OR Dude

Returning to school, I have found things have changed, and one such change is not being given the time to review incorrect responses on an exam. I find this a very deplorable policy, which has come into existence. I also find it very odd, when the instructor says to the class, "Submit any questions you may have regarding the exam via email," but you have no idea which questions you answered incorrectly, since you were not allowed the time to review your exam. You are simply told, you grade is X, you had # incorrect responses. There is a huge disconnect in this logic, and a huge lack of accountability. How can you trust the school, if it says, you missed # questions, but are not allowed to see the questions you missed? Instead, the school is saying, "Trust us, your grade is X." This invites a lack of accountability, to say nothing about other irregularities. Being a former educator, test review was a cornerstone to learning...such is the phrase, you learn from your mistakes. Yet, how do you learn from your mistakes if your are not allowed to see what they were? The world has changed, and the reason for this lack of exam review is in the name of exam security. Avoiding any discussion regarding the larger issue of security in the world of politics, I believe the guise of security, with regards to this topic of exam review, has gone too far, and does not promote learning. In light of this, I have come to question continuing my academic pursuit at this particular university, or any such school with such a policy. If exam security trumps learning, then the academic mission of learning has failed. Before attending a school, ask if students are allowed to learn from their mistakes, and specifically, if they are allowed to review their incorrect exam responses. I believe it is a mistake to accept a school policy such as the one I described above. I call upon all current and future students to demand exam accountability.

Argo: One other thought. By your own admission, "I was a scrub tech prior to nursing...", essentially supports my fundamental argument. Career advancement, and the foundation of knowledge, in the OR, is rooted in scrubbing, and having scrub experience. You may disagree with 95% of what I am saying, but by your own admission, I would offer, you have 100% validated the foundation of my argument/proposal. Respectfully submitted.

Thank you for your opinion regarding your experience. As for your opinion regarding me, personally, you do not know me, and such opinion has no basis.

With utmost respect, Rose_Queen, the overall trend, over the years, has been a parceling of, once-held, nursing duties to other professions, with the role of scrub, now being more widely held by surgical technicians, instead of nurses. Physical and respiratory therapy were previously performed nursing duties. The trend has been an abdication of nursing duties to other professions. Laws change over time. What is the timeframe for such change? Very debatable. Yet, the trend is well underway regarding the changing role of the registered nurse in the operating room. The scrub role, in many hospitals, has already been relinquished to the surgical technician. A few hospitals continue to utilize registered nurses as scrubs; yet, I would argue, such hospitals are in the minority. Looking at the overall trend of the surgical nurse, I would argue it's merely a matter of time until the role of circulator is also abdicated. Change is the only constant. Laws are not permanent, and neither are registered nurses permanently mandated to serve as circulators. My opinion. No disrespect. Just offering ideas for sake of conversation...particularly for anyone considering a career as a circulator.

I too have seen such manipulation of knowledge...and who may ultimately suffer as a result? The patient. These schisms between scrubs and nurses could be avoided if the OR could be composed entirely of nurses, or as I have suggested, surgical technicians (of course keeping the only advance nurse currently in the OR, the CRNA) instead of creating a factional workforce, which can exist in less than perfect teamwork OR settings. Teamwork, for the sake of the patient, should be the overall goal of an OR workforce, not factional issues such as those you (showmethemoney) have experienced.

Most respectfully, regarding your (springchick 1, ADN) statement, "The RN does not and never has supervised the scrub", I disagree. In many states, in the United States of America, the RN is charged with the duty of supervising the scrub, a.k.a., surgical technician. For example, in Georgia, administrative code title 290 rules of Department of Human Resources states, "...surgical technicians perform scrub functions ONLY under the SUPERVISION of a licensed registered nurse..." I do agree about OR teamwork, and an experienced scrub being more knowledgable about working in the OR than a brand new nurse (new grad), and, I'll add, an experienced nurse who has never worked in the OR... which I believe only further strengthens my point: a registered nurse, working as a circulator, is not needed in the OR; and, linking that point with your statement, "...the strongest scrubs...can help them (new nurses) and answer questions" is another example of where the basis of knowledge lies...not within the RN, but within the scrub. Sorry, but I thought I made myself clear earlier...I am not miserable at my job. I was offering my opinion regarding a registered nurse working as a circulator in the OR. I appreciate your input into this discussion, and I am also glad any misconceptions can be clarified, especially regarding the role of the RN in terms of their supervising duties. Kind of odd for some states, in the United States of America, to require the duty of supervision of a scrub (surgical technician) to an RN, when, I agree with you, "...the strongest scrubs...can help (new nurses) and answer questions" being that, as you stated, "...a scrub tech with years of experience is more knowledgeable about things in the OR..." Thank you.

