Should Surgical Technicians Circulate

stevierae · Jun 2, 2004

I really love that attitude that you have to be a nurse to do anything in health care, and if you aren't, you have to answer to the nurse. Everyone in here thinks that nursing is the only place to branch off from, and that everyone should have a two year ADN degree. Well I don't. .

Jimmy, I don't feel that you have to be a nurse to do anything in health care. I have worked with some awesome, awsome operating room technicians, respiratory therapists, pump techs, and PAs. You are a PA. You can diagnose and treat, and are presumably very good at assessment and physical exam and intervention. Your scope of practice is quite a bit broader than that of the average operating room technician--not all, because some have been trained extensively to first assist, and do so very well, in the military (I was when I was a Navy tech) but most straight out of tech school are not. When you compare yourslef to most CSTs, you are comparing apples and oranges.

I would never take it upon myself to tell a PA what to do or how to do it--he or she is working under the physician's license. But the TECH in the room is working under MINE. That's the difference. And we are bound by the rules of AORN and the state nursing board; if we don't follow the rules, we can lose our licenses. Simple as that. And as long as AORN is our governing body, we can't just pretend they don't exist.

I am probably the least territorial nurse I know. If a PA wants to come in my room and balance the microscope or set up the fracture table or prep or put in the foley or put on a tourniquet or do whatever else needs to be done to expedite getting a case actually underway, I welcome his or her assistance. Unfortunately, in many places, the opposite is encountered--you don't see the PA until he or she is scrubbing alongside the surgeon.

Also, be truthful--I am betting that if you saw a nurse daring to tie knots or suture, you would throw a fit. Why? Does one have to be a PA to tie knots, retract and suture? Many RNs, and techs, especially those of us who trained in the military, are really good at it. But most PAs think of that as their exclusive territroy, and, after all, they get paid for doing it. I don't think it's right for us to do it for free and take away a source of income for those who do it for a living.

Marie_LPN, RN, LPN, RN · Jun 2, 2004

And then we have some nurses who beat their chest and essentially denounce other fields "because they aren't nurses" only to go on to say things like "oh we're all a big team :) :) :) ". Yeah, but you only feel that way if you're in charge.

LOL!!! Thank you! :)

PA-C in Texas · Jun 3, 2004

Jimmy, I don't feel that you have to be a nurse to do anything in health care. I have worked with some awesome, awsome operating room technicians, respiratory therapists, pump techs, and PAs. You are a PA. You can diagnose and treat, and are presumably very good at assessment and physical exam and intervention. Your scope of practice is quite a bit broader than that of the average operating room technician--not all, because some have been trained extensively to first assist, and do so very well, in the military (I was when I was a Navy tech) but most straight out of tech school are not. When you compare yourslef to most CSTs, you are comparing apples and oranges.
I would never take it upon myself to tell a PA what to do or how to do it--he or she is working under the physician's license. But the TECH in the room is working under MINE. That's the difference. And we are bound by the rules of AORN and the state nursing board; if we don't follow the rules, we can lose our licenses. Simple as that. And as long as AORN is our governing body, we can't just pretend they don't exist.
I am probably the least territorial nurse I know. If a PA wants to come in my room and balance the microscope or set up the fracture table or prep or put in the foley or put on a tourniquet or do whatever else needs to be done to expedite getting a case actually underway, I welcome his or her assistance. Unfortunately, in many places, the opposite is encountered--you don't see the PA until he or she is scrubbing alongside the surgeon.
Also, be truthful--I am betting that if you saw a nurse daring to tie knots or suture, you would throw a fit. Why? Does one have to be a PA to tie knots, retract and suture? Many RNs, and techs, especially those of us who trained in the military, are really good at it. But most PAs think of that as their exclusive territroy, and, after all, they get paid for doing it. I don't think it's right for us to do it for free and take away a source of income for those who do it for a living.

Actually, I firmly believe that if someone is qualified to do something, they should be able to do. I have long argued for Paramedics in the ED being able to practice at their advanced level. If RN's have been in the military and know how to suture, more power to them. I have NO problem with people using their skills to the full extent.

You talk about techs who aren't qualified coming right out of school. Well the new graduate RN isn't qualified to first assist either.

Also, as I have stated before, AORN and State Boards of Nursing don't have exclusive claim to regulating what happens in an OR. They only have some say because nurses work there. What if the hospital said that CST's could be in charge also? The AORN and state boards can't do jack about it because CST's do not have to abide by what they say. What about the ones who are licensed? By what rationale are they going to be kept from circulating? Because "they aren't nurses"?

Riiiight.....

cwazycwissyRN, RN · Jun 3, 2004

Thought provoking thread here. Nice to see the interest in the OR.

I have been astounded by some of the coments.

I work with some extremely good techs. Some of them are going to nursing school. I would be so very disappointed if they felt that what they are learning in school.....is not applicable to the OR.

Techs can contibute to the patient outcome in such an important way. They know the surgery, the equipment, the surgeons preferences and so on. To me the unseen responsiblilities I have as an RN..... is to know things such as>>>>

Is my patient a diabetic and what fluids should I expect to be administering? When and how to do blood sugar tests. How to administer insuling.....at what rate IV. How about a code....what drugs to administer and when and how to shock at how many jules....what drugs are in what drawer of the crash cart. What meds are not conpatible and what the patient is allergic to. What is the patients labs so that I may be able to obtain products needed in a timely manner. Is there is multi system failure? How much has been out of the foley and what is the significance of the output. What is the side effects of the drugs I (or anesthesia)administered that I am observing the patient for? What is the patients DNR status and does the family really understand what happens to the status in the OR. Why is anestesia asking me for NS instead of LR and what is hesban used for.....or manitol....or ect. hot lines, level ones, difficult intibation carts, airways. airways ..airways....

