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?

To quote Shodobe again:

"As for scrubbing, this entails setting up instruments for the case and passing them during the case to the surgeon.

You have to be very versatile in knowing the procedure so you know what the surgeon is trying to accomplish.

You have to know all the names of the instruments so you can pass them in order. You have to anticipate the surgeon so you know what they will need next without them asking for it. "

Here he makes another good point as to why not just "anyone" can scrub! To folks who think that "scrubbing" entails standing there like a robot, only moving when the surgeon says "Clamp" "suture" etc, like they do on TV (did you think that, 2bPhD?) let me tell you, nothing could be further from the truth.

A more likely scenario is a surgeon asking for something and you giving him NOT what he asked for, but what you know, from experience, he really needs.

It also involves a lot of the surgeon's NOT HAVING TO ASK IN THE FIRST PLACE--a good scrub (RN or tech) KNOWS the routine!

Do you really think any housekeeper who fancies himself an OR tech has that capability? Do YOU have it, 2bPhD? I didn't think so.

AMEN, SISTER!!! (and Brother)

Why yes, anyone can be taught to scrub, if you mean putting on a gown and gloves (in a sterile fashion, or maybe not), and hand instruments to the surgeon. BUT, can anyone use critical thinking skills to constantly assess the situation in the OR before and as the case is going on, realize when the patient or surgeon may be getting into problems, and take the appropriate action? Can just anyone understand the basic principles of microbiology to make appropropriate decisions when a possible contamination has occurred, or when there is a problem with an autoclave or sterile item packaging, or to even realize that contamination has occurred? I think we all know the answer is no--not everyone can learn to scrub and be competent.

To say that an OR nurse should not learn to scrub is to advocate a fragmented, incomplete role-- only someone with little understanding of what goes on in the OR "trenches" would advocate such a system--OR an administrator who wants to save money by using more unlicensed staff.

AMEN, SISTER!!! (and Brother)

Why yes, anyone can be taught to scrub, if you mean putting on a gown and gloves (in a sterile fashion, or maybe not), and hand instruments to the surgeon. BUT, can anyone use critical thinking skills to constantly assess the situation in the OR before and as the case is going on, realize when the patient or surgeon may be getting into problems, and take the appropriate action? Can just anyone understand the basic principles of microbiology to make appropropriate decisions when a possible contamination has occurred, or when there is a problem with an autoclave or sterile item packaging, or to even realize that contamination has occurred? I think we all know the answer is no--not everyone can learn to scrub and be competent.

To say that an OR nurse should not learn to scrub is to advocate a fragmented, incomplete role-- only someone with little understanding of what goes on in the OR "trenches" would advocate such a system--OR an administrator who wants to save money by using more unlicensed staff.

Hi All,

C'mon people, you had a great thread going here. Why the silence for so many months?

I've been incredibly interested in following this thread. In Australia, things are backwards.... the Scrub is the RN and senior nurse, while the circulating nurse, or Scout nurse, is the junior. I've been an Enrolled Nurse (?practical nurse?) in OR for 4 years now, and never been allowed to scrub, even though in many cases because I have spent time in a speciality, and paid a lot of attention to the cases, I had a much better idea of what was going on, and had to explain to a new RN how to put together their instruments, and what the surgeon was asking for.

I'm now a RN, and finally get the chance to scrub, an opportunity I've been desperate for in the last few years. Here the Scrub/Scout role consists as about 50/50 in each job during a day, unless you are teamed up with an enrolled nurse scout. Once I finish my perioperative postgrad course this year, I'm hoping to do some travel nursing in the US. Here is an interesting question, what do you think hospitals will find more important, my 4 years as a circulating nurse, or my post registration 1 year's experience as a scrub/scout?

Jason, I have really found it depends on what hospital you are at, but most times they like that you can scrub and circulate. As far as taking a job scrubbing, the more experience the better. At least one full year rotating through all specialties is the minimun I would consider taking a travel job as a scrub..

Alot of hospitals want you to be able to circulate and be ready to just jump right in. I love the challenge of going to new places and learning how it is done there. The down side for me is that many hospitals have poor equipment and are very disorganized. Another thing I have found is that there is always someone that won't like you because you are the "traveler" like you have leprosy or something. I ignore them, that is their problem, I refuse to own it.

Remember, where you are at is not necessarily backwards, it's just done that way there. That is what I try to remember when I go to a facility and I think they are "backwards" but in Rome do as the Romans do and you will be fine. As long as you are working under standards and giving quality care..

Of course, this is just my opinion...

Originally posted by KarenHalse

Another thing I have found is that there is always someone that won't like you because you are the "traveler" like you have leprosy or something. I ignore them, that is their problem, I refuse to own it.

So true. I am a really easy going person and get along with virually everybody but Karen is correct: there is always one person who won't like you because you are the "traveler--" not because you are an outsider, but because he or she feels threatened by your skill level.

