Published Mar 28, 2002
i started out looking for first assistant info and ran across this info, the part i questioned i put in bold. i always thought circulators had to be rn's or does the rn requirement only come into play with medicare/medicade reimbursement? if so, i would imagine it would be hard for a hospital to run if it excluded these groups. any ideas or opinions? i have nothing against surgical techs, just wanted to make that clear.
http://www.ast.org the following info is taken from the ast website. type in first assistant in their search box & this & other info shows up.
who are surgical technologists?
surgical technologists (formerly called operating room technicians) perform many different responsibilities in the operating room. they act as the scrub person, as the circulator,
and as the first assistant on the surgical team. surgical technologists' responsibilities involve preparing the operating room and instruments, equipment, and supplies that will be needed; positioning and preparing the patient for surgery; and passing instruments, sponges, and sutures to the surgeon. surgical technologists are the surgical team's expert in aseptic technique, being constantly vigilant for any break in the technique that could endanger
the sterile field so necessary to the successful outcome of the operation. those not familiar with the profession may assume surgical technologists are nurses or nursing assistants, which they are not. surgical technologists belong to a separate non-nursing profession of highly skilled, credentialed allied health professionals that possesses specialized education and training to work specifically in the operating room.
how can you support your constituents who are surgical technologists?
carefully scrutinize any purposed regulations that could restrict the use of surgical technologists.
there have been efforts made by nursing groups in many states to regulate the role of surgical technologists and restrict their full utilization, particularly in the first assistant and circulating roles. because hospital accreditation standards do not require an rn to circulate, nursing groups are attempting in some states to make this a legal or regulatory requirement at the state level. these effort will lead to hospitals having no choice in the provider they employ and could cost csts their jobs. if nursing groups are successful in their efforts to restrict this profession, it could result in your constituents who
are surgical technologists losing their jobs.
There is an excellent article in the May, 2001 AORN journal addressing the RN circulator. It list which states allow non-RN's (techs, LPN) to circulate. I think something like 22 states still allow a non-RN to function as a circulator. Read the article and see where your state falls.
AORN is working with state legislative/Boards of nursing to mandate the RN circulator. But, it is a grass-roots effort. Everyone needs to get involved and write their legislature and get the ball rolling.
Like you, I have nothing against CST and believe they are a vital team member in the OR. But, assessment of the patient is an RN responsibility and all patients deserve a registered nurse!
Check out the article. You can assess it online if you go to AORN web page. Go to the government section and look under past health policy articles.
Thanks for the reply K. Lynn, it took me forever to find the article. Then I came back to thank you & noticed you had the month & year of the article in the top of your post. DUH .... smacking forehead with hand......
While I was hunting around I went ahead and joined AORN, the student cost is only $20/yr including the magazine.
So what does everyone else think about this?
There must be a charge nurse in the OR, that is the role of the circulator in Michigan. I cannot comprehend how an unlicensed person can circulate. Who is charge?
The Association of Surgical Technologists believe they are the experts in the OR and the RN is not neededto circulate or scrub. Their programs are available at many of the same colleges where ADN programs are found; lasting roughly the same amount of time and credits They focus only on the OR, while the RN program is limited to 3 days exposure to the surgical suite during clinicals. Read their website at http://www.AST.org. Although I don't agree with the premise, politically they are very strong and may win this argument against AORN.
As a former CST graduating from an approved Surgical Technology program in the eighties. I definately do not agree that a CST should be placed in the role of a circulator. My program at that time did not entail assessment of the patient prior to surgery, did not explain lab values, did not talk about different fluid replacement, it focused on the surgical procedure the anatomy, phisiology, the steps of the procedure, sterile technique, and maintaining a sterile field and last but not least instrumentation. At the time I thought I could circulate didn't seem to be much to it. Then I went to nursing school fully thinking that I would be an OR nurse.
I learned about assessing the patient, learned about disease process, more in depth understanding of lab values and why they are important. I also understand that now some surgical technology programs are two years long. However they are still only geared for the operating room. It is a different area of nursing unique to itself, but as stated previously every patient deserves a registered nurse!
CST's are very valuable to the surgical team, they do bring expertise to the table every day, I don't think that their jobs will ever be in jeaparody. I think with proper training they can be first assisants and excel at it. There is room for both professions in the OR! Just my two cents.
At the risk of insulting many good CSTs, in 22 years of OR nursing, I've yet to find one who remotely had the amount of education equivalent to that of an RN. The scrub nurse role is primarily technical in nature and many an RN cannot do it well. However, the circulating role relies on an overall knowledge base that I would challenge a CST curriculum with showing proof of as a requirement. Any credentialing (ie., JCAHO) surveys I've gone through have always included the specific question regarding whether or not CSTs or RNs are circulators. While CSTs can circulate a room, they still MUST be under the direction of an RN and this RN should be readily able to respond to emergency. Someone tell me how that can be safely done if one RN is supervising several rooms and more than one room has an emergency. As for me or my family, give me an RN anyday. And while we are at it, I also want a second physician to serve as the assistant in surgery and not someone who has attended a two week first assist course somewhere and now has delusions of granduer that they are capable of troubleshooting and consulting during surgical cases. MEOW... I'm on a role...
I did not mean that CST's go to a two week course and become consultants in a surgical procedure!! I do believe that they are capable of serving in the role of first assisant if properly trained. In smaller hospitals many already do out of necessity. In bigger places where there are surgeons who can assist eachother and schedule themselves to do so I say that is the best thing for the patient. I don't think that troubleshooting, or consulting should be up to a CST first assist or a Registered nurse first assist! That is a medical decision and a consult should only be from another surgeon in that field!! Ultimately the surgeon runs the room and is in control of the surgical procedure. The RN being there is crucial for advocacy and for assessment skills, and supervising the CST.
As I have said previously I don't think a CST should circulate, I am with you on that one!
InCanada, where I practice, you must be an RN to circulate in an OR. If an RPN tech. has an RN in the room (who is not scrubbed in), she may then do circulating duties with direct supervision. We only have 2 techs in my workplace. They may not relieve an RN who is circulating at anytime, under any circumstances.
Can the Pre op nurse do the assessment of the patient? Sounds to me this is more and more of nurses trying to hold on to there jobs in the OR.
I am not slamming techs. I was one for 5 years, and graduated from a 2 year tech college. But my training was procedure centered not patient centered. We didn't learn lab values, EKG's, F&E balance etc etc. What it comes down to is the circulator is the patient's advocate and you cannot do that job properly if you don't assess your patient completely beforehand.
So what you are saying is only a nurse can check lab values, consents, orders ect. This is a way for nurses to justify there numbers in the OR. I dont want to slam nurses either but come on. Im not saying nurses shouldnt be in the OR. What would a tech do for a conscience sedation case, or a code? Nurses are needed in the OR just not in large numbers. By the way if the Tech school you went to didnt teach basic ekg or labs then shame on that school and the student.
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