Can a surg. tech. "circulate" a case -give medications?

Uro-DaVinci · Dec 23, 2007

This is an interesting thread and the number of replies shows that it is a sensitive subject to both Tech and RNs. As I am sure it has been said somewhere before, there are legal issues here. In the state in which I practice it is illegal for a non-licnesed person, even if they are duly certified, to give medications. The Techs (God bless them!) in our facility cannot even mix medications that have been dispensed to their field by the RN (example: surgeon want 1% Lidocaine equally mixed with 0.5% Bupivacaine). There are legally defined responsibilities assigned to the RN and the RN is accountable and can lose a license with regard to those responsibilities - it has nothing to do with capability or ability - it has everything to do with assuming responsiblity. I want to scrub some day - so I need the training or go back to school to get it.

ewattsjt · Dec 29, 2007

Regardless of the sensitivity that occurs between most RNs and ORT/ST/CST etc…You must go by fact. The facts vary depending on where you are.

Once again you can not just go by facility policy or personal feelings to say it is that way everywhere. While the majority of facilities may have policies restricting the role of circulating, some may not. It is because of laws and a “nursing shortage”. Just to show how much the laws vary from state to state, here is an example of circulating laws (copied from the AORN link provided previously).

In Indiana the law for a hospital is:

410 IAC 15-1.6-8 Surgical services

Sec. 8. (a) If the hospital provides inpatient or ambulatory surgical services, the services shall meet the needs of the patients served, within the scope of the service offered, and in accordance with acceptable standards of practice and safety.

(2) An experienced registered nurse shall supervise all nursing personnel in surgical services and postanesthesia care units (PACU), as follows:

(B) Circulating duties in the operating room shall be performed by a qualified registered nurse.

Licensed practical nurses and surgical technologists may assist in circulating duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies, in accordance with applicable state law and approved written medical staff policies and procedures.

For a surgery center/ambulatory center it is:

Sec. 5. (a) All patient care services must meet the needs of the patient, within the scope of the service offered, in accordance with acceptable standards of practice. Patient care services must be under the direction of a qualified person or persons. Patient care services must require the following:

(B) Circulating duties in the operating room shall be performed by a qualified registered nurse. Licensed practical nurses and surgical technologists may assist in circulating duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies, in accordance with applicable state law and approved medical staff policies and procedures.

In Missouri the law for a hospital is:

30-20.021 Organization and Management for Hospitals

(3) Required Patient Care Services. Each hospital shall provide the following: central services, dietary services, emergency services, medical records, nursing services, pathology and medical laboratory services, pharmaceutical services, radiology services, social work services and an inpatient care unit.

(L) Surgical Services

4. A qualified registered professional nurse shall be assigned circulating duties for surgical procedures performed.

For a surgery center/ambulatory center it is:

30-30.020 Administration Standards for Ambulatory Surgical Centers

© Nursing Services.

5. At least one (1) professional RN other than the individual administering anesthesia shall be available in each operating room during surgical procedures.

For Kansas it is:

None.

A recap is that Indiana requires a circulator to be an RN in any surgical procedure while techs and LPNs can “second circulate”; Missouri requires an RN to circulate in a hospital but in a surgery center only has to be in the room (CRNA excluded) and Kansas has no laws governing the role of circulating.

To further bolster my point, many here keep referring to being licensed is what makes the difference. In my area a Licensed Practical Nurses (LPN/LVN) can only function in the capacity of second circulating and can only have meds delegated to them like the CST. In fact, the job description is the same except CST and LPN are changed and LPNs can access the Pyxis for meds.

Showing more differences between facilities on a local level…as I said before, my facility only allows RNs and LPNs to access the Pyxis. Some other facilities around my facility allow the CST to access the Pyxis for limited supplies; mainly schedule IV and V (gelfoam, thrombin, antibiotics, locals and topicals). The other meds still have to be retrieved by an RN. Regardless, anything obtained still has to be confirmed by the RN circulating before being dispensed.

My point is to check out state law, facility policies etc…for your area before jumping to a conclusion. Advice on topics like this can be as much difference as night and day.

