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- Mar 7, '08 by ShariDCSTQuote from or-specflaming isn't necessary, and i hope nobody takes up the flame thrower on this one. it seems each person has a different perspective of what gets done, who does it, and what is more important, based on their own personal experiences. granted, as a cst myself, i have to take our side to a point - we do have the "hands on - hands in" side of the case to deal with as far as being elbow to elbow with the surgeon and anyone else at the field, and up to our elbows in it. i can hold 4 clamps and 2 retractors at the same time between both hands - done it lots of times. the sterile field, including setting it up and maintaining it is our territory, and our vigilence is needed in keeping it intact. (a good circulator also keeps an eye out for breaks in technique - we can always use a spare pair of eyes!) we are the ones the surgeon is going to take issue with if everything he/she needs, wants or desires is not immediately available before it's asked for. it is our responsibility to find out and maintain references of what's needed for each case, and to make sure it's pulled, opened and/or ready to go. that is my perspective, based on my experiences over the last 14 years or so of practice as a cst.i recently graduated rn school. i have also been a cst for 5 years and served as a clinical coordinator/instructor for a local surgical tech program for several years. don't get me wrong, i have a ton of respect for my new found profession as a circulator but hands down, cst's have to maintain the more critical focus during the surgery. circulating is merely a task of paperwork, maintaining patient safety and fetching supplies. it is the tech that is responsible for having everything on his field, acting as the surgeons 3rd and 4th hand, anticipating every single move during the surgery, especially during severely acute bleeding. i have to admit the rn schooling is much more intense, however, the circulator has an easier job, hands down. oh, and there's also the 80% increase in pay(at least in my region) depending on whether or not you can convince your boss(and they definitely should) to recognize your or experience. let the flaming begin!!!
however, and that's a very big word, the circulator's job is certainly no less important by any stretch of the imagination. it is their license under which we work - right now, but the change is coming where we will be responsible under our own - his/her name is on the dreaded paperwork, and that person has a big responsibility during the case to make sure the patient is properly prepared before coming to the or, to catch any issue that might have been missed in the process, and is taken care of during the immediate preop period, is monitored properly during the case, and that any untoward or unexepected events are handled post haste. paperwork is a necessary evil, and a major time thief. playing "run and fetchit" isn't a major portion of the case - but someone has to do it and i can't hardly break scrub under normal circumstances to run out in the hallway to the supply room and replace an item that got contaminated, added at the last minute or just forgotten. most of the places i have been - not all, mind you - we work as a team. there is none of this "i'm more important than you are because i have rn after my name" or "you are just a circulator and i am more important because i'm doing the actual scrubbing."
basically - i can't do my job without a good circulator - and i don't know any circulators who can do an entire case themselves without someone to take on the scrub duties. it's got to be team, and each person plays a part in it - who's important and who isn't isn't even an issue - we all have to have each other to make the whole thing work smoothly, and there's at least one patient's life at stake during any procedure - two or more in the case of c-sections for singles or even multiples.
- Mar 7, '08 by Scrubby[I recently graduated RN school. I have also been a CST for 5 years and served as a clinical coordinator/instructor for a local surgical tech program for several years. Don't get me wrong, I have a ton of respect for my new found profession as a circulator but hands down, CST's have to maintain the more critical focus during the surgery. Circulating is merely a task of paperwork, maintaining patient safety and fetching supplies. It is the tech that is responsible for having everything on his field, acting as the surgeons 3rd and 4th hand, anticipating every single move during the surgery, especially during severely acute bleeding. I have to admit the RN schooling is much more intense, however, the circulator has an easier job, hands down. Oh, and there's also the 80% increase in pay(at least in my region) depending on whether or not you can convince your boss(and they definitely should) to recognize your OR experience. Let the flaming begin!!!]
