L/D RN learning to scrub for c/sec

I am a PeriOperative nurse. While I freely admit that routine c/sects are done in the birthing unit we do the occasional c in the main OR. For high risk mothers. Cardiomyopathy, full blown eclampsia, etc. (Anesthesia wants them near the equipment and materials that we have right at hand). Our L&D dept empoys two full time surgical technologists that have graduated approved programs. They are familiar with aseptic technique and the instruments. But all they do are c's. No way could they come to main OR and do a different case. Our overnight techs cover for emergency c's. They have a couple RNs trained to scrub.

It is my belief that running an OR (c-sect or otherwise) takes a trained PeriOperative nurse. It is furthermore my belief that a scrubbing RN needs to be properly trained in aseptic technique for scrubbing, gowning, and gloving not only themselves but the rest of the operative team. Good knowledge of the instruments and how to handle is also a necessity. And how to maintain a sterile field.

A section is different from other surgeries. The speed is much quicker. The health the the unborn child is of utmost importance and generally cut to deliver time is only a few minutes. 10 at most. One must be able to hold up under that pressure and be able to handle unplanned things such as hemorrhage.

That being said, our dept tends to train each other. I guess that works. In the 18 years I've been at my institution there's been no complications. But one doesn't learn to scrub in a day. Rome wasn't built in a day!! So it is said.

Hi

Thankyou so much. I have a lot to think about

I've been in c-sections in the main OR and on the L&D unit, and I have to say I really appreciate the order and organization of the c-sections managed by the OR staff.

Do you have recommendations for peri-op training for OB nurses? The L&D nurses train each other to circulate and scrub in the OR, and in my opinion, the level of meticulousness is just not quite up to where I would like to be. I'm trying not to be overly critical of my OB RN coworkers - I just want to say I've been in the presence of circulating excellence among OR nurses - and would really like to learn how to be the best I can be.

Thanks!

On my unit all of our nurses are trained in both scrubbing and circulating. We ave two RN's who work on our floor with previous OR experience and they do the training. They created a book with all the standards, policies and information on scrubbing, surgical instruments potential complications and how to manage them ect. Usually we train new nurses after they have been on the floor for about a year. Each new nurse will do a 8 hour day with the RN's who do the training just to learn where all the equipment is and to practice gowning and gloving ourselves and others. Then we do two weeks in the OR one week where the new nurse will scrub for every scheduled c-section all week (we do 3-4 a day). and the next week the training nurse will circulate for 1 or 2 sections a day.

This works really well for us and all of our nurses feel pretty comfortable even for STAT stuff. We try really hard to make sure our standards are the same as those of the main OR. Hope this helps :)

Don't personally know of any but some hospitals, especially in large markets, offer a PeriOperative training course. Some charge. Come provide entry level pay. None guarantee that you will find a job in an OR arena. But those that perform the best many times are offered jobs at the place that does that training. Other ORs would be salavating to hire a nurse that's already been through periop training. I've seen threads about it in the operating room nurse specialty section. I'm

Trying to introduce a program like that here in my town, in my hospital. But I'm not sure how well it will take off. Expensive to start up and to run.

Hi

Thanks for your posts. My concern is if there are not enough shed. sections maybe 4-5 week and a scrub tech does those, it frustrating. If I do some on the job training, peri op training, ect how do the the nurses STAY competent

is there a reason in specific that they want rn's to knwo how to scrub? wouldn't it be easier to have OB Scrub Techs instead? we do get paid less but once I graduate I would love to scrub sections at my RN pay rate!

Our FBC (LDRP) , nurses are assigned to either learn PACU or scrubs. It works out fine because if an Rn is the scrub for our shift, the scrub Rn only takes mother baby couplets for patient care and if she needs to go scrub, the rest of the rns will listen out for her patients or the free nurse will take over scrub nurse's patients until she gets back.

when I first was taught to scrub, I had to go to the OR to learn. I thinkOR technique is best taught in the OR. Since sections are done in L&D, the basic technique is done on routine abdominal cases, especially hysterectomies (remember any section could turn into an emergency hysterectomy). After a couple weeks in the main OR, we started going to L&D to scrub the sections done there. Where I now work, our techs scrub. It's cheaper to pay a tech than an RN to scrub. The RNs who circulate are trained just in L&D and don't go to the OR, although the OR does present occasional inservices on problems that have been identified or on new policies that affect us.

I circulate and scrub for sections. At my hospital new hires spend the first 2 weeks back in the OR scrubbing in with a scrub tech. After those first 2 weeks we only scrub PRN so I have gone 1-2 months without scrubbing a case. I would say I'm compitant but I'm not able to anticipate like the scrub techs do. I would tell your supervisor that you want to scrub/observe 6-8 sections with a scrub tech before you come off orientation. You can also ask to have access to an instrument tray..that way you can learn the instruments and practice clamping and unclamping them. Good luck!!

Both labor and delivery units I've worked on the rns scrubbed all sections. Honestly i wad very nervous to learn but I actually feel in love with it. I love the scrubbing and i love theor.

Our unit has the CNA/LNA scrub (they are called OB Techs) and the RN as circulator and PACU (we recover on the unit). Our OB techs have 5 weeks of training in the OR by CSTs. Our RNs complete the AORN Periop 101 course for OB and are trained for 7 weeks by the OR as well. We have to circulate at least 1 case per month to maintain competency. This is in the LNA scope of practice in our state (NH). It has worked well and honestly has been wonderful for the patients. We do skin to skin in the OR immediately after birth. If the case changes to a hysterectomy we call in the OR team but have been trained to get that going. While the perioperative nurses are experts in the OR. We are the experts in OB. We forced RNs to take the training and that did not work well. We lost some great nurses because of it. Circulating is not for everyone. We will eventually cross train some RNs to scrub as well but only those who wish to. As one of the RNs that was forced, I am frustrated that the new RNs do not have to go through the training as it would help share the burden i.e. call and changing schedules is a challenge as there are limited circulators and scrubs. We can't train everyone as it would be difficult to maintain competency.