Circulators

[StudentSandra]

I started out looking for first assistant info and ran across this info, the part I questioned I put in bold. I always thought circulators had to be RN's or does the RN requirement only come into play with medicare/medicade reimbursement? if so, I would imagine it would be hard for a hospital to run if it excluded these groups. any ideas or opinions? I have nothing against surgical techs, just wanted to make that clear.

http://www.ast.org the following info is taken from the ast website. type in first assistant in their search box & this & other info shows up.

who are surgical technologists?

surgical technologists (formerly called operating room technicians) perform many different responsibilities in the operating room. they act as the scrub person, as the circulator,

and as the first assistant on the surgical team. surgical technologists' responsibilities involve preparing the operating room and instruments, equipment, and supplies that will be needed; positioning and preparing the patient for surgery; and passing instruments, sponges, and sutures to the surgeon. surgical technologists are the surgical team's expert in aseptic technique, being constantly vigilant for any break in the technique that could endanger

the sterile field so necessary to the successful outcome of the operation. those not familiar with the profession may assume surgical technologists are nurses or nursing assistants, which they are not. surgical technologists belong to a separate non-nursing profession of highly skilled, credentialed allied health professionals that possesses specialized education and training to work specifically in the operating room.

how can you support your constituents who are surgical technologists?

carefully scrutinize any purposed regulations that could restrict the use of surgical technologists.

there have been efforts made by nursing groups in many states to regulate the role of surgical technologists and restrict their full utilization, particularly in the first assistant and circulating roles. because hospital accreditation standards do not require an RN to circulate, nursing groups are attempting in some states to make this a legal or regulatory requirement at the state level. these effort will lead to hospitals having no choice in the provider they employ and could cost csts their jobs. if nursing groups are successful in their efforts to restrict this profession, it could result in your constituents who

are surgical technologists losing their jobs.

[Heogog53]

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.

[BethCNOR, BSN, RN]

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.

[GadgetRN71, ASN, RN]

Hello,

As a former CST graduating from an approved Surgical Technology program in the eighties. I definately do not agree that a CST should be placed in the role of a circulator. My program at that time did not entail assessment of the patient prior to surgery, did not explain lab values, did not talk about different fluid replacement, it focused on the surgical procedure the anatomy, phisiology, the steps of the procedure, sterile technique, and maintaining a sterile field and last but not least instrumentation. At the time I thought I could circulate didn't seem to be much to it. Then I went to nursing school fully thinking that I would be an OR nurse.

I learned about assessing the patient, learned about disease process, more in depth understanding of lab values and why they are important. I also understand that now some surgical technology programs are two years long. However they are still only geared for the operating room. It is a different area of nursing unique to itself, but as stated previously every patient deserves a registered nurse!

CST's are very valuable to the surgical team, they do bring expertise to the table every day, I don't think that their jobs will ever be in jeaparody. I think with proper training they can be first assisants and excel at it. There is room for both professions in the OR! Just my two cents.

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.

[BethCNOR, BSN, RN]

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.