Can a surg. tech. "circulate" a case -give medications?

stevierae · Jul 3, 2004

Also what is interesting is the definition of "circulating". Out of all the comments from this topic, not once did anyone have a definition of circulating.
~Lonman

Lonman, we have had this discussion before. Operating room nurses don't need to define "circulating" for each other--we know what the role involves. Our governing body, AORN, which is also the organization on which operating room policies and procedures are based, requires that the circulator be a Registered Nurse.

The thread shodobe refers to is entitled "Should surgical technicians circulate?" Here is the link:

https://allnurses.com/forums/showthread.php?t=64713&highlight=techs+circulating

shodobe · Jul 3, 2004

stevierae, I was just about to state exactly what you stated, a seasoned OR RN does not need to define what circulating is. This subject has been brought up to many times to let it linger. If there are states out there that "allow" STs to circulate in any manner, they are the ones I would avoid as a parient. The statement to say that, "we do what is needed to give our patient the best care" is obviouly from an individual that hasn't been in the game long enough and wants to do more than what is "legally" allowed. All ORs that are worth their salt go by AORN standards and as stevierae stated, do not condone the use of NON_LICENSED personel to circulate. It all goes back to the issue of who is responsible for the running of an OR room. It is the RN and not an ST who is in charge and "delegates" what responsibilities are appropriate. The patient is my responsibility, not an ST and believe me when the s**t hits the fan who is going to get raked over the coals, the RN! This also goes back to the question of need, are STs really needed in the OR. Well, if they are going to go beyond their scope of practice in my room, the answer is a resounding NO! I really don't care if an ST knows what I am doing or not, if I think it is important I will tell them other than that they should just do what they are told to do. I am really grouchy today because of very long hours and this subject just irks the bejeebers out of me. mike

shodobe · Jul 3, 2004

stevierae, I was just about to state exactly what you stated, a seasoned OR RN does not need to define what circulating is. This subject has been brought up to many times to let it linger. If there are states out there that "allow" STs to circulate in any manner, they are the ones I would avoid as a parient. The statement to say that, "we do what is needed to give our patient the best care" is obviouly from an individual that hasn't been in the game long enough and wants to do more than what is "legally" allowed. All ORs that are worth their salt go by AORN standards and as stevierae stated, do not condone the use of NON_LICENSED personel to circulate. It all goes back to the issue of who is responsible for the running of an OR room. It is the RN and not an ST who is in charge and "delegates" what responsibilities are appropriate. The patient is my responsibility, not an ST and believe me when the s**t hits the fan who is going to get raked over the coals, the RN! This also goes back to the question of need, are STs really needed in the OR. Well, if they are going to go beyond their scope of practice in my room, the answer is a resounding NO! I really don't care if an ST knows what I am doing or not, if I think it is important I will tell them other than that they should just do what they are told to do. I am really grouchy today because of very long hours and this subject just irks the bejeebers out of me. mike

DawnEyes · Jul 5, 2004

stevierae, I was just about to state exactly what you stated, a seasoned OR RN does not need to define what circulating is. This subject has been brought up to many times to let it linger. If there are states out there that "allow" STs to circulate in any manner, they are the ones I would avoid as a parient. The statement to say that, "we do what is needed to give our patient the best care" is obviouly from an individual that hasn't been in the game long enough and wants to do more than what is "legally" allowed. All ORs that are worth their salt go by AORN standards and as stevierae stated, do not condone the use of NON_LICENSED personel to circulate. It all goes back to the issue of who is responsible for the running of an OR room. It is the RN and not an ST who is in charge and "delegates" what responsibilities are appropriate. The patient is my responsibility, not an ST and believe me when the s**t hits the fan who is going to get raked over the coals, the RN! This also goes back to the question of need, are STs really needed in the OR. Well, if they are going to go beyond their scope of practice in my room, the answer is a resounding NO! I really don't care if an ST knows what I am doing or not, if I think it is important I will tell them other than that they should just do what they are told to do. I am really grouchy today because of very long hours and this subject just irks the bejeebers out of me. mike