Travelers are capable, (or they had better be,) of being thrown into any case--we often, at least before they get to know us well, get the very difficult cases, very difficult surgeons, etc. as some sort of test to "prove" ourselves.

Once you have proved yourself, there is always going to be one person who feels intimidated by you--because they don't, and never will, have your level of skills, could never be a traveler and do what you do, and they feel that you make them look bad and that maybe, just maybe, one day the supervisor will expect them to perform to the same level of skill you and other travelers have brought to the facility--not an impossible task, if one is willing to learn, but most people like this are not.

I worked registry occasionally at a facility where they only did very minor procedures--breast biopsies, hernias, podiatry, lap choles--and made a huge production out of them.

Most of the nurses there were very territorial, very protective of "their" surgeons, very mistrustful of anyone who did anything other than "the way we have always done it--" Most of them had never worked anyhwere else, having been there since they graduated from nursing school many years ago and having made that facility their comfort zone.

Well, that hospital recently shut down abruptly because of bankruptcy. I just chuckle to think of the situation these nurses now find themselves in--incapable of being a registry nurse or traveler, because they can't adapt to new situations, and just don't have the skills.

Jason, I really would not embark on a travel assignment unless you feel really, really comfortable with scrubbing, because travelers often get assigned to do lunch reliefs for each room, which means relieving BOTH the scrub and circulator.

This is particularly true in fast paced university medical centers. They don't want you "learning" to scrub on their time. I saw this happen to an RN who had never scrubbed--only circulated--and had taken the travel assignment with the idea that he could use it as a learning experience in the very complex procedures they routinely did.

They just tore him up--and of course they threw him into situations where he was bound to fail, as if it served him right. Somebody should have given him the same caveats we are giving you before he took the assignment--he would have reconsidered.

Stevierae,

Your reply to Jason was just what I've been searching for! I'm an LPN, in RN school, ready to graduate in May of this year. I'm really fascinated with the OR, and I'd really love to combine OR nursing with travel nursing one day. Unfortunately, I haven't known any OR nurses or Travel nurses personally. I appreciate your advice to Jason about becoming VERY comfortable in scrubbing and circulating before taking a travel assignment. As far as I know, there is only one hospital in the Denver area that teaches their RNs to scrub and circulate. That looks like my best bet for a job after graduation...

Do you have any other advice for a prospective OR/Travel nurse? How many years of experience do you recommend? What are the best assignments to take first? Do you recommend Med/Surg training before going into the OR? Any feedback would be greatly appreciated!!!

Thanks!

Margo

Margo, there are different schools of thought on this one--Shodobe's thoughts may be different than mine, so watch for his reply too--in fact, everybody here can offer you insight as to what worked for them.

I, personally, think every new grad should have a year's worth of med surg experience--just to gain experience in the fundamentals that you learned in nursing school--drawing up meds, setting priorities, charting, etc.

Did I do it? No, because I had floor experience in the Navy as a corpsman, as well as having gone to operating room technician school there and working independent duty in the E.R. for 3 years.

Do I think YOU need a year's worth of med-surg experience? Maybe not--depending on where you have worked as an LPN--your fundamental nursing skills may already be state of the art.

In fact, if you can get into that Denver operating room nursing program that teaches new grads to scrub and circulate, right after graduation, AND you are already comfortable with your basic nursing skills, DO IT!!! Why waste a year slaving away on med surg if you can be training to do what you really want to do anyway, and geting paid for it, to boot! Keep in mind that they MAY want you to sign an agreement that you will stay working for them for at least one year after they train you--but it may be a great place , and you wil end up staying happily for a year or two--then taking off to do travel assignments--

Best assignments to take first? Probably those affiliated with major medical centers--simply because there are always plenty of surgical residents around who are also learnig--thus, the surgeries are somewhat slow--and the residents are always willing to help the circualtor do whatever needs doing--in fact, sometimes they are TOOO helpful, LOL, and they kinda get in your way--you don't feel overwhelmed, because you aren't expected to do EVERYTHING--

At these places, there are also sometimes private PAs or RNFAs woho work with the specialty surgeons--they are really lifesavers in helping with things like positioning, balancing microscopes, settign up fracture tables, etc.--and, as long as you are willing to learn from them, they will share whatever they know--

I would stay away, at least for a while, from university trauma center travel assignments--or those that do huge, complicated neuro or oncology cases--I think you will probably need 5 years of all around scrubbing and circulating experience, and taking call, to feel comfortable with the fast pace required of trauma, especially--

Shodobe, your thoughts?

Thanks for getting back to me so soon Stevierae!!! :) It's nice having some contact with someone who's doing exactly what I want to do!

G'day All,

Thanks for your reponses, very interesting. Have no fear, I'm not going anywhere without a substantial amount of scrub experience.. I haven't waited for EVER to scrub to start shifting before I have done it for a while.