No disrespect intended...sincerely. Can't compare?...comparisons are made all the time, and made with different parts of the world all the time. Sorry, but I beg to differ.

I'm glad to see a healthy discussion. I would like to add, many see the role of a circulating nurse as being the purview of a registered nurse. However, as I mentioned, look south to our Aussie friends and see the roles reversed...the tech being the circulator, and the scrub being the nurse (registered). The roles are so easily reversed, if only you change your location. It works there. Blood/drug administration (most often done by the advanced nurse in the OR, CRNA, here in the good 'ol USA); and, the other tasks (such as prepping the patient, passing meds/instruments to the sterile field, etc. are done by our Aussie surgical technician brethren. So easily is it to switch roles...which still leads to the conclusion...a registered nurse, serving as circulator, is not needed in the OR. For the 90% of a circulator's duty, yes, I agree, anyone can do, and for the other 10%, the advanced practice nurse, CRNA, is available and more than capable of performing. Let's not be so geocentric...no worries, mates.

I agree working in an OR, wherein you are taught (on the job training) to scrub, provides valuable learning experience. Validating my point...a badge of honor (and insight into the surgical field). And, I'd agree an all nurse OR does provide a more egalitarian OR environment. But my focus was on working strictly as a circulator, and my opinion that the basis of OR nursing is scrubbing, in terms of career advancement. Congratulations to those nurses who receive on the job training as a scrub. Does your training equate to the surgical technician's training from their academic program? That's a personal question, which can only be answered by the individual. Nonetheless, my humble opinion remains: the registered nurse's role is not vital to an operating room. The operating room can exist without a registered nurse, and barring state mandates, surgical technicians can replace a registered nurse in the operating room. Also, if you are a registered nurse, and you want to become a RNFA, surgical nurse practitioner, or OR manager, then it is preferred that you have scrub experience, and preferably having gone to school for surgical technician, then become a registered nurse. On the job training may not provide the background experience to advance into these other career prospects. Thus, scrubbing is the cornerstone to working or advancing in the OR. Thinking of being (working strictly as) a circulator?...Think twice (especially a new grad RN).

Actually, my current work environment is not toxic. I've worked in various ORs. This is my opinion, after working in the OR for over 15 years. Team work? Yes. There is team work. But there is a hierarchy. Do you think as a RN you are equal to the surgeon? Or anesthesia (CRNA)? Or the scrub? Who gives the orders? The hierarchy dictates who gives the orders. That's not toxic. That's the structure or hierarchy of the OR. Respectfully I submit.

