Poll and Discussion regarding RNs in the OR. (for research paper ) - page 2
I am currently in Eng 102 doing research for my paper. The subject I have chosen has some personal interest for me, and others on this board. The issue is regarding RNs as circulators in the... Read More
Oct 1, '02Occupation: Diabetes educator, Telephone triage Specialty: 31 year(s) of experience in Everything but psych! ; Joined: Jul '02; Posts: 1,265; Likes: 26I worked in the OR for 3 years, and loved it. I was trained to circulate, but not to scrub (they needed more circulators at the time, and never "got around" to scrubbing.) As I circulator, I used my nursing knowledge to look at everything in the room, including preparing the patient, answering their questions, watching the positioning, and leg placement, helped start IVs, sometimes helped bag pts, sign out narcotics for the anesthetist, and overall watched to make sure the patient was safe and sterile technique was maintained. While some of the tasks a UAP could do, some of the others would be impossible (or illegal) for a UAP to do. I would prefer, and ask, that an RN be the circulator. It's amazing how much they can do in an emergency. What if there's a code? Could the UAP help like an RN could? What if the pt. needed another IV started. How about foleys? I did many of those as well. Again, I would not feel safe supervising 2 rooms of UAPs. I'd rather be responsible for what I am seeing and doing.
Oct 3, '02Occupation: RN/PICU/Charge Nurse Joined: Apr '01; Posts: 9; Likes: 2I was a circulator for 2 years. We had CORT's to scrub. I often felt like a 'handmaiden'. We also covered in PACU in the afternoons and I felt I was using more nursing skills there. What I hated the VERY MOST: Holding retractors! I am not familiar with the term "UAP", but I'm guess it's like a 'certified technician' (CT) that was talked about years ago to augment ICU nursing. This actually supports one MD's opinion that a 'monkey could be trained to do what nurses do'. Only when we act professionally and manifest critical thinking, do we show what nurses are meant to do. I voted 'don't know enough', but I also think UAP's could function in less complex surgeries....with supervision. Really complicated cases need the mulitidimensional observations of an RN. My opinion....Jodie
Oct 3, '02Joined: Jul '01; Posts: 990; Likes: 13UAP means 'Unlicensed Assistive Personnel'. There is no certification earned in their training. In my research, the only documented training I could locate was a month long. It consisted of 1 week of classroom time and 3 weeks of clinical time with a preceptor. Of course, this training was for UAP's that were not left alone in the OR to circulate on their own. But that is all I could find. There is no standard out there, that I could find, by which to train the UAP to circulate in the OR. It is left up to the individual hospitals to develop their own training program.
AnneLast edit by KC CHICK on Oct 3, '02
Oct 3, '02Occupation: CRNA Joined: Mar '02; Posts: 2,000; Likes: 66I voted that patient safety was not at risk provided one RN supervises a limited number (2?, 3?, 5?) rooms where UAP's are circulating. As a CRNA, I say this for a number of reasons:
1. For most general surgery, the role of the circulator is primarily a technical role. Counting sponges, needles, and sharps, handing instruments into the field, taking items no longer needed from the field, packing and sending specimens, etc, do not require the specific knowledge of an RN.
2. Many of the things circulators claim require the knowledge of an RN may not be their responsibility. Positioning, for example. Ultimately (as I have been taught) everything that happens to the patient in the OR outside of the surgical field is the responsiblity of the anesthesia provider. If a patient ends up with a nerve injury as a result of positioning, who gets sued? Not the circulator, but the CRNA or MDA. (Not belittling circulators, but lawsuits filed against parties not responsible for an injury are usually dismissed.)
3. Handing off drugs: See above. Additionally, most circulators I know who have been circulators for a number of years will, in moments of absolute honesty and clarity, admit their knowledge of drugs is extremely limited. They rely on the surgeon and anesthesia to provide that knowledge.
All the debate may be moot, at any rate. I have seen hospitals decrease the number of open OR's because of a shortage of RN's and tech's to run those OR's. If the nursing shortage continues to worsen at present rates, five years from now, having one RN supervise UAP's circulating five rooms may be seen as a luxury.
Kevin McHugh, CRNA
Oct 3, '02Joined: Jul '01; Posts: 990; Likes: 13Kevin, thanks for your reply.
