am doing or not, if I think it is important I will tell them other than that they should just do what they are told to do. I am really grouchy today because of very long hours and this subject just irks the bejeebers out of me. mike
  11. by   DawnEyes
    Quote from shodobe
    stevierae, I was just about to state exactly what you stated, a seasoned OR RN does not need to define what circulating is. This subject has been brought up to many times to let it linger. If there are states out there that "allow" STs to circulate in any manner, they are the ones I would avoid as a parient. The statement to say that, "we do what is needed to give our patient the best care" is obviouly from an individual that hasn't been in the game long enough and wants to do more than what is "legally" allowed. All ORs that are worth their salt go by AORN standards and as stevierae stated, do not condone the use of NON_LICENSED personel to circulate. It all goes back to the issue of who is responsible for the running of an OR room. It is the RN and not an ST who is in charge and "delegates" what responsibilities are appropriate. The patient is my responsibility, not an ST and believe me when the s**t hits the fan who is going to get raked over the coals, the RN! This also goes back to the question of need, are STs really needed in the OR. Well, if they are going to go beyond their scope of practice in my room, the answer is a resounding NO! I really don't care if an ST knows what I am doing or not, if I think it is important I will tell them other than that they should just do what they are told to do. I am really grouchy today because of very long hours and this subject just irks the bejeebers out of me. mike
    I originally had a pretty sharp response to the attitude displayed by Mike...until I read the link posted above (Should ST's circulate?). Now I'm just simply curious....what exactly has spawned such an intense (and I do mean intense, from some of the posts I've read) hatred of ST's? I mean, some of the people got downright nasty! I would think that with the amount of condescending comments RN's receive from doctors because the rn's didn't attend four years of medical school, they would think twice before passing the s**t down a level. (Overheard from a doctor once: "There's no way I could have been JUST an RN. I had to be something more than that." I'm not an RN (yet!) but that comment pissed me off just the same.)

    As a cst myself, I take a lot of pride in knowing my scope of practice and doing my job in a safe, proficient manner. Do I believe that st's should be the primary and sole circulator in an OR? No, we are neither licensed nor trained to do so (ie: pt assessment, dispensing of medications, etc.). I also agree with the posters that every patient should have an rn to help oversee their care. However, I do believe our skills can be valuable in a secondary position, working WITH the rn if we are not scrubbed in (ie: opening a room, helping with pt positioning and padding-- which we ARE taught in our 2-yr schooling--running for supplies so the rn doesn't have to leave the room, answering docs beepers, etc.). And as for when the s**t hits the fan...it happens quite often in L&D. Just because I'm a cst does not mean that I lose my head and start whimpering in a corner everytime there's an emergency section or a code on the table (neonatal or adult). I follow my scope (which is usually running during codes unless I'm scrubbed in) and do what I can to help in a quick and efficient manner. I fully realize that there are techs (as well as rn's) that are lazy, incompetent, and pretty much useless. I think every profession has a few of those, I believe it's due to one's work ethic, not whether you spent 2 years getting a st degree vs. 2 years getting an rn.

    And I don't know about where all of the negative posters work, but here the rn's, techs, and doctors all work together to....****, IMAGINE THIS....give the patient the best possible care, and make them as comfortable as we can while they are in the hospital.

    A lot of the posters should be ashamed of the comments they wrote. I think we all (techs, rn's, doctors, lpn's...even housekeeping) have our specific role in the hospital...our little niche to work from. And I think it says a lot about one's character to belittle someone who isn't on your *perceived* level.

    I can't remember who said it, but I believe this rough paraphrase fits this thread well:

    "Judge a man not by how he treats his equals, but by how he treats those beneath him."
    Last edit by DawnEyes on Jul 5, '04
  12. by   shodobe
    I have a minute and need to get to a case. I DO NOT hate STs. The question was, "should STs be allowed to circulate"? The answer is still absolutely NO! I do not hide my opinion of STs in the fact that I don't think they are needed in the OR. Why, you ask? If it wasn't for the shortage of qualified RNs, and the fact ALL hospitals are downright cheap, STs would be of little use in the OR. I have been this game for 27 years and till recently, the past 5-6 years, I had not worked with an ST. My hospital I work at now does not use them, never has. The other reason for not wanting them is back to my other answer that when something goes terribly wrong, the RN is the ultimate responsible person, not the ST. The ST can take their knocks from the boss but it is different in a court of law. I have no problem with them working in the OR because I admit they are here to stay. I would still rather have an ALL RN staff anyday. The problem here is that my comments are what the majority of RNs feel in the OR, they just won't really come out and say it. Besides, I have never heard in all of my nursing career an MD say they wouldn't waste their time being an RN. Just the opposite, some are actually saying maybe nursing school would have been better. Go figure! Good luck anyway and sorry to be so blunt, just my opinion for what it's worth. Mike
  13. by   stevierae
    You will never hear me say or insinuate I dislike or hate STs--if you do any kind of a search, you will see me praising some of the ones I have been lucky enough to work with in my day--I've worked with several who really, really should have been surgeons--they are that knowledgeable--they are the ones who end up guiding the docs through the case--this is true often of total joint cases in which the system is unfamiliar to the doc but intimately familiar to the tech, or complicated total joint revision. Same thing with complex spinal instrumentation cases. Without exception, these techs trained inthe military; often during Vietnam (as I did) and are used to an expanded role and greater responsibilities.

    However, AORN requires that the circulator be an RN, and patient assessment cannot--simply cannot--be delegated to an OR technician. That's the law. Any OR nurse who delegated assessment to a tech would lose her license to practice nursing, and I kinda like practicing nursing!
  14. by   stevierae
    This is just food for thought--not to provoke controversy, but to provoke THOUGHT. This is an actual case in which a hopsital was sued successfully because an operating room technician went outside his scope of practice. You had better believe the circulator in the room was made to testify and was held accountable, too, for allowing him to do so. Don't think that she could fall back on blaming the surgeon--THE CIRCULATOR IS IN CHARGE OF THE ROOM. Those old days as "surgeon as captain of the ship" are long over.

    Also, for those of you who, in the other thread addressing this issue who insist that AORN has no jurisdiction over operating room technicians--well, read this article, (an actual lawsuit) and you will understand that you are incorrect.


    Legal Eagle Eye Newsletter for the Nursing Profession(5)6 Jun 97



    Quick Summary: A surgical facility must be able to prove that all surgical personnel present during a specific procedure had been cleared and documented before the fact as competently trained for the specific tasks and procedure in question.

    Assignment of surgical personnel to specific tasks and specific procedures in the operating room must be based on their individual qualifications.

    It is negligent for a surgical facility to permit a surgical technician to perform tasks, such as holding retractors, for which the technician does not have specific training.

    It is negligent for a surgical facility to assign a surgical technician to a procedure with which the technician is unfamiliar.

    Training and familiarity with procedures performed on adults is not necessarily directly transferable to pediatric situations.

    Surgical techs should have an understanding of human anatomy, as it relates to the risk posed by improper handling of their responsibilities. SUPREME COURT OF ALABAMA, 1997.

    To protect its patients, a hospital or other healthcare facility offering surgical services must see that its operating room personnel have been adequately trained.

    To protect itself from civil liability for negligence, a surgical facility should document, before the fact, that its surgical personnel have been adequately trained for the specific tasks they will be asked to perform and that they are familiar with the specific procedures they will be involved in, according to a recent case from the Supreme Court of Alabama.

    This case involved a surgical technician. At the time of the incident in question, the court noted, surgical techs were not subject to mandatory licensing or required certification under state law. The court nevertheless looked for guidance to the then-current version of "Standards and Recommended Practices for Perioperative Nursing" published by the AORN. This publication was accepted by the court as evidence of the legal standard of care. The court believed the publication established a necessity for surgical personnel to have specific training in the tasks and procedures they were asked to perform.

    Specifically, the surgical technician in this case should not have been allowed to hold retractors in a pediatric hip arthroplasty. Never having been trained for that task with pediatric patients, the technician was not aware of the risk to the sciatic nerve that could result from even the slightest deviation from the surgeon's manual positioning of the retractor.

    The court was willing to accept the qualifications of a registered nurse with considerable operating room experience, who had held local offices with AORN, and who was well versed in the Joint Commission's standards for perioperative nursing practice, as an expert witness. She testified against the hospital. The verdict against the hospital was in excess of $800,000.00. Healthtrust vs. Cantrell, 689 So. 2d 822 (Ala., 1997).

    Legal Eagle Eye Newsletter for the Nursing Profession
    Last edit by stevierae on Jul 5, '04

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