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Is scrub role still a thing?

Posted

Hey guys,

So I'm a ways away from being an OR nurse, but different things I've read here on AN have led me to ask: How common is it for an OR to train a newbie for the scrub role? I've read about nurses not really getting to scrub since there are PAs/residents/former surg techs/NPs with surgical exp/etc who would more likely supercede a new employee. So I'm wondering, would a new OR nurse get scrub training after some time (like a year or so)? Or would one have to proactively ask for that experience? Or am I completely wrong and it actually is common for newbies to get scrub training?

I only ask because it seems like I keep reading about newbies that only get trained as circulators or something like that? Can anybody speak to this?

Thanks!!!

Sorry, I don't have an answer, but what's the difference between a scrub nurse and a circulator?

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

Sorry, I don't have an answer, but what's the difference between a scrub nurse and a circulator?

The person who is scrubbed is responsible for the sterile field, handing instruments to the surgeon, and any other duties within the sterile field. The circulator is not part of the sterile field. They are responsible for positioning, prepping, and documentation, along with any other non-sterile duties. Many states have laws requiring the circulator to be an RN. CMS requires an RN to be immediately available to the surgical patient for reimbursement by Medicare.

Whether nurses are trained to scrub is very dependent upon the facility, its staffing structure, and a few other variables. One such variable is the surgical technologist (ST). The people who obtain this degree come out of school (supposed to anyway) knowing how to set up and maintain a sterile field, how to handle instruments, what various instruments are used for, etc. Theoretically, the orientation they would require should be mostly surgeon specifics and briefer than a nurse who comes out of school needing to learn the vast majority of that information. They are also much cheaper to hire than RNs- at my facility, they max out at the pay rate a nurse starts at.

So, as an example, my facility relies heavily on an ST presence in the scrub role. New nurses have a week of scrub experience during orientation, and it is primarily in an observation role. However, some of our nurses who were previously STs will fill in the scrub role in the event of call offs/vacations/etc. Our cardiac specialty team nurses are taught to fill the role of the second assistant (a scrubbed role where the person may hold retractors and other duties as permitted by the surgeon, facility policy, and scope of practice). However, we do use many PAs or NPs as a first assistant; we also have a few CFAs (STs with additional training who may first assist) and RNFAs (RNs with additional training who may first assist).

When I oriented to the OR I only got two weeks of scrub training... I could get through a smaller case but definitely couldn't do a big complex case. I didn't like scrubbing at first but now I wish I had more training so I could. I would request to be trained to competently scrub (it ultimately benefits them to have you trained because if they are short scrub tech you could be used) They will usually agree to it!

Thanks for the answers, Rose_Queen and edel254. So I'm wondering now:

Let's say you want to be an RNFA one day...how would you get the scrub experience required for RNFA training if most places use STs? Because don't you have to have scrub exp. for RNFA training or do you just have to be CNOR certified? Thanks.

Rose_Queen, BSN, MSN, RN

Specializes in OR, education. Has 16 years experience.

Here's a great resource for those seeking additional information about RNFA: First Assisting (RNFA) : Association of periOperative Registered Nurses

And the website of the organization for CRNFA: Credentialing programs and professional development opportunities for OR nurses

As for how to get the scrub experience, that may require a lot of footwork on your end. Some facilities will work with RNFA students to get them that scrub experience- my facility recently began using first assistants, and those who were interested applied (had to already be employed by the facility). The facility then worked with them to provide the experience they needed, to the extent that they were actually removed from the schedule rotation as a circulator or scrub and solely worked on required experience- and the hospital paid for the program. Granted, they were required to sign a contract agreeing to work for the hospital for 3 years following completion of the program, but that seems like a fair deal to me.

I don't have much experience with RNFA's. They aren't used much in New England that I am aware of. Sorry I can't help more with that!

Thanks for the help, y'all!!

RobtheORNurse

Specializes in Surgery. Has 30+ years experience.

The hospital where I worked required all nurses to be able to scrub all cases as well as circulate. We had a high percentage of RN's vs Techs. Probably 60% RN to 40% CST.

Yes scrub role is very important because only qualified Perioperative Nurse can scrub and performed that task effectively. Patient should always be availed with a qualified staff in the hospital setup especially in OR

Where I work, the RN fellowship covers a little of scrubbing and a few nurses will get to scrub a little until they are part of full-time staff. The tech-to-nurse ratio, though, makes it so that it's really hard for nurses to scrub unless they have a lot of experience in certain specialties and they need the staffing, e.g. ortho, big joint cases, etc. This is apparently a pretty new thing that developed only a few years ago here when it was almost all nurses. There's also a relatively new policy where ADN/diploma RNs aren't allowed to circulate and are only hired as scrub nurses. I'm one of those, so all I do is scrub. half our staff are two-year degree nurses, but they were grandfathered in because they'd been circulating all this time. It's frustrating not being allowed to practice as a full nurse in the OR, grouped in with the techs (who are awesome, but that's not what I went to school for and took boards for), and being paid less than the BSN nurses that were in my same fellowship cohort, but there are also a lot of nurses here who are jealous of my getting to scrub all the time. From what I hear from travelers who come through here, though, this is an extremely rare and strange circumstance.