What's up with RNs who refuse to scrub?

Specialties Operating Room

Published

This trend, at least in the Western states, is starting to irritate me more and more, the more I see it. I have been an OR nurse for over 20 years; scrub and circulate all areas; have done all kinds of trauma. Nowadays I only work as an OR nurse on a travel assignment once a year, to keep up my skills. The rest of the time I work as a legal nurse consultant and as an IV nurse educator.

So, what's up with these new RNs in some (not all) ORs who don't scrub, and won't learn? To me, it's like doing only HALF your job, and leaving your colleagues who DO scrub left to do their share PLUS yours. I really want an answer to this.

One time I went to a job interview to see if I could pick up some occasional per diem work at a local OR. Just for this stupid little per diem job, in an OR that is not even a trauma center, and does pretty much just VERY basic surgeries (i.e., lap choles, arthroscopies, breast biopsies, TAH-BSOs--you get the picture--) I was interviewed by the director PLUS the "charge nurses" of those areas--that is, general surgery, GYN, and ortho--all new grads. Out of the blue, the director asked, during the course of the interview, "What makes you angry?" I said, "OR nurses who refuse to scrub." Every one of the charge nurses stared at the floor. I realized, then, that NONE of them could scrub, nor would they ever learn. I knew I wasn't going to be getting that job!!! (I also knew I did not WANT that job.)

The funny thing is, scrubbing is fun; sometimes, you really bust your a** running around circulating big cases and scrubbing is a very welcome break, where you can almost let your mind go on autopilot--well, you can if you know what you are doing. Those prima donna charge nurses never will.

Oh, by the way--I always take my OR travel assignments in California, and ALL the OR nurses in those facilities scrub and circulate all areas. Are California OR RNs just better, more well-rounded RNs than the RNs in the rest of the Western region? I don't live there, but I teach there quite a bit, (as well as doing the aforementioned annual travel assignment) and I am beginning to suspect that this just might be the case. What is the trend like in the rest of the country?

Specializes in O.R., ED, M/S.

I hope 2bPHD you were joking about anyone can learn to scrub or assist. This is totally false in my opinion. I have been doing both for over 26 years and have found that most and I do mean most circulators that do not scrub are mediocre in their role as a OR nurse. I know this will infuriate those out there that have been nothing circulators their whole career, but it really gets to me when people state that the only reason an RN wants to scrub is to do something that is "easy". This is hogwash! Circulating anything from a D&C to an open heart procedure is BORING! Up at that table is where the action is and I for one want to be there. When I said most circulators are mediocre I meant unless you have been in a scrub role you don't know what's going on most of the time at the table and I find myself anticipating the scrub on what they will need next, because I have been there. I still hold to the statement that a complete OR nurse is one that can do it both ways. The problem today is that most nurses that have gone into the OR in the past ten years do not ever learn to scrub because, as said before, Techs are cheaper therefore don't bother teaching the RN any real skills. Where is stevierae when you need her! Just my 2 cents worth, have at it. Mike

shodobe,

Whatever made you think the surgeon is "captain of the ship"? That is VERY OLD law and has been replaced with the judicial rulings that say that each professional is responsible for their own acts. Of course, everyone involved may be named in a lawsuit, but that is legal strategy, not law. If you or your surgeons can give me a legal reference that says he or she is the captain of the ship in 2003, I would love to have it.

It really is just an ego issue on the part of the surgeons.

YogaCRNA

Specializes in O.R., ED, M/S.

yogacrna, Actually I was upset at first that you made reference to thia old, archaic line because I did not remember saying it but then I did find the quote from me. If you read closer you will see that I was really just stating something that has been around for qiute along time. I don't believe in this way of thinking. I agree everyone is responsible and no one should lead themselves into a false since of security. The hospital or the surgeon will only be looking out for themselves. I have been around too long to really trust anyone when it comes to liability. Sorry I said it. I also stated the OR circulator was the "field marshall" when it came to running a room. I hold this title far above. The "captain" can go down with his ship, but a "field marshall" is land locked and can't really go anywhere. I have been sniffing too much Sevo during induction! Mike

PS, very egotistical

Mike

Well said. I am pleased that you understand the reality of practice and want you to know you could work with me anyday. Ego and all.