Merely a task of patient safety? That comment shows why we are fighting against technicians in Australia. We want university trained nurses who have an appreciation of the important of patient safety during surgery, because of this sort of attitude by people whose role is more task orientated than multiskilled is inappropriate. I'm alarmed that someone who has been an instructor and works in the OR can even say this. You are obviously ignorant of the risk factors patients face when having surgery and the interventions of the scout nurse to prevent post surgical complications and even morbidity. You may be the best instrument nurse in the world but if your scout is no good, then neither are you because your pretty much useless to do anything because your at the table and cannot leave to get an important item. If the scout doesn't ensure that the patient is positioned correctly, kept warm then all your hard work and the surgeons may not lead to a good outcome.
From reading your comments about the scout being the surgeons third and fourth hand, you shouldn't really be assisting and instrument person at the same time. It's not fair on you and the patient because you need to be able to focus on doing ONE job really well. I've had to do it during a shortage (under protest) but it's really not a good idea to do both roles.
- Mar 8, '08 by OR-SPECI understand that the patient must be kept safe during the intraoperative period and during the entire case, we as circulators must monitor every inch of that OR table. The thing is if you've done your job properly and positioned in accordance w/ current safety protocols utilizing safety straps/armboards/foam pads/warming devices correctly, then you should be able to breathe a little easier once things get going. Otherwise, your not doing things correctly and this job will drive you insane. The CST on the other hand cannot even drop their hands below their waist, cannot itch that persistent ear itch and cannot wipe the snot dripping down their face for the entire duration of that surgery. CST's deserve more credit than they receive and I will always give that credit for their hard work and dedication. Maybe you should pull up a stool under the drape next to the patients legs to make sure they dont fall off the bed while doing your paperwork. Individuals like you make working as a team much harder than it should be.Last edit by OR-SPEC on Mar 8, '08 : Reason: revision
- Mar 8, '08 by GadgetRN71I can do both, scrubbing and circulating, and I personally view scrubbing as somewhat of a "break"..Not saying it's easier really, but you have less responsibility as far as maintaining the room. As a circulator, you'll get held responsible for everything that goes wrong in that room, even if it's not really your fault. You also have more to lose than the tech, license wise.
I pride myself on the fact that I view the patient as my priority, not the paperwork and I've saved the tech's fanny quite a few times because they didn't realize the surgeon needed a piece of equipment, instrumentation or suture and I've gotten it for them without being told.
I'm not flaming anyone. But I don't agree that circulators have an "easier" job by any means. I suppose if you are a lazy circulator or someone that thinks of circuating as getting to sit on your fanny and chart, then I could see why it could be viewed as "easy". But, IMO, if you're doing the job correctly, it's a heck of a balancing act. You're monitoring that field( and I've caught a few breaks in technique, both by techs and docs), helping anesthesia, and yes, getting things for the sterile members of the team, which can be very frustrating if you have one of those "needy" techs.(they ask for stuff they don't need and they neglect to pick or ask for the needed items) The "droppers" also drive me batty-by the end of the case, a good majority of the instruments/sponges are on the floor
Everyone has a job to do and each job has its own challenges.
- Mar 8, '08 by Scrubby[I understand that the patient must be kept safe during the intraoperative period and during the entire case, we as circulators must monitor every inch of that OR table. The thing is if you've done your job properly and positioned in accordance w/ current safety protocols utilizing safety straps/armboards/foam pads/warming devices correctly, then you should be able to breathe a little easier once things get going]
Not really. You summarised the scout nurse role in your previous post into just three parts which were merely 'doing paperwork, maintaining patient safety :icon_roll, and 'fetching supplies'. Where i work we have to organise a barouche or bed for the patient (we don't have orderlies), sometimes we have multiple specimens going off at once, we have to organise someone to come in and do an on table x-ray,we have to sometimes reposition the patient if they are having multiple procedures, we have to get sterile supplies, we have to get out for the next days cases, we have to check the next patient off and makes sure they are ready to go to ensure a fast turnover, we have to document EVERYTHING including counts, implants, meditrax stickers, pathology forms, specimen forms, x-ray forms etc. We need to count with our instrument nurse, change suction liners, bring in equipment such as microscopes, harmonic machines if they are required. |We have to restock the theatres because no one else does. We have to take phone calls and messages for the surgeons, sometimes we have to weigh packs for our anaesthetist. And of course maintain patient safety at all times. And if it's a case like a free flap and you have two operating teams doing different procedures then your workload pretty much doubles.
