What's up with RNs who refuse to scrub? - page 7

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... Read More

  1. by   patadney
    Everybody,lighten up! You don't know why another person does something until you have been there.Each hospital and situation is unique and with the nursing shortage we will be seeing more "re-engineering" with housekeeping being trained to scrub,EMT's working in ICU,and ward clerks watching heart monitors. Don't be so critical of your fellow nurses!
  2. by   mumhuff
    Seems to be a heated topic. I'm a nursing student and will begin clinicals this fall. I'm interested in becoming a surgical nurse but I do not know the meaning of "scrubbing" can someone explain please? Thank-you.
  3. by   spineCNOR
    mumhuff- the scrub is the sterile person who passes instruments to the surgeon. The circulator is an unsterile person who is involved with patient positioning, prepping, delivering sterile supplies and instruments to the sterile field.
  4. by   mumhuff
    Thank-you spineCNOR for explaining the difference between the scrub and circulator nurse.

    If my particular nursing school and the hospital in which I will be trained doesn't teach us how to scrub - where am I to learn this important procedure?

    I'm in a 3 year ADN progtram and am wondering whether this type of program is sufficient enough for me to become a surgical or er/trauma nurse? Thank-you for your help.
  5. by   stevierae
    I think this is a good place to give some kudos to scrub techs. We have all worked with those who are prima donnas, and who are convinced they know far more than the nurse does, and could do her job any day of the week--

    But, I have ALSO been lucky to have worked with OR techs, especially those who do major ortho (like complicated total joint revisions)and spines, who know some of the procedures HANDS DOWN better than the surgeon does, having done those procedures many, many, many times with various surgeons over the years, and having seen every possible problem that could occur, so therefore are knowledgeable about the solutions, and are willing to share them--
  6. by   stevierae
    Originally posted by 2bPhD
    After they taught the housekeeping staff how to scrub, the task was no longer considered a skilled nursing technique. After all, anyone can scrub and assist in the OR. Medical students and interns do it all of the time. Nursing time should be devoted to more skilled aspects of care that require the unique background that nurses possess.
    Oh, gosh. It sounds like we have one of those ivory tower nurses here whose "experience" is related to the research she is doing climbing her way to PhD (are you at NIH?)

    This is one of the most inane comments I have ever read: "ANYONE can scrub and assist in the OR."

    Do you truly believe this? Have you ever actually BEEN in an operating room? I am CONSTANTLY learrning new things from people who scrub, both techs and nurses, and I have been scrubbing and circulating for over 25 years. I am constantly amazed by how sharp some 21 year old techs are, and I hope they go on to become RNs, because their skills will make them incredible operating room nurses. They already know how to prioritize and how to function in a crisis. One never stops learning--things are always changing in the operating room.

    By the way: medical students do not really "scrub, " as we who SCRUB define "scrub."

    Medical students do little more than stand and observe; they are occasionally entrusted with a retractor or the suction.

    Usually their knowledge of sterile technique is not quite that good yet, and they must be constantly watched.

    They are always grateful to the scrub, who is kind enough to take them under his or her wing.

    Residents, also, do not "scrub" as we define the role.

    They often know only the instruments related to their specific rotations--not all, as we do.

    They do not know various sutures and all the types of needles available, as we do--they, again, know the types used in the specialty they are training for.

    A general surgery resident cannot finish a Whipple, go from there to scrub a total hip, go from there to scrub a crani, go from there to scrub a AAA--as we can, and do.

    I have said it before, and I will say it again: If you have never scrubbed, you cannot truly anticipate the surgical team's needs, ESPECIALLY when all hell breaks loose and things are not going "by the book."

    If you have not been in the scrub's shoes, you will not have a clue as to what could be going on up there at the field that has deviated from the norm, and how you can best prioritize how to help the team when seconds are critical.

