Is there a law or rule that states nurses are not allowed to scrub/assist?

Editorial Team / Admin · Feb 21, 2003

KSS, in our facility who does the scrubbing is directly related to who is administering the sedation. Our conscious sedation policy is VERY clear that the RN giving sedation must not have any other duties besides giving the sedation and monitoring the patient. period. Apparently this is based on ASA recommendations. I've worked in three different cath/angio labs over the past 25 years, and yes we did scrub AND administer IV sedation AND monitor the pt for the LONGEST time (even when we knew it wasn't supported in policy; "they" didn't get around to rearranging /hiring new staff to effect the necessary change for a long time). Considering my background, it's not surprising that I personally think it rounds one out to have that hands-on experience; think it gives you a better "feel" for what's happening, what's needed next, etc. 'Course, you may have that anyway, based on observation, training, experience and intuition (even without the hands-on). We recently trained the cath techs (both are resp. therapists) to scrub in. Now the RN monitors/sedates the pt, the cath tech scrubs in and the rad. tech handles the Cathcor. Every now and then one of us needs to scrub while another RN monitors, if for some weird reason the two cath techs are unavailable. Only the "older" ("grandfathered," if you will) RNs scrub in with the Cardiologists. Two new RNs in training, unfortunately, will not get that hands-on training.

Radiology is a different story (we staff the Cath Lab and all aspects of Radiology too); the Rads are willing for the nurses to assist (as long as another RN handles sedation), and we're trying to allow the newbies to scrub in as much as possible, for that experience.

Check your conscious sedation policy; that, rather than territorialism, may account for the "hands off" practice. And even if it isn't, the techs may feel threatened by this change (some people are more resistant to change than others). You may need to reassure them (using the sedation policy ) that this is not based on a desire for a takeover.

CCL"Babe", BSN, RN · Feb 21, 2003

In my lab the RNs do scrub in. Our CVTs used to give meds. They are not allowed anymore. Only RNs can give meds. This has severely cut back on the amount of scrubbing that we can do. We usually rotate through circulating, monitoring and scrubbing. Unfortunately if there are not enough nurses available to give meds, we can't scrub. Personally I'd rather scrub than do anything else, and most of us feel that way. We have two other labs in our system. RNs will occasioanally scrub in one, but feel that it is a "tech" job, the other has fellows that scrub. Try and go for the experience if you can. Good Luck!

KSSRN · Feb 22, 2003

Thank you both for your responses to my question. I'm fairly new to the cath lab and it has been interesting reading all the topics addressed in this web site.

I don't want to give the wrong impression here. Our lab is a very close group, RN's and RT's. We rarely discuss this topic. Its just that I still get a feeling that the RN's are being told that we cannot scrub because the RT's cannot give meds. Yes, our IVCS policy is also very clear that only RN's can sedate, which I feel is very appropriate. And "most" of the time we are not able to scrub because we are monitoring the patient. I just feel that it would be beneficial to me and the other RN's to learn to scrub, as one of you stated, to get a better feel for what is happening. Yes we observe and know what is going on, but all the RN's would like to have a little "hands on" experience. Again, thanks for your responses.

NurseGirlKaren · Feb 22, 2003

Ours is the same as CCLBabe said. RN's CAN scrub in our lab; it's just a matter of how many people there are. Only RN's can give meds. Also, we must have an RT present if x-ray equipment is in use. So, it usually just works out that the RT scrubs and the RN circulates, not that we can't scrub.

smittybike · Sep 29, 2003

KSSRN,

It may depend on your state, but in Oregon, there is no law preventing that. It is driven by the facilty. I worked in one where nurses scrubed, in fact all the staff did and I worked in on cath lab, that only the RT's scrub.

RTR-RN · Sep 21, 2004

I have worked as an RN in an Interventional Cath Lab for almost 2 years now. We have 3 rooms and each room is staffed with 2 RT's and 1 RN or 2 RN's and 1 RT. Either way the RT is the only one who is allowed to scrub in to assist the physician. Recently I approached our manager (who is also an RT) and asked her if the RN's could learn to scrub and assist. I was told that we could not. We would have to have been grandfathered in? Does anyone know what that means?
Several years ago the cath lab was staffed by RT's only. They gave meds, including IVCS. The first RN staffed in the lab met horrible resistance. During the last few years our cath lab has hired more RN's, we are up to 6 now. Up until the last 2 years the cath lab was a horrible place for an RN to work. I attribute the change to the attitude of the current nurses. We have an average of 10 years of critical care experience and are comfortable with who we are and what we know. We don't feel the need to strong arm our way into the lab. The RT's have realized that we are an asset to the lab and not a threat. Plus most of them are young and have never worked in a lab that did not have RN's. Yet we still have a few that are opposed to our learning to scrub. We are not wanting to replace them, we just want to learn how.
Is there a law or rule that states nurses are not allowed to scrub/assist?