TwinsMom2008 · Aug 20, 2011

These are really old posts because if everyone blogging would go to the Association of Surgical Technologists website, they would see that surg techs are allowed to circulate based on the decision of their place of employment. Accredited schools of surg tech programs train students how to circulate. It is soo crazy how nurses put Surg Techs down because of education and scope of practice when in reality, Surg Techs may have an Associate Degree just like an RN. Myself as well as other Surg Techs I know have Bachelor's degrees in other areas....does that make us superior to you all? Some people are in healthcare for what... we are suppose to be focused on the health of our patients!

jeckrn, BSN, RN · Aug 23, 2011

These are really old posts because if everyone blogging would go to the Association of Surgical Technologists website, they would see that surg techs are allowed to circulate based on the decision of their place of employment. Accredited schools of surg tech programs train students how to circulate. It is soo crazy how nurses put Surg Techs down because of education and scope of practice when in reality, Surg Techs may have an Associate Degree just like an RN. Myself as well as other Surg Techs I know have Bachelor's degrees in other areas....does that make us superior to you all? Some people are in healthcare for what... we are suppose to be focused on the health of our patients!

This is not true if you read the post before this one it shows the laws from several states. Recently in Pennsylvia they passed a law that only RN's can circulate. Just because the Surgical Tech website states they can circulate they do not speak for the state's board of nursing. Since medications are being used and documented that would leave out the techs for the most part. I realize that unlicense personal can give medications in some circumstations and do not think the OR would be one of them.

If a RN puts down a tech they are wrong and remember how they feel when the physican puts them down. Everyone is a member of the team and needs to be treated with respect.

GadgetRN71, ASN, RN · Aug 27, 2011

In my state, surgical techs cannot circulate.

jacosta003 · Oct 8, 2011

This is for Carcha.

Carcha, the bottom line is this. You cannot do your job without a CST and We (CST) cannot do our job without you (Rn). There are lots of policies and procedures in place to prevent anyone from being sued in a lawsuit. An RN is covered as CST's are under hospital insurances for mistakes that happen. The only way an RN can become liable in a lawsuit is only if the RN does something intentional to harm a patient. And because you are better than a CST that wont happen. Example, missing sponge; if we've (CST and RN), counted incorrect sponges but come to the conclusion it is not in the patient, via xray etc, you will not be sued nor liable. There is this overwhelming divide within CST's and RN's. In order to provide excellent patient care, whether it be a CST, and/or RN, teamwork is always the best way. Everyone is specialized in the OR. Yes CST do circulate, I've done it! Can we mix meds, Absolutely not. CAn an RN mix meds, absolutely not. They come from the pharmacy already mixed by a specialist (e.g Pharmacist). Eveyones education reflects there duties. I suggest knowing what your's are and following hospital policy. Another bottom line, We(CST) provide a specific patient care, is it less than the RN patient care, absolutely not. We are trained and educated as well as RN, who also provide patient specific care. Unless your like Carcha who provides every care under the sun. CST also communicate with managers, representatives, surgeons, other RN and patient care technicians just like the RN. Thanks everyone!

luv2scrub · Oct 9, 2011

At the hospital where I currently practice we sometimes have 2-RNs and 1-Surg. Tech in a room (on good days). In some cases the Surg. Tech. is allowed to "ciculate" the room with one of the RNs. My question is when a surg tech "ciculates" can they spike IV bags or give medications to the scrub RN for the surgical field? I have refused to allow the ST to spike IV bags or give me drugs when I am scrubbed because I think that this exceeds her scope of practice but I am not sure. I have asked this question to AORN without results but I think this question goes beyond AORN into the Board of Nursing Practice Act. Please help me to bring some clarity to this situation.

this is an old thread but it caught my eye. our policy is that a nurse and a tech have to verify the medications together. when we have three people in a room (rare but nice), it is often two scrubs and a nurse. one scrub is expected to circulate as "second circulator"... so the nurse who is circulating with a scrub as a second circulator can verify the drugs and then the tech can pour the meds to the field as the scrub is setting up and the circulating nurse pays the utmost attention to the patient and the needs of the anesthesiologist. It's a matter of efficiency at that point...while accomplishing the policy which of course is made to ensure patient safety.

STLin · Oct 10, 2011

Ok I am a bit scared now. I am a current surgical technologist student, We are being taught every role of the OR, though we only get to play surgeon. Our teacher makes sure that we understand every aspect of the OR. We must know the procedure been taken place cause many surgeon's cannot tell you the difference between the different types of clamps or forceps, it is our job to know what they need. We are not nurses yet we do get to work with some of the nurses in our school, and we switch around so we get the feel of everyone's shoes. Our teacher will curse and throw the insturments just like some surgeons do and it can be nerve wreaking but we have to remimber "Don't take it personally!" We are being trained not by a regular teacher but by a certified 15yr Tech who cares about who works in the hospital ORs, cause he is not doing it for the pay. He tells us that our job is to watch and count everything we have to watch the surgeon, frist assistant, circulator, Anesthesia provider, and whomever is in the room. Nurses are very important but a few bad apples and can disrupt an OR with their "personal chatting". Nurses get to do more than we, for its the OR or CSPD(the basement), Yes we do know how to circulate and yes we can draw meds from you since you and the bottle are non-steile you hold while we draw, we do not administer the meds we pass them off to the surgeon or first assistant. We rely on the circulator for opening extra supplies, dancing with us, assisting with counts, keeping the non-sterile Anesthesia provider from contaminating the field, amoung other roles.

