What's up with RNs who refuse to scrub?

[stevierae]

This trend, at least in the Western states, is starting to irritate me more and more, the more I see it. I have been an OR nurse for over 20 years; scrub and circulate all areas; have done all kinds of trauma. Nowadays I only work as an OR nurse on a travel assignment once a year, to keep up my skills. The rest of the time I work as a legal nurse consultant and as an IV nurse educator.

So, what's up with these new RNs in some (not all) ORs who don't scrub, and won't learn? To me, it's like doing only HALF your job, and leaving your colleagues who DO scrub left to do their share PLUS yours. I really want an answer to this.

One time I went to a job interview to see if I could pick up some occasional per diem work at a local OR. Just for this stupid little per diem job, in an OR that is not even a trauma center, and does pretty much just VERY basic surgeries (i.e., lap choles, arthroscopies, breast biopsies, TAH-BSOs--you get the picture--) I was interviewed by the director PLUS the "charge nurses" of those areas--that is, general surgery, GYN, and ortho--all new grads. Out of the blue, the director asked, during the course of the interview, "What makes you angry?" I said, "OR nurses who refuse to scrub." Every one of the charge nurses stared at the floor. I realized, then, that NONE of them could scrub, nor would they ever learn. I knew I wasn't going to be getting that job!!! (I also knew I did not WANT that job.)

The funny thing is, scrubbing is fun; sometimes, you really bust your a** running around circulating big cases and scrubbing is a very welcome break, where you can almost let your mind go on autopilot--well, you can if you know what you are doing. Those prima donna charge nurses never will.

Oh, by the way--I always take my OR travel assignments in California, and ALL the OR nurses in those facilities scrub and circulate all areas. Are California OR RNs just better, more well-rounded RNs than the RNs in the rest of the Western region? I don't live there, but I teach there quite a bit, (as well as doing the aforementioned annual travel assignment) and I am beginning to suspect that this just might be the case. What is the trend like in the rest of the country?

[heartholder]

yes at the present time we have 2 travel techs. No travel RN's here. I did travel myself for a while and I stayed in TN. I went to Nashville and Chattanooga. In Nashville I scrubbed Hearts. In Chattanooga the problem was too many techs and not enough nurses. so I only scrubbed one time. for a Lap Chole.

[Helpin'Heart]

I am a nurse in a 48 OR suite, Massachusetts based Hospital. I've been in the OR for almost 4 years. I SCRUB and CIRCULATE everything!

When I began training, I insisted to learn both proficiently. Now I precept new nurses and have been noticing many are not crazy to learn to scrub. I try to help alleviate anxiety over this, as I know that this is the basis for many to be hesitant to scrub.

I feel that if more and more nurses only circulate, this will cause the hire of more surg techs and thus diminish the need for more RN's in the OR. We need to be advocators of our abilities and skills, and gently urge our new RN's to learn both.

[spineCNOR]

There is no question - a nurse who knows how to both scrub and circulate is more well-rounded. A srub who knows how to circulate is a better scrub, a circulator who knows how to scrub is a better circulator. This also fosters a team environment in the OR when both people understand the other's role.

In the area I work (the Southeast) many administrators don't want RNs in the scrub role because they think they are saving money by having a staff that is 50% techs. Saving money to make themselves look good to their bosses is more important to quality patient care to many managers, sad to say. In this type of work setting there is no opportunity for nurses to learn to scrub.

Nurses who don't want to scrub - one factor could well be fear. If these nurses weren't given an opportunity to learn to scrub during their orientation they might be afraid to try and fail.

Another factor could be surgeons - they tend to not be the most patient people on Earth. Nurses might be hesitant to push for an opportunity to learn to scrub when the surgeons they work with in their OR are a bunch of impatient jerks.