Is this stuff important in the OR too. Yup team work! respect for each others roles!!!!! I would hope we never confuse the roles under the false pretense of the word teamwork. Our roles are specialized....each of of them. We can certainly assist each other in our roles. But hopefully respect eeach others roles in the mean time.

I certainly believe the person who comes out of school saying they did not learn much that applies to the OR may want to reconcider her role in the OR.

YOU ARE NOW A PATIENT ADVOCATE AND THE PATIENT IS RELIANT ON YOUR PROFESSIONAL ABILITY TO KEEP THEM SAFE THOUGHOUT THEIR SURGICAL EXPERIENCE. That means medically safe, as well as surgically safe.

Good luck to all. Enjoyed reading all of these responses....a little controversy can cause alot of growth.

stevierae · Jun 3, 2004

Well the new graduate RN isn't qualified to first assist either.

And that's why you don't see new grad RNs in the OR first assisting!! In fact, you RARELY see RNs first assisting unless they are RNFAs! Wherever I have worked, one has to apply for hospital privileges to be able to first assist--simple skill and knowledge is not good enough--and those rules are made by the hospitals.

DNRme · Jun 5, 2004

Why would you have a problem with a tech giving blood? What do you think pump techs in the heart room are? (I think their official name is "perfusionists.") Same thing with the people who work for Red Cross or private companies to run the Cell Saver for autotransfusion--they are techs, and very, very good at what they do.
I guess you are referring to an OR tech hanging donor blood from the blood bank, though, is that it? Of course, that is only in the scope of practice of an RN or the anesthesiologist, in the operating room setting--or, if it is spun down autologous blood from the cell saver, of course that tech who spun the blood down in the first place could and would give it--but not an operating room technician, who has not received training to do so.

Yes, I was using donor blood as my example

DNRme · Jun 5, 2004

DNRme,
I DO know what makes a good OR nurse. I have worked in the OR for 10 years, maybe you should re-read my post before you slam me. And I still stick by my guns in that (at least in my nursing school) I have not learned very much in school that will help me in the OR.
eg.....The sterile technique they teach is a joke,no instruments ever covered, (you really should know what you are counting) positioning? I dont think so... I could go on but hopefully you get the idea.
I was under the impression that the OR is a specialized area and that nursing school just covers the basics, the rest you learn OTJ. They rotated us thru the OR for 2 half hour cases, IMHO don't really think that's gonna cut it.

First of all, I didn't slam you. Please read the post by cwazycwissyRN. There is soooo much more to being a good OR nurse that just the mechanics of it. I hope in nursing school, one of the things that is being cultivated is "judgement." You look at things very differently when your scope of knowledge is increased. This applies to many things in life.

As you said, your exposure to the OR in school was lacking. We all need to remember that we are responsible for "patients" and not for "cases." You need to know about everything going on with your patient and how you can best manage that while the patient is under your care. Everything you are learning about disease processes, meds, teaching, etc. is important to being as I said before, an advocate for the patient during their most vulnerable time.

Finally, I have yet to meet a tech or LPN that became an RN and did not find it to be much more than they thought it was going to be.

RNKITTY04 · Jun 5, 2004

Ok, I'd like to think I have an open mind and what was posted does make sense to me. I certainly don't think I know it all (very far from it actually)

I did just find out yesterday that I got approved to do my transitions in the OR. I am very excited as this has never happened at my school before, and I have bascially fought tooth and nail for this since last year.

Anyway.... on my way to learning all the things I DON"T know about circulating.

I do have 2 questions though, Do you think they will want me to scrub alot or will they let me concentrate on the circulating part?

Also after I do my 120 hours of transitions and if they like me well enough to offer me a job, how long of a orientation could I expect? (in general)

Thanks for the input.

suzanne4, RN · Jun 5, 2004

You probably will not be scrubbing at all. You will be learning the didactics of working in the OR. And right now you are in a student capacity for a different role, so you will be expected to learn those skills. You may have been in the OR for a long time but things will now be from a different perspective. If you work at that facility once you finish, you will be expected to go thru the same orientation that all of the nursing staff goes thru. At least that has happened wherever I worked with a tech that was transitioning.

To give you some idea on how long that it takes to train a a nurse for the OR, at last to AORN standards, approximately one year to have them feel comfortable in all areas and able to handle about anything.

You now become the boss. What happens on off-shifts when you are the one in charge?

:balloons:

RNKITTY04 · Jun 7, 2004

very good. Thanks for the info.

nurselily3 · Jan 13, 2005

Should they, NO

When surgical tech's become legally responsible for what happens to the patient, not working under the RN's license, then sure..let em circulate.

Tiki_Torch · Jan 13, 2005

Should OR Tech's be Circulators? My answer is No.

Granted I know many absolutely wonderful techs who are excellent team players and can work circles around some other people, HOWEVER, I must say that when it's ME in the position as a patient under anesthesia and with my body going through surgery I want an RN in there to watch over me. When in my life would I be more vulnerable than when I'm on an operating table??!! As I remember from nursing school, one of the main purposes of the nurse is to be a Patient Advocate and all the things we are taught in school prepare us to be advocates for our patients when they need us and our extensive knowledge and critical thinking skills the most.

I don't want to hurt any feelings around here; just adding my 2 cent answer to the original post question....

Tiki