I'm an RT and when i was in school we learned that scrubbing was part of our jobs in the cath lab and also in interventional . in every hospital i've worked in the RTs scrubbed. The hospital i do PRN in is a teaching hospital so the residents scrub and the RT and RN both monitor the pt. The RT has other duties too. I don't see why an RN would not be able to scurb in. I don't know the laws in NY. i do know you need an RT in the room for the fluoro equipment and an RT can't give meds. RNs scrub in the OR so I don't see the difference.

Kristy K · Sep 27, 2004

It is very interesting to hear these similar concerns in other places. We actually have the opposite concern here. We have had to pressure the nurses to allow techs to scrub. How we came to the point were RN's, and only RN's, scrub I'm not certain. I am a new Radiology nurse supervisor and have my work cut out for me getting techs back in the room and not just behind the controle panel.

jer_sd · Oct 6, 2004

well in most states that regulate rad techs their scope of practice does not include scrubbing or manipulating tissue. so they are essentially considered unlicensed personnel when scrubbing and under the same regulations as surgical technologists if they are present. which means in many states the rn is held accountable for their actions....here is california's opinion http://www.rn.ca.gov/practice/pdf/npr-b-14.pdf make me wonder about risk management issues....

but scrubbing is an accepted nursing practice in all states... and radiology experience does count to cnor certification. personally i like to scrub on endovascular cases but who ever does it just needs to be adequately trained...

jeremy

RTR-RN · Oct 19, 2004

well in most states that regulate rad techs their scope of practice does not include scrubbing or manipulating tissue. so they are essentially considered unlicensed personnel when scrubbing and under the same regulations as surgical technologists if they are present. which means in many states the rn is held accountable for their actions....here is california's opinion http://www.rn.ca.gov/practice/pdf/npr-b-14.pdf make me wonder about risk management issues....
but scrubbing is an accepted nursing practice in all states... and radiology experience does count to cnor certification. personally i like to scrub on endovascular cases but who ever does it just needs to be adequately trained...
jeremy

radiologic technologists are regulated in every state and are liscensed. they are not considered surgical techologists by all means. a radiologic technologist goes to school just like all other health care professions. you can't be a radiologic technologist without being liscensed. i currently work at 3 different hospitals in upstate ny and all of the interventional techs scrub in.

we are taught this in school. no nurses scrub. the tech needs to scrub in because the assist the radiologist in using the c-arm and other fluoroscopy equipment. an rn can not do this. an rn has no training in radiation protection through school. i know this because i am working on my bsn. rad techs do not manipulate tissue, they assist the radiologist. rts help guide wires in and operate the sterile tray, along with taking all the pictures that are taken throught the procedure. i have never heard of an rn being accoutable for any actions done by a rad tech, how can they be? an rn and an rt are two very distinct jobs and you can't hold resposiblity over each other.

jer_sd · Oct 19, 2004

rad techs are not licensed in every state, one of the reasons the care bill is a good idea. if you look at the actual legislation i am not aware of any state (but i have not look up all of them) that allows radiological technologists to perform sterile invasive procedures. just a quick list of states that do not regulate rad techs wisconsin, south dakota, nevada, alabama, alaska, colorado..... there are more than this but just an idea.

they are trained to function in a sterile environment, and do it quite well. but if they are performing duties which are not regulated by the state such as deploying a closer device ect.. they are functioning as unlicensed personnel in that function...

prepping/draping, maintaining sterile field, applying hemostatic medications/devices, closure devices ect.. i believe that rad techs should be able to do these functions if trained just as nurses need to be trained. unfortunately the licensing laws of sates that do regulate rad techs are very narrow and do not include many of these functions. hence when performing them they are legally considered unlicensed since the state does not license them to perform that function.

for example in california a radiological technologist may not hold a retractor used in placing a port or deploy a closure device that sutures the vessel since both of these actions are classified as manipulating tissue. (even though the fda clears that device to be deployed by technologists and nurses) but idaho radiological technologists are not licensed but it is a medical delegatory state and those functions may be preformed.

depending on the i agree that nurses should not apply ionizing radiation with out additional training; in some states it is possible such as texas, and washington. but that is a different discussion.

the bottom line is that the aorn and other professional bodies consider the ir suite a surgical area, hence when scrub functions are preformed by personnel who are not regulated by that state to perform those functions they are considered unlicensed in that aspect and the rn and physician are both responsible for the actions of the scrub.... now if the state laws include those dependant functions in the scope of practice for the radiological technologist then they are not considered unlicensed personnel.

i agree they are very different jobs but there should be a large deal of job sharing responisbility in a good department.