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

cristinak · Jul 18, 2004

This discussion is pointless and this contribution is my last. While the RNs on this thread have focused on the professional aspect of the role of the RN compared to the task allocated to the st or cst, the non nurses on the thread have hidden behind such words as "hatred, competence, insecurity". I am a registered nurse and proud of it. I have studied and worked hard and continue to do so to this day. I have no personal feelings towards st or cst's . My beef is that they are taking the place of a registered nurse who is more knowledgable, more accountable and multi skilled. Scrubbing and handing instruments is only one aspect of peri operative care, no big deal. Give me an all around peri operative nurse capable of multi tasking, who is multi skilled and then I am impressed. ST's and CST'S are just filling gaps, sorry but thats how I feel.

Well gee Carcha.. I didnt realize we (CST's) were that low on your totem pole! I hate to be the bearer of bad news but, CST's are here to stay and sorry if you dont like that.. You know you could always go work in a rest home.. you will have your multi skilled nurses capable of mulit tasking.. or you could just go work somewhere else in the hospital.. normally i am not rude on my posts, but your attitude toward CST's is not needed. we are there to do a job that is important or they wouldnt even have a career for it.

mare-mare · Aug 4, 2004

Boy, what a heated thread!

Ok, I work with some awsome CSTs and I work with some horrible ones too, just as I work with some awsome nurses and some terrible ones also. Carcha has said that CST's are here to stay, but personaly feels against them... it's an opinion. In sitting here reading this entire thread just now I think that the CSTs are the one coming out a little defensive. It's like they have to continually try and get one-up on the RN's. Lets face it, we both have our roles and we should concentrate at being the best at them we can. I do have to say though, I have a huge pet peeve about people who are not registered nurses refering to themselvs as nurses... I worked hard to become an RN, and yes others may work hard at becoming LVN's, CSTs, etc... but you are not a REGISTERED NURSE.

DawnEyes · Aug 4, 2004

Mare, I know you didn't mean your last post to go to anyone in particular, but I just wanted to clarify...I've never told anyone I am a registered nurse, nor will I until I complete the nursing program and pass the NCLEX. Then (and only then) will those words come out of my mouth. I always correct our L&D patients when they refer to me as "nurse," letting them know I am a surg. tech that will be helping her RN during her care. I want to be a nurse, which is why I am going back to school, but I'm not in such a rush to take that role that I would flat out lie about my position on the floor.

Marie_LPN, RN, LPN, RN · Aug 4, 2004

Boy, what a heated thread!
Ok, I work with some awsome CSTs and I work with some horrible ones too, just as I work with some awsome nurses and some terrible ones also. Carcha has said that CST's are here to stay, but personaly feels against them... it's an opinion. In sitting here reading this entire thread just now I think that the CSTs are the one coming out a little defensive. It's like they have to continually try and get one-up on the RN's. Lets face it, we both have our roles and we should concentrate at being the best at them we can. I do have to say though, I have a huge pet peeve about people who are not registered nurses refering to themselvs as nurses... I worked hard to become an RN, and yes others may work hard at becoming LVN's, CSTs, etc... but you are not a REGISTERED NURSE.

I am a nurse, although not registered, i am a licensed practical nurse who worked hard to become an LPN and also to be where i am now, who gives respect first, and gets respected, first as a person and then as a nurse. If that seems defensive, well yes it is, and rightly so because i don't appreciate it when people come across as 'this is what should be required, and coincidently it also what i am'. :rolleyes:

I am a part of the group who is well-aware that i am NOT an RN, but i'm also sharp enough to know that i wouldn't need to be reminded of this. I have a nametag that states my job title (the last word of it being "nurse"), not to mention a thick book with the details of my job description, along with the laws of my state that outline what i can and cannot do as an LPN.

Eventually i will go back and complete at least a BSN program (looking toward MSN though) because i want a broader choice of opportunity that also includes teaching. And even then, i'll keep an open mind that if the job title contains the exact word of "nurse" and accompanies a nursing license (be it RN or LPN), then they are, in fact, a nurse.

My point being, respect needs to go all around, and your post seems very condescending of those that are not RNs.

mare-mare · Aug 5, 2004

General society does not know what the difference is between a LPN or an RN. They think "nurse" means registered nurse, look at studies it's a fact. When you tell people that you are a "nurse" they think they are getting something different then what in fact they are. We all need to educate those we come into contact with. If you took my reply as condescending, too bad.

lalalady · Dec 18, 2007

I know nobody's reading this anymore. So here I am talking to myself. Wow, I was really excited to become a CST...someday...would be a huge deal for me, I would be so proud of myself. Some of you guys really suck. You make me doubt this as a career choice if I have to work with people like some of you. If I would be looked DOWN on for doing something I would be SO PROUD OF, how dumb am I? Maybe they are not paid as much as RNs but if their RNs are as mean as some of you, they deserve 2x your pay for putting up with your crap. I am posting this after reading page 2...don't know what's on page 3, 4, 5, or 6 yet, but so far I am very dissapointed. :crying2: Even heart-broken. Tell me, is being a CST really a horrible thing to be in some people's eyes? Gosh, I feel like I'd be going to 2 years of school to be totally derr..stupid. Looks like you don't need any fresh faces. I wonder how the surgeons or the hospitals would feel about this.