    Shodobe said it best when he said, "Scrubbing may not make you a better nurse--but it DOES make you a better OPERATING ROOM NURSE."
    Last edit by stevierae on Aug 7, '03
  7. by   stevierae
    To quote Shodobe again:

    "As for scrubbing, this entails setting up instruments for the case and passing them during the case to the surgeon.

    You have to be very versatile in knowing the procedure so you know what the surgeon is trying to accomplish.

    You have to know all the names of the instruments so you can pass them in order. You have to anticipate the surgeon so you know what they will need next without them asking for it. "


    Here he makes another good point as to why not just "anyone" can scrub! To folks who think that "scrubbing" entails standing there like a robot, only moving when the surgeon says "Clamp" "suture" etc, like they do on TV (did you think that, 2bPhD?) let me tell you, nothing could be further from the truth.

    A more likely scenario is a surgeon asking for something and you giving him NOT what he asked for, but what you know, from experience, he really needs.

    It also involves a lot of the surgeon's NOT HAVING TO ASK IN THE FIRST PLACE--a good scrub (RN or tech) KNOWS the routine!

    Do you really think any housekeeper who fancies himself an OR tech has that capability? Do YOU have it, 2bPhD? I didn't think so.
    Last edit by stevierae on Aug 7, '03
  8. by   spineCNOR
    AMEN, SISTER!!! (and Brother)
    Why yes, anyone can be taught to scrub, if you mean putting on a gown and gloves (in a sterile fashion, or maybe not), and hand instruments to the surgeon. BUT, can anyone use critical thinking skills to constantly assess the situation in the OR before and as the case is going on, realize when the patient or surgeon may be getting into problems, and take the appropriate action? Can just anyone understand the basic principles of microbiology to make appropropriate decisions when a possible contamination has occurred, or when there is a problem with an autoclave or sterile item packaging, or to even realize that contamination has occurred? I think we all know the answer is no--not everyone can learn to scrub and be competent.

    To say that an OR nurse should not learn to scrub is to advocate a fragmented, incomplete role-- only someone with little understanding of what goes on in the OR "trenches" would advocate such a system--OR an administrator who wants to save money by using more unlicensed staff.
  9. by   spineCNOR
    AMEN, SISTER!!! (and Brother)
    Why yes, anyone can be taught to scrub, if you mean putting on a gown and gloves (in a sterile fashion, or maybe not), and hand instruments to the surgeon. BUT, can anyone use critical thinking skills to constantly assess the situation in the OR before and as the case is going on, realize when the patient or surgeon may be getting into problems, and take the appropriate action? Can just anyone understand the basic principles of microbiology to make appropropriate decisions when a possible contamination has occurred, or when there is a problem with an autoclave or sterile item packaging, or to even realize that contamination has occurred? I think we all know the answer is no--not everyone can learn to scrub and be competent.

    To say that an OR nurse should not learn to scrub is to advocate a fragmented, incomplete role-- only someone with little understanding of what goes on in the OR "trenches" would advocate such a system--OR an administrator who wants to save money by using more unlicensed staff.
  10. by   Ferret
    Hi All,

    C'mon people, you had a great thread going here. Why the silence for so many months?

    I've been incredibly interested in following this thread. In Australia, things are backwards.... the Scrub is the RN and senior nurse, while the circulating nurse, or Scout nurse, is the junior. I've been an Enrolled Nurse (?practical nurse?) in OR for 4 years now, and never been allowed to scrub, even though in many cases because I have spent time in a speciality, and paid a lot of attention to the cases, I had a much better idea of what was going on, and had to explain to a new RN how to put together their instruments, and what the surgeon was asking for.

    I'm now a RN, and finally get the chance to scrub, an opportunity I've been desperate for in the last few years. Here the Scrub/Scout role consists as about 50/50 in each job during a day, unless you are teamed up with an enrolled nurse scout. Once I finish my perioperative postgrad course this year, I'm hoping to do some travel nursing in the US. Here is an interesting question, what do you think hospitals will find more important, my 4 years as a circulating nurse, or my post registration 1 year's experience as a scrub/scout?
  11. by   KarenHalse
    Jason, I have really found it depends on what hospital you are at, but most times they like that you can scrub and circulate. As far as taking a job scrubbing, the more experience the better. At least one full year rotating through all specialties is the minimun I would consider taking a travel job as a scrub..