I have, until this point kept my personal opinion to myself. You raise some very good points.
I agree that anesthesia must bear the majority of responsibility for the patient, along with the Doc. However, when I circulated, there were times that I was alone with the patient in the room....CRNA had not gotten to the room yet-or had to go back to the anesthesia workroom to grab something else, doc had not been called in, and the surgical tech was out at the sink scrubbing in. This time period could last anywhere from 5 to 15 minutes. (15 minutes was rare....but did happen on occasion.)
Who would be responsible for the patient then? The RN that is alone in the room with the patient.
If this were, perhaps, a pacemaker/defib implant patient for example....the patient could have problems at any moment that could require the assistance of an RN when no one else is in the room. What would a UAP do in that case...if the supervising RN were not able to immediately respond in an emergency?
You mentioned that positioning was the ultimate responsibility of the CRNA. Yet, there were times that I positioned the pt. on my own without the input of the CRNA present. In regards to mixing drugs. No, we didn't use many and I felt that was indeed a weak area of mine. However, it is still important to mix them correctly regardless of the number of drugs used.
I agree, there are alot of things a circulator does that do not require a nursing license. I felt that same way at times.
In my opinion, it's the unexpected situations that arise that require the presense of an RN. Which one, RN or UAP, would you want help from if you needed it in your practice?
AnneLast edit by KC CHICK on Oct 3, '02
Oct 4, '02Occupation: Staff Development Coordinator - OR Joined: Jun '02; Posts: 577; Likes: 11Kevin, yes the anesthesia provider plays a crucial role in patient positioning. BUT in my experience anesthesia is responsible for the patient's head and arms. What about the heels, the genitals for prone patients, the dependent knee and ankle for lateral cases??? In my experience this is the circulator's responsibility, not anesthesia. (Where I work the surgeons DO NOT assist with postioning--they are not what you would call team players, for the most part).
Just one woman's opinion....
And another thing--if someone that you care about were having, say, a retina procedure done--who do you want to be handling the eye drugs--a licensed nurse or a UAP?
Oct 4, '02Occupation: CRNA Joined: Mar '02; Posts: 2,000; Likes: 66Just a quick note on positioning. Yes, the RN or whoever in the room often positions parts of the body, prior to the patient being asleep. But, responsibility to ensure that positioning is correct falls to whoever is doing the anesthetic. Remember, s/he who gets sued is responsible.
More later, but am putting in a new kitchen floor with my father in law. We're having a ball.
Oct 4, '02Occupation: Staff Development Coordinator - OR Joined: Jun '02; Posts: 577; Likes: 11I hate to argue with the "argumentative member"--BUT-for shoulder scopes and other lateral cases, spines and other prone cases, etc, etc--the circulator is responsible (with the help of anesthesia and nursing assistants) for positioning AFTER the patient is asleep--at least where I work.
Oct 5, '02Joined: May '00; Posts: 2,065; Likes: 8positioning is anaesthesia PLUS the surgeon doing the operation, she/ he has to make sure patient is on the table the way it schould be.
This is a federal law here, so you can bet your license the great-gods- of-cutting, check it.
Take care, Renee
Oct 5, '02Joined: Jul '01; Posts: 990; Likes: 13Who, then, is responsible when the CRNA is not there for a local only procedure? At my hospital, if only local is used, there is no anesthesia person present....only 2 RNs (one to circulate and one to local monitor), surgical tech, and surgeon.
**Good Luck on those floors. Yuck! What a way to spend a weekend.***
Oct 5, '02Joined: Jul '01; Posts: 990; Likes: 13Semstr....Who in that room is the BEST at laying blame on someone else?
Oh, that's right, you already gave me the correct answer. Duh! The surgeon.
Oct 5, '02Occupation: Psychiatric Research Joined: Aug '02; Posts: 1,467; Likes: 6I would LOVE to give you my opinion. But I've never worked OR, have seen maybe a total of 4 surgeries during nursing rotations, and I just don't know enough.
My gut feeling is with supervision by an RN, a tech would probably work. But then the RN has to do her job AND watch the tech. Plus if the surgeon is uncomfortable with it, he will be watching the Tech AND the RN....
PS I love your Indian legend.