ewattsjt · Dec 18, 2007

wallamame, this thread is coming from a while back…there are mistruths spoken here and you can check them out by going to www.aorn.com and looking up the information yourself. never take what someone says as fact without checking them out. the original post was about “second circulating” which the posts got away from that fast!!! my post will be on “second circulating” as the author intended. there are differences in languages in state laws as well as a difference between surgi centers and hospitals. some have laws concerning circulating and many of those are in need of stronger language because the facilities manipulate it. ie they will say the charge is the rn in charge of the rooms so the tech is a “second circulator”. the charge assesses etc...http://www.aorn.org/publicpolicy/currentlaws

there have also been many changes to the associate degree cst with regards to “second circulating” in that they receive adequate training not only in class labs but by taking classes like pharmacology, microbiology, psychology etc...most classes will transfer to rn programs meaning you will have all your prerequisites out of the way. the program i took only has the core nursing or surgical technology as differences. ie the ivy tech programs in indiana..rn... http://www.ivytech.edu/schools/health/nursing/nursing.html surg tech... http://www.ivytech.edu/schools/health/surgical-tech/index.html you can see that the core classes are the difference.

you also have to understand that when this thread was started and even now some places train their own sts. only about 33% of the techs sit for the national exam given by the nbstsa which really indicates that about two thirds of the techs really do not know about meds, pressure points in positioning, etc…not that they couldn't learn it; just that they usually haven't.

also there are some posts from the uk which does not have csts or sts. they have operating department practitioners who do a three year program and do the same as csts but also can administer anesthesia (not conscious sedation but gased…) my point is to look at the location before jumping to conclusions on why the person feels this way. different country…different theaters (ors).

my facility has an rn for a circulator and a cst (must be a cst unless grandfathered with the facility) and a third person for an assistant. the third person is usually a cst for $$ reasons (cheaper) and they second circulate until ready to scrub. policy allows the rn to delegate the task of passing meds or spiking an iv bag, under the delegation of the rn. so, for some we do and others we don’t…it’s their call as it should be. what the facility policy, state law... prohibits is that the cst can not assess the patient, inject or administer meds or sign off on the documentation. all other functions can be delegated to the cst. this ensures patient safety, job security and financial gain to the facility; which is where all the hostilities really stem from. as you can see, my place has a true team effort that is for the benefit of all and not all places have the hostilities you have seen in this thread.

my facility is a great place to work and most people are supportive and not so flaming like on this forum. i am currently a cst going on into becoming an rn but, for $$$$ reasons only. i don't think i could be a better patient advocate than i am now! my only heartbreak will be that the growing trend here is that csts scrub and rns circulate and i love to scrub!

by the way, i would strongly recommend that anyone who is in the or know the aorn’s policies because if there is no federal or state law or facility policy on something; it goes to the standard of care which usually goes back to aorn policy.

for resources for the cst programs you can go to www.ast.org , there is also a discussion forum at www.ast.org/forum that is probably more of what you are looking for.

lalalady · Dec 18, 2007

Yeah, thank you so much for all of this. The hostility I suppose I understand if an RN used to scrub but can't now because a CST is cheaper. But that really shouldn't be directed at the CST as they went out of their way to train for something they could be proud of. It's a money/policy/hospital issue, and anyone should be able to be proud of getting a degree or even being capable of doing such an important job. To tell you the truth, I was just searching the site for anything about CSTs because I am so curious about being one. I found out about it maybe a month ago while my husband was getting ready to register to take pre-nursing classes. Nothing really interested me execept science and anatomy. I thought, *WOW I could DO that.* I want to scrub (hopefully) someday...I have dreams about it every night ever since I found out about that career. But I was wondering about RNFA, is that what you are going to be? In that case, don't they get to keep scrubbing? I was also thinking about CSAssistant, but I would LOVE to be able to close, and it seems you are more likely to get to do that if you are RNFA, am I right? Maybe even all that falls into which state you are in, etc, but you can see why I might be confused. Gosh, yeah, it made me really sad to see those posts, but man, I have a really hard head. People with degrees should not put people with degrees down, or anyone else. That's just not *smart.* I know that nobody is better than me. I'm not any better than a waitress or a porter or the person that gives me my mocha. I feel like I am stating the obvious, but even a child can understand that concept. Some people's kids,:icon_roll huh? MY children are better behaved. People have a right to choose a carreer for money or enjoyment or whatever. Nobody should have to justify their choice, especially if it's to HELP people. Sheesh! And it seems to me that the hiring hospital doesn't think that they don't need CSTs. They are totally hiring in my area, good money, too. I'm not from a wealthy situation, this is the first time I have EVER heard of anyone putting down people for a higher education. I don't want to ever get used to that or think that's normal. They can be frustrated with the politics, but the CST is just doing his/her job, which they should be emensely proud of. A career like that would be (literally) a dream-come-true for me. YOU are a very nice person to reply to my lonely post in here. THANK YOU I AM INSPIRED!