Yoga

Specializes in O.R., ED, M/S.

yogacrna, actually I meant the surgeons were egotistical. I really am laid back and very unassuming. Gotta go now, time to clock out. Wasted too long tonight waiting for a surgeon to get here, almost two hours! Lucky we did not have anything else to do. Mike

I thought it was funny you mentioned Ca. as the place where nurses most often scrub, because I have found that to be the opposite in my travels!

I have done OR travel assignments in NJ and Ca., and I scrubbed alot in NJ, but NEVER in Ca. - the places I have been in Ca. have always been heavy on surgical techs, and short on circulators.

I do agree that it would be good for all RN's to learn to scrub, but be fair minded and realize that with the nursing shortage today, the use of technicians has increased, and often times many new grads enter the OR without ever getting the opportunity to learn the scrub role. I think it is more an issue of lack of opportunity to learn than it is lack of desire to learn.

Everybody,lighten up! You don't know why another person does something until you have been there.Each hospital and situation is unique and with the nursing shortage we will be seeing more "re-engineering" with housekeeping being trained to scrub,EMT's working in ICU,and ward clerks watching heart monitors. Don't be so critical of your fellow nurses!

Seems to be a heated topic. I'm a nursing student and will begin clinicals this fall. I'm interested in becoming a surgical nurse but I do not know the meaning of "scrubbing" can someone explain please? Thank-you.

mumhuff- the scrub is the sterile person who passes instruments to the surgeon. The circulator is an unsterile person who is involved with patient positioning, prepping, delivering sterile supplies and instruments to the sterile field.

Thank-you spineCNOR for explaining the difference between the scrub and circulator nurse.

If my particular nursing school and the hospital in which I will be trained doesn't teach us how to scrub - where am I to learn this important procedure?

I'm in a 3 year ADN progtram and am wondering whether this type of program is sufficient enough for me to become a surgical or er/trauma nurse? Thank-you for your help.

I think this is a good place to give some kudos to scrub techs. We have all worked with those who are prima donnas, and who are convinced they know far more than the nurse does, and could do her job any day of the week--

But, I have ALSO been lucky to have worked with OR techs, especially those who do major ortho (like complicated total joint revisions)and spines, who know some of the procedures HANDS DOWN better than the surgeon does, having done those procedures many, many, many times with various surgeons over the years, and having seen every possible problem that could occur, so therefore are knowledgeable about the solutions, and are willing to share them--

Originally posted by 2bPhD

After they taught the housekeeping staff how to scrub, the task was no longer considered a skilled nursing technique. After all, anyone can scrub and assist in the OR. Medical students and interns do it all of the time. Nursing time should be devoted to more skilled aspects of care that require the unique background that nurses possess.

Oh, gosh. It sounds like we have one of those ivory tower nurses here whose "experience" is related to the research she is doing climbing her way to PhD (are you at NIH?)

This is one of the most inane comments I have ever read: "ANYONE can scrub and assist in the OR."

Do you truly believe this? Have you ever actually BEEN in an operating room? I am CONSTANTLY learrning new things from people who scrub, both techs and nurses, and I have been scrubbing and circulating for over 25 years. I am constantly amazed by how sharp some 21 year old techs are, and I hope they go on to become RNs, because their skills will make them incredible operating room nurses. They already know how to prioritize and how to function in a crisis. One never stops learning--things are always changing in the operating room.

By the way: medical students do not really "scrub, " as we who SCRUB define "scrub."

Medical students do little more than stand and observe; they are occasionally entrusted with a retractor or the suction.

Usually their knowledge of sterile technique is not quite that good yet, and they must be constantly watched.

They are always grateful to the scrub, who is kind enough to take them under his or her wing.

Residents, also, do not "scrub" as we define the role.

They often know only the instruments related to their specific rotations--not all, as we do.

They do not know various sutures and all the types of needles available, as we do--they, again, know the types used in the specialty they are training for.

A general surgery resident cannot finish a Whipple, go from there to scrub a total hip, go from there to scrub a crani, go from there to scrub a AAA--as we can, and do.

I have said it before, and I will say it again: If you have never scrubbed, you cannot truly anticipate the surgical team's needs, ESPECIALLY when all hell breaks loose and things are not going "by the book."

If you have not been in the scrub's shoes, you will not have a clue as to what could be going on up there at the field that has deviated from the norm, and how you can best prioritize how to help the team when seconds are critical.

Shodobe said it best when he said, "Scrubbing may not make you a better nurse--but it DOES make you a better OPERATING ROOM NURSE."

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