[liveintheOR]

I think All RN's who train in the OR should be required to scrub exclusively for at least 6 months to start off with, then learn to circulate. If I didn't know how to scrub, I would be less effective as a circ. I can listen to the conversation between the doc and scrubs (even with my back turned at times) and know what they need. We train our new RN's very little to scrub/first assist. I think many of them are reluctant because they are unsure of what to do. Some of them ask to scrub as much as possible and it shows in their circulating. What scares me is to be on call with 2 other RN's who rarely scrub. This is rare, but it happens. I pray we don't get a ruptured AAA, C-section, or craniotomy. I have decided if this happens, I will call in extra help. Bottom line is it all comes down to $$$$$. Hospitals save by using techs instead of RN's. Less RN's = RN's circulate only.

[VictoriaG]

Geez, you people are tough! I am a very good circulator, but I have no desire to scrub. I do not want to stand at attention in one spot for hours with my wrists screaming in pain, thank you very much. While I am getting $24/hour doing what I do best, our techs are making $11/hour in a much more physically challenging role.

For many years I was a top notch L&D nurse and did not feel I wasn't "well-rounded" because I chose not to do post-partum. Nursing is so specialized, why do some of you demand we expand our speciality?

[Y2KRN]

I was an OR tech for 10 years, I am now an ER nurse and I miss scrubbing. I didn't go back to the OR partly because I knew I would not get to scrub as much as I once did or at all. I miss scrubbing very much and would love to do it on a part-time basis. Many places over the years while I was a tech did not have RN's that scrubbed. I can remember the two bigger hospitals I worked at RN's did not scrub at all.

Y2KRN

[CardioTrans, BSN, RN]

Ok being a former OR nurse I had to get in on this one....... When I started in the OR I was an LPN/ scrub nurse......... did that for almsot 3 yrs.......... absolutely loved it............ when I became an RN and circulate........ that was good too........ but I told them I wanted to scrub also........... which I did............ as a circulator who knows how to scrub you have the knowledge to know what is going on and what is going to be needed and to help out the scrub nurse who doesnt know the "routine" of the physician. you can anticipate the needs of the scrub nurse and the surgeon BEFORE its needed. I helped precept scrub nurses and circulators......... they would stay with me in whatever room I went in.... whatever case I did they did........ if i scrubbed they scrubbed....... if I circulated they did as well.......... you have to know whats going on on the field to know what you need to do off the field.

[CardioTrans, BSN, RN]

oh........ another thing......... the thing that ticks me off........ is the RNs who only scrub "the things they like" ie: tubals, lap choles, biopsies and such........ and the scrub techs who have been scrubbing a year and dont know the difference between hip retractor and a weitlander, and have no wits about them to be afraid when they are on call on the weekend and have a little old lady who needs a total hip done. They refuse to learn how to scrub orthopedics during the week when someone is around to help them, but they "dont want to take buddy call" cuz "they know how to scrub" grrrrrrrrrr that really infuriates me.

[DIPLOMATICRN4HIRE, MSN, RN]

It depends on the area and the facility if I scrub or not , being a Traveler they really rather have me circulating the room only because they are paying me much higher rates then what thier scrubs get and Im versital enough I can go into any room into the OR and circulate or scrub in it. I can scrub any case need be , I cant say I will be as fast as the scrub is because they scrub constantly, but I wont sit and ponder what the Dr is asking for either. I have many cases first assisted and love it I love being in the middle of things and it being a madhouse. I thrive on it, I love trauma and I can pop down to the ER with any Dr and do what needs to be done , but most places wont allow that because its not Good Management to have an Rn down there when a scrub is sufficant. Thats what I have been told I personally think its a crock of crap but I dont make the rules. The majority of the hospitals dont have their Rns scrubbing anymore , but dont think for a minute those nurses dont know whats going on in that room, I have worked with many that can not look up and hand suture thats going to be needed in 3 minutes or less and they not once look at whats going on in the case , they know thier cases that well.

