Circulators

All this from a thread that was originally started 3-28-02......wow, it did not get much response then....why bring this thread back to life CSTCFA ???
The facts have changed quite a bit in the last 4---nearly 5 years.

I never looked at the date and if it that old why is the thread still posted and not archived. Yes quite a bit has changed but have people change also.

Some things haven't changed though, as evidenced here.

I have to say that you are very one minded. I was trained as a Surgical Tech in the Navy and we were trained to circulate rooms. I have to say that while not all techs may have the "knowledge base" that you apparently have some do. I feel that I (and many techs I work with ) have a broarder and better knowledge base than many RN's I know. I think to just generally state that techs are "essentially not as good as RN's " is a poor choice. I think you need to rethink how the operating room works and look around you with your eyes open. I hope I wasn't on to much of a role (or roll).

I would agree with this. As someone who just started as a new circulator in surgery and as a new nurse as well, I look up to everyone who is there, tech, nurse, or whatever. Everyone has been in surgery longer than me, so I feel that the tech's have a larger knowledge base than I do. While they may not have RN after their name, most of them would be able to circulate the room alone. I still feel a nurse should be in the room to be available for emergencies, but it should not be said that nurses are so much above techs. Techs in the OR are NOT the same as techs out on the floor. The schooling and training OR techs have done set them apart from the majority of other healthcare 'techs'

I am writing a paper on labor relations and policy. Is anyone out there who work in states that do not require a RN circulator in the room for each procedure? If yes, what is your experience like?

Thanks so much.

I'm an RN. I am a three year Diploma in Nursing. I've been a CNOR. I work at a large university that employs mostly ST's. Not CST's but just plain ST's. There is no incentive, no push, no recognition of certified techs. Every other civilian hospital I worked for made it a term of employment that those without a certification would take the test within a year or two of employment. This same hospital has trouble remembering to celebrate tech week, too. Pretty sad.

Now then. I worked for the USArmy. I learned that in Vietnam, many techs, with just a 12 week course, were thrown into the OR, assisting, many times finishing up procedures such as amputations by stopping bleeders, cutting the remnants off, suturing and closing the leg/arm in question. I also learned that nurses were so scarce that one RN could be responsible over four OR's at a time. Surgical techs were elemental in assisting that nurse. I was privileged to work with at least one such tech, but the one I'm thinking of specifically was to good at what he did that he could have done a good many procedure for the surgeon, if given a chance.

I met LPN's who were not allowed to work in the OR as anything but techs. I've worked with military tech students who got a 12 week course in class, then were sent to where we were and spent the next 12 weeks learning how to do basic surgical procedures. We were at a very small hospital, so none of them had a chance to see big cases or trauma, unfortunately. With that training, they were sent out to help out in surgery.

I have watched as surg tech training went from 6 months to a year. From a year to 2 years. From a certificate to a degree program. I admire the techs here who have said that they did understand what an H and H meant, or a CBC. Very unusual in my experience. I was working with two ST's who were taking the pre-reqs for nursing school and their basic attitudes at the time were, if it wasn't TECH business, they couldn't have cared less about whatever it was, "because the nurse stuff!" I found that kinda hard to swallow, since they were, after all, going to nursing school....

Some of my best teachers scrubbing were techs. Some of worst were techs. Where I did my OR training, we had a balance of techs and nurses, so if the nurses were lucky, we did get to scrub. We didn't have MD assistants; we had techs and nurses assisting. Some of our techs and nurses were absolutely fabulous first assistants; some had no interest in assisting. Some nurses scrubbed to learn how to do it, but really hated it.

Whether I am scrubbed or circulating, my opposite number is very important to me. A good tech who knows what the doc wants can make my job much easier. If I'm scrubbed and my nurse knows the same, then life goes pretty well. It's when either side ends up "scrubulating" and carrying the load for the other when the situation gets "techy", as southerners are wont to say.

The first place I worked tried to have three people in the room at all times. that didn't always work, and there was a mix of 3 nurses(very rarely), 2nurses/1tech or 1nurse/2techs. Most of the techs were absolutely happy that they didn't have to do the paperwork, the various coordination chores that nurses do, but were more than happy to check the next case to make sure it had everything, that the one who was the designated assistant would not scrub in til the doc did, so as to help get the rooms get going faster and more smoothly. No one seemed to care who was who. But that's the 1980's, early 90's.

Even now, most of the techs I work with have no interest in what the nurse does. The viewpoint at this institution normally is- I do my job, you do yours. The best and most skilled techs get a case cart with basics and will pull all the extras like staplers, etc, etc on their way out of the storeroom and make life so much easier during the case. While they do their thing, I go see the patient and try to make sure that all those issues are taken care of. When I "scrubulate", it's usually with a tech who brings the case cart inthe room with the basics and "forgets" the rest, making me run the entire case for things that this doc uses EVERY TIME.

As for those who do a two year degree- bravo. I for one am glad that techs are now recognized as people with a need for just as much specialized training as a radiology tech or an ultrasound tech or many others.

Just one question- if being a scrub tech isn't enough work for you, ie , keeping your trays in order, washing your instruments, anticipating what the surgeon is going to do the best you can, making sure that you have what you will need on your back table for later on, then perhaps you need a more challenging job at a larger hospital, or go back to school to become something else.

I respect the techs I work with who are wiling to count with me when we need to, during change of shift, just in case I've relieved and am the sixth nurse in the case and am not sure that my laps add up, etc. I respect those who know what they need when they walk in on a case(and working 3-11, we don't get "standard cases"), who can tell me what trays they know they're gonna need, etc. I appreciate being taught new ways to scrub, too.

I dislike the passive-aggressive nurse or tech, the ones who end up making your job painful because they send you off to get one thing, then when you get back, they want another thing- instead of letting both of us take care of the surgeon, anesthesia, each other so we can all focus on the patient and patient safety.

Just my side of the story.

What happens when the patient codes in the OR? Who checks blood with the anesthesia provider? I worked as a CST in the OR and would not have wanted to circulate. Too much responsibility that I wasn't trained for. I'm sorry, but every patient deserves a RN circulator.

I agree 100% with your post..I too was a surgical technologist before I was a nurse. My program was similar to yours-we had in depth training on instrumentation, and surgical procedures but did not receive the training that allows a n RN to get the "big picture" regarding a patient. I also thought I was going to have it made when I graduated..I found out that,done correctly, circulating is a challenging job with ridiculous amounts of responsibility. I also still scrub on occasion and view it as a break, because the scrub pretty much just focuses on the field and the surgeon. The circulator focuses on the field, the surgeon, the tech,anesthesia and most important, the patient as a whole. Throw in the fact that I run the board on my shift and I'm worrying about what goes on in other rooms as well.


I know at least in my state, the circulator must be an RN and this shows no signs of changing anytime soon.

How on earth did we get off on this tangent? The problem seems to lie in the fact that not all techs are educated the same, just as all RN's don't receive the same level of education. Not all states require techs to be certified. Not all RN's are certified, either. This is what needs to be addressed and with the same fervor as this discussion. We can argue or discuss all day long between ourselves and get no results or we can get involved in the Grassroots movements involving these issues. How many of you have contacted your representatives at either the state or federal level? There is legislation being considered.