Surgical tech duties beyond our scope of practice?

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    Hello all, sorry this is so long! I need some information and I'm hoping that some of you can provide insight. I'm not sure if this should go here or in the L&D forum because it covers aspects of both specialties. And please let me say ahead of time...I have read the arguments asking for techs to be taken out of OR's and replaced with RN's due to a larger overall functional capacity. I'm not looking for that type of thread. It would be really great for our RN's to scrub (we have 2 OR's on our L&D. Scheduled c/s are done in the main OR; we handle unscheduled, emergency c/s, emergency hysts, etc.). Unfortunately, 1) we are short RN's for regular pt care, and 2) scrubbing is not considered a role of the RN here. We frequently have new RN's (lots of agency and new military RN's) and none of them are trained/instructed on instrumentation, OR sterile technique, or what is required of them in the general circulatory role other than charting.

    My problem has been...there is one nurse in particular that seems to pick and choose what is/is not in my scope of practice according to what she does or does not want to do at any given moment.

    To help alleviate the situation with this particular nurse however, I went to the head nurse and asked to see the surgical tech's scope of practice/major duties for L&D Mind you, I have a degree in surgical technology. No LPN/RN/CNA or other patient-oriented certification/licensure. What I found threw me for a loop. I'm listing the duties that seem questionable to me. Does anyone feel the same, or am I off my rocker?

    Major duties of the surgical technologist: Scrub 50%/Nursing Assistant 50%

    In the OR:

    -Moniters pt's under local anesthesia for minor procedures that do not require an anesthetist's presence. Takes blood pressure, vital signs, notes any changes in the pt's condition. Alerts surgeon to changes in patient's condition and the need for anesthesia.
    -Maintains and cares for specimens/Records information on the specimen sheet/log and the intraoperative record such as times, procedures performed, unusual occurences.
    -Assists anesthetist when patient wakes up.

    On the L&D Ward:

    -Records obstetric information, including retrieval of prenatal record, assessment of vital signs, significant OB events, assisting with admission and delivery paperwork.
    -Prepares patient for examination and treatment, explaining procedures and providing emotional support.
    -application of external fetal monitors, assist with the placement of internal monitors.
    -performs venipuncture for lab specimens and initiation of IV.
    -Obtain fetal heart tones by Doppler.
    -Correctly identify patients and newborn identification bands.
    -Under supervision of nurse or physician, assess newborn and assign APGAR scores.
    -Initial suctioning of neonate.
    -Complete delivery paperwork and nurses' notes IAW hospital policy.
    -Performs assessments of patients in recovery, providing close observation to include vital signs, uterine status, lochia flow, bladder status, maternal bonding/attachment, and level of analgesia/anesthesia.
    -Recognize abnormal findings and report changes to nurse or physician.

    Yes, this is straight from the ACTUAL job description. After reading this, I went back to the head nurse to confirm these duties. I told her I didn't think that these duties were within our (the ST's) scope, and had concerns on them being listed/expected (I have heard RN's ask techs to do some of these things on several occasions.). She told me that was what the orientation checklist covers, to make sure we know how to do these procedures.

    I'm not trying to shirk work/responsibilities in any way...I really enjoy my job here. 99% of the RN's have been excellent in teaching me what they can about general pt care (adult and neonatal) because they know I am applying for nursing school this year. The operative words being...I am applying. I am not yet an RN. I'm not sure where to go from here....comments?
    Last edit by DawnEyes on Aug 5, '04
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  4. 11 Comments so far...

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    Well, Wow is about all I will say. First off I am new to OB but even I know that you are not trained to do nursing assessments and duties. You are a ST and only and ST(no offense meant) just stating you were trained to be a ST not a nurse. The job description list things that you or anyone could do like placing monitoring and doing vitals etc and I am sure there are things that you have learned through working there but that doesn't mean you should be doing them. From what I understand of a surgical tech is that you report or answer to the RN and surgeon so to me NONE of these things are your job........APGARS no, fetal assessment NO, etc. Your job is to directly manage and assist in the OR not to do nursing duties. I think that job description needs some serious adjusting.
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    Quote from DawnEyes
    ?

    Major duties of the surgical technologist: Scrub 50%/Nursing Assistant 50%

    In the OR:

    -Moniters pt's under local anesthesia for minor procedures that do not require an anesthetist's presence. Takes blood pressure, vital signs, notes any changes in the pt's condition. Alerts surgeon to changes in patient's condition and the need for anesthesia.

    -Assists anesthetist when patient wakes up.
    I am only going to address these 2 issues, becuase I am horrified that your nurse supervisor would try to put you in this precarious position. These 2 duties require assessment skills. Operating room nurses, who are RNs, are not allowed to delegate patient assessment to ANYONE but another RN. If one does so, she can lose her license. This comes straight from our governing body, AORN. Tell your supervisor to go on the AORN website www.aorn.org and call them directly if she is skeptical of what I am telling you here. Trust me--I have been doing this for nearly 30 years. I know some operating room technicians I trust more than I trust some of my fellow RNs; however, I simply cannot delegate patient assessment to them--I would lose my nursing license.
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    Thanks much for your replies. I'm going to go in on Monday (when I work next) and speak with the HN and wardmaster about my concerns again, and see about bringing about a change/amendment to that description. I'll point them to Aorn.
  8. 0
    Quote from DawnEyes
    Thanks much for your replies. I'm going to go in on Monday (when I work next) and speak with the HN and wardmaster about my concerns again, and see about bringing about a change/amendment to that description. I'll point them to Aorn.
    "Wardmaster!" Is that a real term? Sounds like a prison--similar to "warden!"

    Let us know what happens....and stick to your guns...
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    Yes your duties are beyond your scope of practice. Your a surgical tech. If you were never taught to do any of those skills mentioned in a classroom, then chances are you are going beyond your scope of practice. Maybe OB isn't the place for you. Last thing you want to do is end up in a courtroom with expert witnesses getting onto you.
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    One thing that has not been asked. Are you in the USA?
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    Yes, I live in TX. What does your question have to deal with the topic?
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    Lmao. Don't be so self centered jdg. My question is directed to the original poster as most comments and questions in this thread should be.
  13. 0
    Quote from Argo
    Lmao. Don't be so self centered jdg. My question is directed to the original poster as most comments and questions in this thread should be.
    This thread was started in 2004, and the OP hasn't been back since 2005. Something tells me you aren't going to get an answer.


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