And do you think that maintaining patient safety is something scout nurses just do at the start of a case when you put on the safety straps etc? It's a process that should be monitored and assessed during the entire procedure.
[The CST on the other hand cannot even drop their hands below their waist, cannot itch that persistent ear itch and cannot wipe the snot dripping down their face for the entire duration of that surgery. CST's deserve more credit than they receive and I will always give that credit for their hard work and dedication. Maybe you should pull up a stool under the drape next to the patients legs to make sure they dont fall off the bed while doing your paperwork
Ummm I am a scrub nurse. you don't have to explain to me what i already know. I've sneezed into my mask and have had snot plastered all over my face, been scrubbed for loooong hours and have had to do burns surgery where it's like working in a sauna. I've spent hours scrubbed in lead gowns and have had to hold on because i can't get out to go to the toilet. The comment about dropping your hands, what is your point exactly? You can rest your hands on your mayo table or trolley, it's not that big a deal to me.
[Individuals like you make working as a team much harder than it should be.]
No people like you who disregard the hard work of the other team members during surgery and don't have a proper understanding of perioperative nursing roles make it much harder than it has to be. People who say such a thing as 'merely maintaining patient safety' need further education. We are all equally accountable and responsible for the patient, not just one team member.
- Mar 9, '08 by MsLeylaBarI traveled for 5 years as an OR nurse so I have experienced everyone's frustration when the RN and scrub tech does not work well together.
I don't agree with techs saying a circulator has the easier job. We each have our own responsibilities in the OR and we are working towards a common goal and that is to provide the patient with the best care possible and for them to have surgery that is free from any complications.
I guess I'm just lucky nowadays, I'm working in a place where almost everyone works well together. My good friends at work are actually techs, the ones who've worked with me a lot on long, long cases. We have each other's backs.
- Mar 9, '08 by zerby1470Thank you. It is not comparing apples to apples. Both have skills that are brought for the operating room, some can to both, some cannot. But a good, well working and well trained team is in the best interest of the patient, regardless of the name that you give the roll. There are techs that I would let work on a family member in an instant, and nurses that I would not either. The inverse is also true, regardless of the role. If you are working with your best skills for your patient in the role that you are assigned and trained, the entire procedure does well.
- Nov 30, '09 by aprilflower123I see everyone's point of view here, to some extent. You have some really good techs, some really good RN (circulators) and you have some lazy techs and you have some lazy circulators....this is true EVERYWHERE you go. I have to honestly say, too, that being certified, or not, AS A TECH, yes, there is a rate of pay difference and some have worked very hard to obtain that certification and some apply it very well. I have to say that it is not all taught in school, either. I have seen and worked with some tech's that were "on the job trained" that I would much rather let assist with my surgery, as some that I have worked with that are certified that I wouldn't let work on my dog! As to one job being more complicated than the other, they both have equally totally different roles, and at times, I'm sure one person's job looks to be more easy than the other, for example...you take a really long case (6-8hrs), Im sure to the tech that the circulators job looks easier because for the most part after the o.r. record is filled out, they do get to set for most the rest of the case, observing of course, or having to run, but if all goes smoothly, for the most part, the tech has the more difficult position here. In other cases, like lil simple mole removal or something, it seems the circulators job is more difficult...checking pt, transport pt to o.r., positioning, prepping, calling report, specimens, takes longer for her to fill out her o.r. record than it does to finish the procedure,etc....Everyone here that has commented is either a tech or nurse defending their own, but if all would agree, IM RIGHT! THE MAIN THING HERE IS NOT ABOUT WHO'S JOB IS THE HARDEST BUT TO DO THE BEST POSSIBLE JOB THAT YOU CAN DO, WORKING TOGETHER TO PROVIDE THE BEST PATIENT CARE AS IF THAT PATIENT WAS YOU OR YOUR FAMILY MEMBER, HOW YOU WOULD WANT TO BE TREATED!!!!