Thinking of being a circulator?...(especially for new RN grads)...consider carefully. If you will only circulate, and you will be working in an OR with surgical technicians, or scrubs, who do not have a nursing background, then you may find yourself answering to, not supervising, surgical technicians, who may harbor resentments towards you being "the nurse". In these OR settings, there is often a hierarchy: surgeon, anesthesia (often the CRNA, who is the advance practice nurse, and who knows far more about the patient's vital signs than the RN circulator), then comes the surgical technician, or scrub, and at the bottom of this hierarchy, the RN circulator. In such OR settings, when the surgeon asks, "How is the patient doing?" The surgeon wants anesthesia (CRNA) to provide the information, not the RN circulator, who could possibly not have a clue, especially if said circulator had to leave the room for an instrument, said scrub forgot to pull prior to the surgery. If the patient needs meds, such as for blood pressure, heart rate, etc., the CRNA is the advance practice nurse, and will be administering such drugs. Basically, they are the primary nurse in the room. As a circulator, you will be the secondary nurse. You will be charting, helping position the patient, going get stuff from outside the OR (which was forgotten, or is unexpectedly needed), checking the paperwork (consents, H&P, etc.), and setting up the OR with the scrubs. When the surgeon, CRNA, or scrub politely asks (or yells), "I need...!" It's your job to fulfill their needs...not the other way around. In such OR settings, don't think, "I'm the RN! I'm in charge of this operating room." No. You are not in charge of the operating room. The surgeon is the captain of that ship, or operating room. Then comes anesthesia (usually CRNA). Then the scrub, who is working with the surgeon, and anticipating, or relating the needs of the surgeon. Then comes you...the RN. So why have a RN in the operating room? Because some states mandate their be a RN in the operating room, as a circulator, who may assist (often assisting the CRNA, when the patient crashes) during emergencies. But, laws are not written in stone. Could these state mandates change? Sure. In Australia, the nurse (RN) works in the position as a scrub, and the surgical technician works as the circulator. So do operating rooms need registered nurses (barring state mandates)? In my humble opinion, No. Registered nurses are not needed in the operating room. Surgical technicians can easily perform the duties done by a circulator. They do it in Australia. Just a matter of time, probably, until RNs are phased out of the OR. So, thinking of being a circulator? Consider what career growth and potential you may have. Want to be a RNFA? Your gonna have to learn suturing and instrumentation...scrub work...that's their area of expertise. They don't teach such things in nursing school. Want to be a surgical nurse practitioner? Helps to have scrub experience...otherwise you are in the same position of not knowing the basic suturing and instrumentation. See the trend? Career advancement in the operating room is rooted in knowing how to scrub if you're a RN. Even if you want to be the OR manager. Never scrubbed? Then let's see how much respect you will have among your subordinates. Sure there are all RN ORs, in which even the scrubs are nurses. But scrubbing is the badge of honor. Still thinking of being a circulator? Good luck.

Realizing there are many OR units, and each has their particular idiosyncrasies; yet my current OR is run, if not managed, by scrubs and not nurses. Disclosure: I am a nurse. While the scrubs do very good work in this particular OR, the nurses definitely have little if any input regarding daily assignments, duties, scheduling, etc.. Instead the scrubs oversee this OR. Not the first time I have encountered this power arrangement. Always leaves me wondering, Why even bother having a nurse in the OR? Being a nurse for many years in the OR, I have enjoyed the OR, but the re-occurring power struggle nurse vs. scrub is always ever-present. Sometimes I think nurses should abandon the OR, and many a scrub I have encountered has argued as much in the past. I know there are nurses who may read this and take exception to this proposal of relinquishing OR duties (scrubbing, if some nurses still do, and circulating) to scrub techs. I applaud your defiance to what I have seen as being a trend to a no-nurse OR, in which the nurse is merely a figurehead, secretary, and/or gopher. I've heard of all-nurse ORs, but not in this neck of the woods. I hate leaving the OR. I enjoy the OR. But seeing, and being part of, such a diminished role leaves such an empty feeling at the end of the day. Maybe it's time to go into another area of nursing? Or maybe I should hang up being a nurse, and join the tech ranks? Either which way, it's just sad to see nurses take such a backseat in this "specialty" of nursing.

Without going into specifics, this rep has a history, at our hospital, of being belligerent in actions and words. I've discussed this with other nurses, and the response is, "X is just that way", as if this is the tolerated norm. I was thinking of making a complaint to the nurse manager. I've also considered complaining to this rep's company. Also, I don't know if this rep's professional behavior would be better managed by the nurse manager, or this rep's company. I tend to think that complaining directly to this rep's company would perhaps result in a more demonstrable change of behavior since the rep is directly employed by the company, and they are the ones who have a vested interest in maintaining a professional relationship with our facility. Any other additional thoughts?

Has anyone ever had an instrument representative behave unprofessionally in the OR, and if so, what course of action did you take? Did you present your grievance to the private company the instrument representative was representing or to your hospital's management?

Regarding mandatory flu shots, I'd have to say that I'd prefer these shots not be mandatory, and specifically, I'd rather not have my employment be dependent upon receiving such shots. Personally, I have a family member who recently, just this past week, received the flu shot, and has now developed neurological symptoms. The symptoms began as eye twitches, then they noticed one side of their face appeared to be drooping with unilateral facial paralysis. The first doctor diagnosed Bell's palsy. 24 hours after the initial doctor's visit, my family member began noticing tingling in her extremities, and bilateral facial paralysis (drooping). This began Monday. By Friday, the doctors are beginning to speculate that the initial diagnosis may not be correct. My family member had no pre-exisiting conditions. She ran 5 miles a week, and was healthy as a horse. She's very concerned at this time. The only change in her lifestyle, has been the flu shot.