HeatherB,CST · Dec 19, 2007

Thank you, edwattsjt, for bringing some level-headedness to this discouraging thread.

Scrubby · Dec 19, 2007

I don't want to insult any techs on this forum but i would absolutely hate it if they brought them into my HCF and replaced us at scrubbing. Surgical tech is a very dirty word at my work (you just don't want to bring the subject up), and the powers that be are absolutely against the idea. That's fine by me.

I would hate it because i love scrubbing and would hate to be stuck scouting all the time. I love the variety and to be forced out of it would be devastating. If they did bring techs in i wouldn't take it out on them because it's not their fault but i'd probably go to another HCF to work where i could scrub.

In Australia we have RN's and EN's (enrolled nurses). From what i gather an enrolled nurse is the same as your LPN. Your still nurses but supervised by the RN who delegates workload etc?

I find it amusing that over in the US the LPN's are scrubbing, while the RN is mainly the scout. Well it's the opposite down under. EN's can scrub for minor cases such as hernias, amputations, small plastic cases only. The RN's scrub for the major cases. The EN's function is mainly as the circulating nurse here.....

GadgetRN71, ASN, RN · Dec 19, 2007

I don't look down on techs-I was one for years. But I have experienced just as much nastiness from techs as I have from nurses. The reason why this is so is because every job has nasty people or those who think they can do stuff outside of their scope of practice or those who are bitter because other people go back to school etc. When I was a tech, there were the old OTJ trained techs who looked down on those of us who went to school and were certified. There were also the techs who thought I was a traitor for going over to the "dark side" and getting my RN.

Now that I'm an RN, there are nurses who think I'm nuts for wanting my BSN. Some of them get upset with me because if we have extra people, I'll get the scrub out for a 15 minute break(not all of the RNs scrub)or a supper break. Seems to me there will always be someone who gets pissed off about something. As long as I'm within my scope of practice and doing the best I can, they can kiss my chubby white fanny.

I also agree with Scrubby that all RNs in the OR should know how to circulate and scrub. How can you run the room effectively if you don't have a good idea of how it feels to be the one scrubbed in? I think hospitals that don't allow the RNs to scrub are shortsighted and I also don't believe that CSTs should circulate. Not because they are inferior or anything but it is a different education and mindset. I know, because I have an Associate's in surgical technology and my ASN. In a nursing program, you are trained to get a bigger picture of the patient. whereas in my ST training, it was surgically based.

I think there is room for all of us. Sounds corny but teamwork is one of the most important things in the OR.

ORTech2RN · Dec 20, 2007

I don't look down on techs-I was one for years. But I have experienced just as much nastiness from techs as I have from nurses. The reason why this is so is because every job has nasty people or those who think they can do stuff outside of their scope of practice or those who are bitter because other people go back to school etc. When I was a tech, there were the old OTJ trained techs who looked down on those of us who went to school and were certified. There were also the techs who thought I was a traitor for going over to the "dark side" and getting my RN.
Now that I'm an RN, there are nurses who think I'm nuts for wanting my BSN. Some of them get upset with me because if we have extra people, I'll get the scrub out for a 15 minute break(not all of the RNs scrub)or a supper break. Seems to me there will always be someone who gets pissed off about something. As long as I'm within my scope of practice and doing the best I can, they can kiss my chubby white fanny.
I also agree with Scrubby that all RNs in the OR should know how to circulate and scrub. How can you run the room effectively if you don't have a good idea of how it feels to be the one scrubbed in? I think hospitals that don't allow the RNs to scrub are shortsighted and I also don't believe that CSTs should circulate. Not because they are inferior or anything but it is a different education and mindset. I know, because I have an Associate's in surgical technology and my ASN. In a nursing program, you are trained to get a bigger picture of the patient. whereas in my ST training, it was surgically based.
I think there is room for all of us. Sounds corny but teamwork is one of the most important things in the OR.

Great post..I could not agree more..teamwork is of the essence when it comes to the OR. Fortunately where I work, the techs and Rn's get along great and we are more or less a big dysfunctional family.

I can relate to the snide comments from other techs about "going to the dark side," although they are very few and far between. Counting myself, there are five techs in our OR that are in prenursing classes. All of the RN's that I work with are extremely supportive of the techs that are moving on to nursing. As for our role in regards to helping the circulator, we mainly help with positioning, gather supplies during cases (dressings,suture,GI staplers, Ortho supplies etc). I've been guilty a few times of dispensing Lidocaine/Marcaine to other techs. But I definitely stay away from offering to spike bags, or to dispense toradol or duramorph.