I originally had a pretty sharp response to the attitude displayed by Mike...until I read the link posted above (Should ST's circulate?). Now I'm just simply curious....what exactly has spawned such an intense (and I do mean intense, from some of the posts I've read) hatred of ST's? I mean, some of the people got downright nasty! I would think that with the amount of condescending comments RN's receive from doctors because the rn's didn't attend four years of medical school, they would think twice before passing the s**t down a level. (Overheard from a doctor once: "There's no way I could have been JUST an RN. I had to be something more than that." I'm not an RN (yet!) but that comment pissed me off just the same.)

As a cst myself, I take a lot of pride in knowing my scope of practice and doing my job in a safe, proficient manner. Do I believe that st's should be the primary and sole circulator in an OR? No, we are neither licensed nor trained to do so (ie: pt assessment, dispensing of medications, etc.). I also agree with the posters that every patient should have an rn to help oversee their care. However, I do believe our skills can be valuable in a secondary position, working WITH the rn if we are not scrubbed in (ie: opening a room, helping with pt positioning and padding-- which we ARE taught in our 2-yr schooling--running for supplies so the rn doesn't have to leave the room, answering docs beepers, etc.). And as for when the s**t hits the fan...it happens quite often in L&D. Just because I'm a cst does not mean that I lose my head and start whimpering in a corner everytime there's an emergency section or a code on the table (neonatal or adult). I follow my scope (which is usually running during codes unless I'm scrubbed in) and do what I can to help in a quick and efficient manner. I fully realize that there are techs (as well as rn's) that are lazy, incompetent, and pretty much useless. I think every profession has a few of those, I believe it's due to one's work ethic, not whether you spent 2 years getting a st degree vs. 2 years getting an rn.

And I don't know about where all of the negative posters work, but here the rn's, techs, and doctors all work together to....OMFG, IMAGINE THIS....give the patient the best possible care, and make them as comfortable as we can while they are in the hospital.

A lot of the posters should be ashamed of the comments they wrote. I think we all (techs, rn's, doctors, lpn's...even housekeeping) have our specific role in the hospital...our little niche to work from. And I think it says a lot about one's character to belittle someone who isn't on your *perceived* level.

I can't remember who said it, but I believe this rough paraphrase fits this thread well:

"Judge a man not by how he treats his equals, but by how he treats those beneath him."

shodobe · Jul 5, 2004

I have a minute and need to get to a case. I DO NOT hate STs. The question was, "should STs be allowed to circulate"? The answer is still absolutely NO! I do not hide my opinion of STs in the fact that I don't think they are needed in the OR. Why, you ask? If it wasn't for the shortage of qualified RNs, and the fact ALL hospitals are downright cheap, STs would be of little use in the OR. I have been this game for 27 years and till recently, the past 5-6 years, I had not worked with an ST. My hospital I work at now does not use them, never has. The other reason for not wanting them is back to my other answer that when something goes terribly wrong, the RN is the ultimate responsible person, not the ST. The ST can take their knocks from the boss but it is different in a court of law. I have no problem with them working in the OR because I admit they are here to stay. I would still rather have an ALL RN staff anyday. The problem here is that my comments are what the majority of RNs feel in the OR, they just won't really come out and say it. Besides, I have never heard in all of my nursing career an MD say they wouldn't waste their time being an RN. Just the opposite, some are actually saying maybe nursing school would have been better. Go figure! Good luck anyway and sorry to be so blunt, just my opinion for what it's worth. Mike

stevierae · Jul 5, 2004

You will never hear me say or insinuate I dislike or hate STs--if you do any kind of a search, you will see me praising some of the ones I have been lucky enough to work with in my day--I've worked with several who really, really should have been surgeons--they are that knowledgeable--they are the ones who end up guiding the docs through the case--this is true often of total joint cases in which the system is unfamiliar to the doc but intimately familiar to the tech, or complicated total joint revision. Same thing with complex spinal instrumentation cases. Without exception, these techs trained inthe military; often during Vietnam (as I did) and are used to an expanded role and greater responsibilities.

