Surg.Tech VS Scrub Nurse

[nessajune21]

What can a scrub nurse do that a surgical tech. can't?

I understand that a surg. tech works under an RN, but as far as tasks performed during surgery- what skills is an RN allowed to perform that a surg. tech can't?

[ashluvsOR]

OK guys first off who cares who surg techs work under...is it really about who is in charge?...Come on now.....anyway the real question was....What can a scrub nurse do that a surgical tech. can't?

Well I know that the OR nurse can handle medicine and dispense medicine and the scrub can't. Usually the scrub tech is scrubbing in on cases....usually the scrub NURSE circulates and handles everything else. That is the job of the scrub tech...to assist the surgeon with surgery. I can't believe that in this professional field there is so much animosity between nurses and scrub techs...who cares? we are all very skilled and qualified in our job choices...all that matters is the patient. Period.

[RNOTODAY, BSN, RN]

This reply is only for the USA as laws and guidelines in other countries vary.

With the exception of a few states, during a wrong count the ST or CST is held just a liable as the RN.

While there are some states with law with regard to the practice of surgical technology; most have no law governing the practice of surgical technology. In those states when a suite if filed; everyone who was in the room is named and things are sorted out during depositions. Since there is no regulatory boards for surgical technology (most states do not even require program accreditation or certification), they are sometimes dropped but also sometimes fried as an example. Typically the tech is dropped because they do not have anything worth going after.

The RN has a license and is regulated by a board in every state. They have rules that must be followed and the AORN recommended standard of practice is what is used for acceptable duties if no law or facility policy states what is in question. Since the RN has a license (something of value to loose and typically more malpractice insurance because of it, they are a better target (like a surgeon is a better target than a RN).

If a ST or CST is named in a lawsuit for most states; it is not the end for them as they don't have as much to loose. They can simply move and take up the practice again (may have to be in another state) because there isn't much regulation across the country with this profession.

Getting back to my point--- They are named and are responsible but not typically sought after.

I guess we are talking semantics here...in plain terms, as a ST in an OR, they are most definitely under the supervision of the RN in that room. The RN in that room works under the CHARGE....the CHARGE works UNDER the clinical managers....etc etc.....An RN has a license to lose. If you think that for one second that the RN's word means equal to or less than the tech's, your kidding yourself.And I say this with no malintent whatsoever. I am new to the OR, and quite frankly, I depend on alot of the techs I work with to learn everyday. But there simply is a pecking order, and the tech is "under" the RN.

[ewattsjt]

If you think that for one second that the RN's word means equal to or less than the tech's, your kidding yourself.

In my area, the word of a CST is carried with the same weight. I guess it goes to different ideas of the level of professionalisms and education standards in different areas of the country. In my area the RNs are mostly associate and the majority of techs are associate as well. The prereqs are the same (A&P, Micro, Chem, Psychology, Microbiology, Pharm, etc...) the difference being the core classes NUR or SUR. It is typically also recognized that the ST program focuses on surgery only while the NUR program only does a two day observation in surgery and all other experiences are learned on the job as the RN orientates.

When I started the last post, I said that with the exception of a few states... What that means is that CA, NY, and WA have laws that specifically address the role of the Surgical Technologist and Surgical Assistant. There are other states that see the need for education of the tech as well as some kind of regulation (mandated accredited education, certification, etc). There are also many states that have absolutely nothing except requiring an RN to fill out documentation or requiring an RN to be in the room. This information can be found on the AORN website and one can see where the AORN thinks that the laws in regard to RNs in the OR are good, need to be reworded, or need legislation because none exists.

While I agree that there is a pecking order; it is not that cut and dry for the majority of states. Here is a good example where I work (which has no law in regard to the scope of practice for surgical technology or assisting).

Most of the time (unless there is a staffing shortage) we have an RN for the circulator, a CST for the scrub role and we provide an assistant to the surgeon which is a CST or CFA and we do have one CRNFA. During turnover and setup, the techs and/or CRNFA are under the supervision of the circulator because someone has to coordinate and it would be disastrous if everyone ran around independently doing their own thing. When the patient is brought into the room, whoever is assisting will second circulate which is also under the supervision of the RN but when it comes to positioning and prepping, the assistant is responsible for making sure the surgeon's preferences are carried out. Once the procedure has started it is impossible for the circulator to document, keep assessing the patient, run for needed supplies, etc and supervise the techs. While it sounds good, in reality it is impossible. The surgeon is the person supervising at this point.

Moving to the assistant; an assistant in Indiana can cut tissue, ligate vessels, use ESU or chemical hemostasis, etc, etc, etc, under the direction of a surgeon. They can do a saphenous vein harvest while the surgeon works on opening the chest and preparing the heart. They can also close all body planes except closing a cavity itself which the surgeon must do. During the closing of surgical procedures the surgeon has to be immediately available which means that they have to be in the surgery unit (PACU, Lounge, Dictation station, etc...). Given this assisting scenario, it is clear that the assistant is under the direction of the surgeon during the procedure.

As the staffing of one RN and two techs has become the norm for my facility, most RN's hardly ever scrub if ever at all. They have to scrub for a week during on orientation and typically only hold retractors but that is it. How can someone supervise if they have no clue to what is actually happening? I have also seen where the RN doesn't know their medical terminology enough to know what procedure is listed. How can they supervise a case they simply don't know? I don't want to sound disrespectful but most our RNs don't even know what instrument sets are needed for what case. They do know were they are kept. How can one supervise another's performance with out knowing what the case is about, what instruments will be involved, etc..

Having said all that, the RNs and CSTs where I work have a great relationship and function as a team for the best outcome of a patient. There really isn't a RN-CST divide. We each know that we contribute our special knowledge and skills of each profession for the best outcome for the patient.

This will probably be my last post to this subject as it is one that has been around for ages and it keeps going in circles.