practice questions

Specialties Operating Room

Published

i was wondering if anyone knows in what capacity may a cst close the skin of a patient. we have a 'rogue' cst who is gung-ho on what he can do. he has even completed a first-assist home study program.....but is not certified as an FA. he has been observed closing the skin w/o the physician present (the physician knew he was closing). i don't think that they are licensed to perform any medical procedure without the proper certs. or license. any info and reference sources would be helpful.

Specializes in Operating Room,, Plastic Surgery.

:eek: :chair:

I believe that that is unacceptable

The circulator in the room may hay his/her license in jeopardy

I would check w/ the OR director

CYA

marci

Specializes in O.R., ED, M/S.

Report this to your Director. If that doesn't help then go to the V.P. of nursing, then make a report to your states BRN who can then report this individual to their respective board. This is unacceptable! First I would confront this individual and then make it plain and simple to the surgeon that this will not continue or he will be getting a new circ, not me. CSTs work under the license of the RN in the room. Make it clear, make it LOUD that you will not jeopardize your license for this person, Foot down, no discussion! Mike

Specializes in O.R., ED, M/S.

I forgot to mention one thing, FAs in my book have no place in a OR. I have no need for them. Mike

shodobe, love the dogs!. I feel if this CST is closing wounds everyone who allows this to take place is accountable for not taking action. Haul him up and find out if that is in his job description. I once worked with a head nurse who one day scrubbed in on my case and asked me for the skin clips to close the wound. I refused and complained to my supervisor about this change of practice. It turns out the head nurse was not insured to carry out this procedure on a patient. If I had gone ahead I could have found myself in trouble. Why dont people just enjoy their own role instead of trying to adopt another?. I love being an OR nurse with all its ups and downs.

Curious to know was he running sutures or the stapler????

At my old place of employment, we were taught to run the stapler as the MD would approximate the skin incision. I have done it but it was something we were trained by the MDs and signed off for. These were only for the times when the residents were busy or there was an emergency. As for running sutures...BIG no-no. We could assist by holding retention on the sutures as the MD would run them and by tagging them and cutting them but never using them!

Home study FA program???? I wonder what kinds of hands on you could learn at home????

well here is the real kicker to the story. the guy in question did the home study and then went to vegas to do the practicum. he still has to complete x amount of hours to complete the program but he is still considered nationally certified. this of course has been confirmed to me by his wife who just happens to be the DON of the hospital. when i questioned whether or not this was covered under our insur. and my license, i was informed that the hospital would not allow someone to perform something that they were not qualified to do. i still disagree but feel i can't do anything about it since i do need a job and do not want to make any fuss. it's just frustrating that as 'the person in charge of the or room', i don't feel like i have any control. we are given all the responsibility and none of the power....

Geo, I understand your frustration, you are the one responsible for the LEGAL charting of all occurances in the OR and feel the responsibity of those working under your license, I can totally feel your pain. And the fact that the DON is married to this tech, well, doesn't help by any means, making it harder to have a objective stance on the situation at hand, I agree. And a Los Vegas "practicum" Hmmmm, that sounds like "fun" go to vegas, learn to do surgical techniques in between gambling and drinking???? Shouldn't say anything because I am considering a conference in Vegas for fetal monitoring...But one thing I don't understand is if he has this under his belt and still has some hours to complete, HOW can he be nationally certified????

Though you had to finish the clinical aspect before becoming cert?

And if he is cert., is he still your repsonsiblity or that of the surgeon????

Specializes in O.R., ED, M/S.

Sorry, just because the DON, who is married to this individual, says it is OK isn't enough. Find out what law firm is under retainer and ask their legal advisor. Every hospital has one and will give you the right answer. You are in a pickle if you make waves and could lose your job, but if your better judgement barks out, NO WAY, then you make the decision. I guess I have been at my place long enough that I would just sit done and tell them to get someone else to circ for him. Good luck, Mike

I agree; how can this CST be nationally certified AND still need 'X' amount of directed surgeon-present-at-the- field clinical hours? Does this surgeon's patients know that a CST is doing the skin closure?

You must have a risk management department in your place of employment, don't you?

Good luck,

Paula

sounds to me like your being stitched up Geo! . (sorry couldent resist that one)

I have investigated the issue myself, since there is a CST in my dept. who is planning on becoming an FA.

They take the practicum as a "test" to determine suturing ability, and then as a requirement for completing the program the person has to have X number of hours logged in suturing by a physician to complete the program and be a FA, but there is no way this person is certified yet, as you have to complete the clinical hours and be signed off as having completed them with competence by the physician before certification can take place.

Therefore, there is no way this person can be certified yet without the clinical practice, and the physician should be watching him suture so that he can determine competence.

This absolutely should not be allowed.

+ Add a Comment