However, AORN requires that the circulator be an RN, and patient assessment cannot--simply cannot--be delegated to an OR technician. That's the law. Any OR nurse who delegated assessment to a tech would lose her license to practice nursing, and I kinda like practicing nursing!

stevierae · Jul 6, 2004

This is just food for thought--not to provoke controversy, but to provoke THOUGHT. This is an actual case in which a hopsital was sued successfully because an operating room technician went outside his scope of practice. You had better believe the circulator in the room was made to testify and was held accountable, too, for allowing him to do so. Don't think that she could fall back on blaming the surgeon--THE CIRCULATOR IS IN CHARGE OF THE ROOM. Those old days as "surgeon as captain of the ship" are long over.

Also, for those of you who, in the other thread addressing this issue who insist that AORN has no jurisdiction over operating room technicians--well, read this article, (an actual lawsuit) and you will understand that you are incorrect.

Legal Eagle Eye Newsletter for the Nursing Profession(5)6 Jun 97

Quick Summary: A surgical facility must be able to prove that all surgical personnel present during a specific procedure had been cleared and documented before the fact as competently trained for the specific tasks and procedure in question.

Assignment of surgical personnel to specific tasks and specific procedures in the operating room must be based on their individual qualifications.

It is negligent for a surgical facility to permit a surgical technician to perform tasks, such as holding retractors, for which the technician does not have specific training.

It is negligent for a surgical facility to assign a surgical technician to a procedure with which the technician is unfamiliar.

Training and familiarity with procedures performed on adults is not necessarily directly transferable to pediatric situations.

Surgical techs should have an understanding of human anatomy, as it relates to the risk posed by improper handling of their responsibilities. SUPREME COURT OF ALABAMA, 1997.

To protect its patients, a hospital or other healthcare facility offering surgical services must see that its operating room personnel have been adequately trained.

To protect itself from civil liability for negligence, a surgical facility should document, before the fact, that its surgical personnel have been adequately trained for the specific tasks they will be asked to perform and that they are familiar with the specific procedures they will be involved in, according to a recent case from the Supreme Court of Alabama.

This case involved a surgical technician. At the time of the incident in question, the court noted, surgical techs were not subject to mandatory licensing or required certification under state law. The court nevertheless looked for guidance to the then-current version of "Standards and Recommended Practices for Perioperative Nursing" published by the AORN. This publication was accepted by the court as evidence of the legal standard of care. The court believed the publication established a necessity for surgical personnel to have specific training in the tasks and procedures they were asked to perform.

Specifically, the surgical technician in this case should not have been allowed to hold retractors in a pediatric hip arthroplasty. Never having been trained for that task with pediatric patients, the technician was not aware of the risk to the sciatic nerve that could result from even the slightest deviation from the surgeon's manual positioning of the retractor.

The court was willing to accept the qualifications of a registered nurse with considerable operating room experience, who had held local offices with AORN, and who was well versed in the Joint Commission's standards for perioperative nursing practice, as an expert witness. She testified against the hospital. The verdict against the hospital was in excess of $800,000.00. Healthtrust vs. Cantrell, 689 So. 2d 822 (Ala., 1997).

Legal Eagle Eye Newsletter for the Nursing Profession

HazeK · Jul 6, 2004

I have refused to allow the ST to spike IV bags or give me drugs when I am scrubbed

Question: if YOU are the RN, why are YOU scrubbed in and no other RN circulating in the room??? IF only one RN available, why isn't the tech functioning in their role as a scrub nurse (legal!) and you be ciruculating?

They cannot circulate. Period.

They CAN be immensely helpful, WITHIN their scope of practice!!