As for new grad programmes, I've been an Enrolled nurse since 1995, working on the wards, and started theatres in January 1999. As such, I'd decided not to do a Newgrad course, but immediately do a Postgrad course in theatres, specialising straight away.

I understand that the role of a registered nurse and an enrolled nurse are substantially different, and this may affect my understanding of medication admin and other ward stuff, but my Uni time in the wards gave me enough grief... I wanted back into theatres!!!!! I've been told by my new hospital that they want me to do the components of the new grad course anyway, so I'll end up doing both courses simultaneously and get more study days!

As well, I'm joining the Royal Australian Air Force Active Reserves (RAAFAR) as an RN, so will be doing some things to broaden my experience there.

In short, my advice on the subject is, if you want to do something, GO FOR IT! You never know until you try.

Have fun! Jason 8^)

Specializes in Main O.R. and CVOR.

:angryfire people like you make me sick. you think you are so great!! when in reality you probably are the worst o.r. nurse. no one gives a rat's @## that you are so great. some nurses may just want to do circulating it doesn't mean the lack the greatness you pocess. i was a tech for 11 yr and have been a r.n. in the o.r. for 14. the nurses that don't want to scrub just gives me more chance to scrub. i am still a scrub tech at heart.

It depends on the area and the facility if I scrub or not , being a Traveler they really rather have me circulating the room only because they are paying me much higher rates then what thier scrubs get and Im versital enough I can go into any room into the OR and circulate or scrub in it. I can scrub any case need be , I cant say I will be as fast as the scrub is because they scrub constantly, but I wont sit and ponder what the Dr is asking for either. I have many cases first assisted and love it I love being in the middle of things and it being a madhouse. I thrive on it, I love trauma and I can pop down to the ER with any Dr and do what needs to be done , but most places wont allow that because its not Good Management to have an Rn down there when a scrub is sufficant. Thats what I have been told I personally think its a crock of crap but I dont make the rules. The majority of the hospitals dont have their Rns scrubbing anymore , but dont think for a minute those nurses dont know whats going on in that room, I have worked with many that can not look up and hand suture thats going to be needed in 3 minutes or less and they not once look at whats going on in the case , they know thier cases that well.

I have been called to a room to set up or open a case and I usually send a scrub for a break and when they enter their rooms are cracked and thier mayo set up and Im scrubbed in setting the instruments up , It keeps me in tune with whats on the table and whats needed. I make sure my scrubs are taken care of. I have scrubbed in on a many of cases as well , and have the Dr almost faint because an Rn is scrubbed in and it not be a Heart we are doing. I dont particularly like scrubbing in on a Lap Chole they bore me , but I will do it, IF SOMEONE IN MANAGEMENT WILL LET ME, but Im not clueless when it comes to circulating any rooms what so ever. I could care less if I scrub or not , It makes no difference to me , I can function at either roll and not give a rats behind about it. They pay me to do a job and whatever they see fit for me to do is what I do. Yes I think it would be nice for new Rns to see how it is to scrub that way the scrubs recieve the respect they deserve, because its not always fun and games up on that table. It would be nice to have a world where things are done correctly , but in the Nursing world we are far from correct on many issues. As far as the well rounded issue: I think all Rns in the OR need floor experience , but thats my opinion, Nothing like getting a fresh one off the boards thats clueless on how things work on the floors as well. When I was trained for the OR I had 3 yrs Cardiac/Med -Surg floor experience , and I was amazed at what went on in the OR the Heart surgeon I worked with chose his team and me and 4 others from my floor learned the hard way on the care given and taken by theses patients. We went from the cardiac med surg to the CVICU and were cross trained then down to the OR , and was trained on every aspect of the cases. It didnt matter if it was a gen,gyn,uro,neuro ,ortho , plastics or a Heart were were in the middle of it . So why is it that heart nurses only do hearts anymore??? Its the same standards as any other cases but very seldom do you see a Heart Nurse or scrubb in any rooms down the hall???Are they too good for it? I just love to hear them whine about it, and it makes me ill. I dont knock Nurses who dont scrub its thier choice and when and if they feel comfortable to scrub they will but someone will have to allow them the chance to do it and the way ORs are staffed nowdays I dont see them being able to.

My 2 cents

Zoe

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

Hey beans, get a life! Who cares if you are a scrub tech or an RN. As far as I am concerned a tech is a one dimensional person. Only good for one thing. If you can't be a little less hostile, go somewhere else to vent. Maybe you can find a tech forum to troll. It sure would be better for you since your opinion, as meaningless as it is, is not welcomed here. Also don't make rash judgements on a person's ability, you don't know them and have no idea what kind of nurse they are. We could make the same judgement on you and rip you another one in the skills area. If you are such a "tech" person, then why did you become an RN and why didn't you just stay a "tech"? To mimic you own words, "people like you make me sick", just what kind of people are you refering to? If your not careful your posts may not number beyond "2". Go ahead make my day and reply. Mike

Hey stevierae, get a load of this guy or gal

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