    Alot of hospitals want you to be able to circulate and be ready to just jump right in. I love the challenge of going to new places and learning how it is done there. The down side for me is that many hospitals have poor equipment and are very disorganized. Another thing I have found is that there is always someone that won't like you because you are the "traveler" like you have leprosy or something. I ignore them, that is their problem, I refuse to own it.

    Remember, where you are at is not necessarily backwards, it's just done that way there. That is what I try to remember when I go to a facility and I think they are "backwards" but in Rome do as the Romans do and you will be fine. As long as you are working under standards and giving quality care..

    Of course, this is just my opinion...
  12. by   stevierae
    Originally posted by KarenHalse
    Another thing I have found is that there is always someone that won't like you because you are the "traveler" like you have leprosy or something. I ignore them, that is their problem, I refuse to own it.

    So true. I am a really easy going person and get along with virually everybody but Karen is correct: there is always one person who won't like you because you are the "traveler--" not because you are an outsider, but because he or she feels threatened by your skill level.

    Travelers are capable, (or they had better be,) of being thrown into any case--we often, at least before they get to know us well, get the very difficult cases, very difficult surgeons, etc. as some sort of test to "prove" ourselves.

    Once you have proved yourself, there is always going to be one person who feels intimidated by you--because they don't, and never will, have your level of skills, could never be a traveler and do what you do, and they feel that you make them look bad and that maybe, just maybe, one day the supervisor will expect them to perform to the same level of skill you and other travelers have brought to the facility--not an impossible task, if one is willing to learn, but most people like this are not.

    I worked registry occasionally at a facility where they only did very minor procedures--breast biopsies, hernias, podiatry, lap choles--and made a huge production out of them.

    Most of the nurses there were very territorial, very protective of "their" surgeons, very mistrustful of anyone who did anything other than "the way we have always done it--" Most of them had never worked anyhwere else, having been there since they graduated from nursing school many years ago and having made that facility their comfort zone.

    Well, that hospital recently shut down abruptly because of bankruptcy. I just chuckle to think of the situation these nurses now find themselves in--incapable of being a registry nurse or traveler, because they can't adapt to new situations, and just don't have the skills.

    Jason, I really would not embark on a travel assignment unless you feel really, really comfortable with scrubbing, because travelers often get assigned to do lunch reliefs for each room, which means relieving BOTH the scrub and circulator.

    This is particularly true in fast paced university medical centers. They don't want you "learning" to scrub on their time. I saw this happen to an RN who had never scrubbed--only circulated--and had taken the travel assignment with the idea that he could use it as a learning experience in the very complex procedures they routinely did.

    They just tore him up--and of course they threw him into situations where he was bound to fail, as if it served him right. Somebody should have given him the same caveats we are giving you before he took the assignment--he would have reconsidered.
    Last edit by stevierae on Jan 30, '04
  13. by   Muggle1
    Stevierae,

    Your reply to Jason was just what I've been searching for! I'm an LPN, in RN school, ready to graduate in May of this year. I'm really fascinated with the OR, and I'd really love to combine OR nursing with travel nursing one day. Unfortunately, I haven't known any OR nurses or Travel nurses personally. I appreciate your advice to Jason about becoming VERY comfortable in scrubbing and circulating before taking a travel assignment. As far as I know, there is only one hospital in the Denver area that teaches their RNs to scrub and circulate. That looks like my best bet for a job after graduation...

    Do you have any other advice for a prospective OR/Travel nurse? How many years of experience do you recommend? What are the best assignments to take first? Do you recommend Med/Surg training before going into the OR? Any feedback would be greatly appreciated!!!

    Thanks!
    Margo

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