Dealing with SA's and PA's in the OR

[RNsurgerygrl]

Hello I would like to obtain the opinion of other circulating RNs regarding surgical assistants and PA's authority in relation to patient care. They seem to be under the impression that they are in charge of the room due to the fact their job description states they are in charge of positioning and so on of the patient under the direction of the surgeon. How many surgeons do you know who enter the room until the patient is draped?

This is causing a HUGE debate among our staff.

My point is that they are NOT licensed. They are working under my license and the MD's license.

Please give me your thoughts.

Thanks,

Lori

[jwk]

Hello I would like to obtain the opinion of other circulating RNs regarding surgical assistants and PA's authority in relation to patient care. They seem to be under the impression that they are in charge of the room due to the fact their job description states they are in charge of positioning and so on of the patient under the direction of the surgeon. How many surgeons do you know who enter the room until the patient is draped?

This is causing a HUGE debate among our staff.

My point is that they are NOT licensed. They are working under my license and the MD's license.

Please give me your thoughts.

Thanks,

Lori

There's a couple of different issues here.

Most SA's, at least the ones that I'm familiar with, are surgical technologists with a little additional training (formal or otherwise). Some are certified, some aren't. Some of them have a very grand opinion of themselves. One at our hospital wanted to make the initial incision while the surgeon was still scrubbing - that was shortly before he lost his privileges. It is not unusual for us to have some over-zealous SA's who believe their TECHNICAL training somehow makes them a superior provider. We try and be polite if possible, but in a disagreement between my group (anesthesia) and them, we ALWAYS win. No license, no malpractice liability? Sorry, you ain't the boss!

PA's are licensed in most states. I won't get into the RN/PA debate here. Assuming they work for a particular surgeon, their boss may want them to perform certain tasks getting the patient positioned, etc. In some states they have prescriptive authority, but that varies. Prescriptive authority and "giving orders" in the OR are entirely different animals in my book. However, they're not YOUR boss, and you have your own set of responsibilities. In our hospital, the PA's are very professional and it would be a rare thing to have a problem with them.

If there's a clash, remind them that we're all here for the benefit of the patient. Hopefully your hospital policies outline how different professional groups relate to each other - MD to RN, RN to CST, etc.