Dixiedi · Jul 6, 2004

I originally had a pretty sharp response to the attitude displayed by Mike...until I read the link posted above (Should ST's circulate?). Now I'm just simply curious....what exactly has spawned such an intense (and I do mean intense, from some of the posts I've read) hatred of ST's? I mean, some of the people got downright nasty! I would think that with the amount of condescending comments RN's receive from doctors because the rn's didn't attend four years of medical school, they would think twice before passing the s**t down a level. (Overheard from a doctor once: "There's no way I could have been JUST an RN. I had to be something more than that." I'm not an RN (yet!) but that comment pissed me off just the same.)
......
"Judge a man not by how he treats his equals, but by how he treats those beneath him."

I have found there is a lot of hostility towards anyone who is not an RN in the threads around here. And, there is a very strong preference to those with BSN behind their name.

It's sad, they are nurses, no more no less than any other nurse or other support tech.

If they actually understood the health care system they would understand that there is more than enough room for every one of us and pt care would not be jeopardized.

I am not saying every RN has this attitude! I said only I have found a lot of it here. There are so many who think they should not have to actually be a nurse on the floor, even though they want to be a staff nurse, because they have a BSN.

It's so sad. So very very sad.

It's also very funny. When I was in nursing school the head nurse of the ER was an LPN. Of course her shift charge nurses were RNs, but the unit head nurse was an LPN. Oh my how times have changed.

stevierae · Jul 6, 2004

I have found there is a lot of hostility towards anyone who is not an RN in the threads around here.

I don't have a BSN. Never wanted one, never will. I want to practice hands on NURSING--not move up in management. And, as I said, I have worked, and continue to work, with some awesome, awesome OR techs. Why the heck would they want to circulate? Why would they want to take on the added responsibility or headaches for a scrub tech's pay? Anytime my tech is not scrubbed in I am making sure he or she is taking a much deserved break!!

I don't need anyone to "help" me circulate--if some crisis develops that needs another nurse, (or if I really, really just need to get to the bathroom) I know how to get on the phone and ASK for another nurse! There's usually SOMEBODY available, either ordering supplies or sitting in the lounge!

Dixiedi · Jul 6, 2004

I don't have a BSN. Never wanted one, never will. I want to practice hands on NURSING--not move up in management. And, as I said, I have worked, and continue to work, with some awesome, awesome OR techs. Why the heck would they want to circulate? Why would they want to take on the added responsibility or headaches for a scrub tech's pay? Anytime my tech is not scrubbed in I am making sure he or she is taking a much deserved break!!
I don't need anyone to "help" me circulate--if some crisis develops that needs another nurse, (or if I really, really just need to get to the bathroom) I know how to get on the phone and ASK for another nurse! There's usually SOMEBODY available, either ordering supplies or sitting in the lounge!

I was commenting on another post that noted hostilities in the thread. I did not say that any one nurse was hostile. It was a general statement, not naming any person or persons. I really don't know why you took what I said personally, I didn't direct it at you.

I will not be harrassed like this by someone I didn't even speak to! You surely owe me an appology.

carcha · Jul 6, 2004

Same old, same old, we have this question every week about the role of the tech vs the role of the rn. I'm surprised people are not hostile towards the whole thing. Just a few observations here from england. One, in response to "Dawneyes" and the comment I believe about the 2 year tech course vs the 2 year rn course. I myself took a three year rn course, a two year midwifery course, and a one year or course. I can tell all of you out there , any or tech working with me in the past did not circulate and was closely supervised while scrubbing and if I'm in charge of the room I will take those responsibilities very seriously. I just cannot understand why if there are CST who feel they are as good as the RNS, then go back to school do your rn training and you will be as good as us. This whole topic just annoys me, lots of people bash the RNS for their attitude but lets face it when the s£%t hits the fan those same people are quick to hide behind the RNs as the innocents who were just doing what they were told by the RNs. The only way to settle this argument is to just have RNs in the OR and I look forward to the day.