I have been called to a room to set up or open a case and I usually send a scrub for a break and when they enter their rooms are cracked and thier mayo set up and Im scrubbed in setting the instruments up , It keeps me in tune with whats on the table and whats needed. I make sure my scrubs are taken care of. I have scrubbed in on a many of cases as well , and have the Dr almost faint because an Rn is scrubbed in and it not be a Heart we are doing. I dont particularly like scrubbing in on a Lap Chole they bore me , but I will do it, IF SOMEONE IN MANAGEMENT WILL LET ME, but Im not clueless when it comes to circulating any rooms what so ever. I could care less if I scrub or not , It makes no difference to me , I can function at either roll and not give a rats behind about it. They pay me to do a job and whatever they see fit for me to do is what I do. Yes I think it would be nice for new Rns to see how it is to scrub that way the scrubs recieve the respect they deserve, because its not always fun and games up on that table. It would be nice to have a world where things are done correctly , but in the Nursing world we are far from correct on many issues. As far as the well rounded issue: I think all Rns in the OR need floor experience , but thats my opinion, Nothing like getting a fresh one off the boards thats clueless on how things work on the floors as well. When I was trained for the OR I had 3 yrs Cardiac/Med -Surg floor experience , and I was amazed at what went on in the OR the Heart surgeon I worked with chose his team and me and 4 others from my floor learned the hard way on the care given and taken by theses patients. We went from the cardiac med surg to the CVICU and were cross trained then down to the OR , and was trained on every aspect of the cases. It didnt matter if it was a gen,gyn,uro,neuro ,ortho , plastics or a Heart were were in the middle of it . So why is it that heart nurses only do hearts anymore??? Its the same standards as any other cases but very seldom do you see a Heart Nurse or scrubb in any rooms down the hall???Are they too good for it? I just love to hear them whine about it, and it makes me ill. I dont knock Nurses who dont scrub its thier choice and when and if they feel comfortable to scrub they will but someone will have to allow them the chance to do it and the way ORs are staffed nowdays I dont see them being able to.

My 2 cents

Zoe

[Helpin'Heart]

If you are an OR nurse, I believe you should be able to circ and scrub proficiently. I don't understand how you can just "specialize" in circulating. I can understand specializing in an area such as ortho or cardiac, that in itself is a whole spectrum of nursing. However, in the general OR, your main priority is Patient

care. If you can scrub and circ, you can anticipate more quickly. You can help to shorten anesthetic time, thus improving Patient outcomes. You came make your day flow that much smoother, especially if you have a novice scrub in your room (believe me, we have a TON!). Lastly, how can you work in an OR and not enjoy all the aspects of being an OR nurse? That's why I became one, and I am so happy I did.

[kellyseye]

i too believe that new nurses to the or should be given an all round view to the different aspects of operating room nursing ...

the first hospital i worked at was rather small in comparrison to the one im at now ... we were made to multi skill and work in all areas including anaesthetics and recovery

it allowed me to work every area and find the area which most suited me ... certainly does make you a more well rounded nurse to have gained experience in all areas...

the hospital im in now ... does have speciality areas such as cardiac/gynae, neuro/ortho/trauma, and so on ... staff stick to their particular speciality ... however, we are not allowed to refuse to scout/ scrub whichever

in my experience ... i found ppl do not tend to work quite the same together as ppl with the multi skilled advantage of understanding each others work ... mmm (dunno if that makes sense)

i kno my training has helped me in all areas ... even tho i do not scout or scrub now ... i was pulled in to scout a few weeks ago ... even tho it has been ages since ive done that .... i was able to be of some use even still .... due to that training that covered all areas of the suite

agree with that comment re. being able to anticipate the scrubs needs when you have actually performed that role yourself for a while

[Pam RN]

I love to scrub. When I worked at a community hospital I did both and taught both to new RN's and Scrub Tech's. My old manager was pro-nursing and made sure we had a mostly RN staff. But the few techs we had were excellent and had been there a long time. When I got a job a huge university hospital I only scrubbed a lunch relief maybe twice. I hated not scrubbing. I felt left out of the action. Fortunately, I left that job and if I go back to the OR I'll make sure I go to a place that will allow me to scrub.