Some of the duties of the Circulator:

-Assisting with room prep, conducting pre-op pt. review, transporting pt. to OR, verifying correct pt., moving pt. to OR table, positioning pt., assisting the anesthesia provider, verifying correct surgical site, prep the pt., connecting cords and tubing, providing additional items to the field, maintaing the pt. operative record, caring for specimens, securing dressings, pt. from OR tables, transporting pt, to PACU, prepare room for next care.

I do agree that the circulator should be a nurse (RN, LPN, LPV), cause you know the hospital, we really only see the OR.

Anyways like many have already said, It is not U, Me it is WE. Everyone in the OR is there for one thing the pt. and to make sure that our asepsis and steile technique is correct to prevent anything happening to the pt, that could have been prevented by us. If you want to be a ST then take the exam and be one.

Who cares as long as everyone is doing their job properly and efficently! See you in the OR! I'll be the blue monster next to the green monster. :lol2:

OR/GI Nurse Lisa · Oct 11, 2011

not sure how your techs circulate- that is a registered nurses position. they are not trained like a RN, so they should not be going this. they are trained in the scrub role. that's scary that your hospital allows this.

STLin · Oct 12, 2011

Who says that a Tech or any person can not learn more than one job. We are taught this was so that we know what is going on around us, so we won't be distrasted why the circulator or nurse is doing something we think strange. My aunt has been an RN for over 35yrs and loves it, she give me little tid bits on how to handle "certain" nurses. I do not care about drama at all, I just want to work and with all the things I have learned I am proud to become a Surgical Tech it is much more exciting than when I was just an IT Tech. The detail and dedication that goes into making the instruments, the knowledge of the surgeon, The attention of the tech the love and care from the nurses. I am a part of something great in the hospital. I enjoy learning some of what our nurses are taught but it not for me. I want to know all I can, though I can't do much of it because I am not ceritfied in that field like an RN is not instantly certified to be a SurgTech, you go to school as do we all. BTW, our hospitals (meaning 4) love it cause We have a better understanding of why everyone is their and what they each should be doing and help out when needed.

It is like when You know someone who has worked in a resturant or retail before, Cause they don't destroy anything and they are more curtious and do things that help out the worker instead of making more work.

CST can be a First scrub, Second Scrub, Assistant Circulator or Surgical Assistant. And yes We are taught All roles.

Think Boy scouts, "Always be Prepared!":lol2: We are not above nor below anyone at the hospital except the Surgeon.

jeckrn, BSN, RN · Oct 12, 2011

Ok I am a bit scared now. I am a current surgical technologist student, We are being taught every role of the OR, though we only get to play surgeon. Our teacher makes sure that we understand every aspect of the OR. We must know the procedure been taken place cause many surgeon's cannot tell you the difference between the different types of clamps or forceps, it is our job to know what they need. We are not nurses yet we do get to work with some of the nurses in our school, and we switch around so we get the feel of everyone's shoes. Our teacher will curse and throw the insturments just like some surgeons do and it can be nerve wreaking but we have to remimber "Don't take it personally!" We are being trained not by a regular teacher but by a certified 15yr Tech who cares about who works in the hospital ORs, cause he is not doing it for the pay.
If your "teacher" is telling you a surgeon does not know the difference between clamps etc. that is scary. Instead of throwing things in the OR he should be teaching you how to properly handle it so it STOPS. It also sounds like he really does not know what a RN does, our job is more then just doing, which almost anyone with half a brain could do a lot of, it is the mental/thinking part. ie drug interactions, how & which medication to use and why, what will happen if you give epiphrine vs heparin in a case, allergies, etc. Another reason the circulator needs to be a RN is that we are Licensed, not certified, and document on the case.
This instructor sounds like he fits the saying for healthcare. Those who can do and those who cant teach.
As far as your later post then this one you are right, it is a team and everyone has to work together.

jeckrn, BSN, RN · Oct 12, 2011

[Think Boy scouts, "Always be Prepared!":lol2: We are not above nor below anyone at the hospital except the Surgeon. Not sure wher you came up with this but if you are thinking like this then you are falling in a trap. We are all equal members of the team but we all have a place in the heriachy of the OR.