Regular RN scope of practice in the OR

[USAF RN]

I have a question for the OR crowd. I am a BSN RN who has no certifications, but recently was allowed in to surgery to hang out because that's what I want to do someday. The surgeon was present the whole time and allowed me to hold instruments, suction, suture, and de-epithelize some skin. Is this outside my scope of practice (Missouri)? I know that RNFA do more of that stuff, but i was under the direct supervision of an MD and didn't do anything that i thought would put the patient in harm's way, meaning I never did anything below the dermis.

any opinions??

The charge nurse pulled me out and banned me from the OR for going outside my SOP.

[traumaRUs, MSN, APRN]

I guess my concern was "you were just hanging out." Who asked you to come into the OR? The MD?

[USAF RN]

Yes, I run the program--it's a visiting plastic surgeon, i set up all the appointments in the clinic. so in return for doing all the grunt work, they let me come in and scrub in. at the heart of it, i can't tell if i really did something i wasn't suppose to do.

[TakeTwoAspirin, MSN, RN, APRN]

Putting aside what might or might not be within the scope of practice in Missouri the little voice screaming in my head while reading your post was asking "what on earth would the patient think if they knew you were just hanging out and suturing etc". I think the doctor was WAY out of line for allowing you to do this and I suspect that the patient would not be happy if they knew someone with no training what-so-ever was being allowed to "have a go".

What also disturbs me, and frankly highlights your lack of knowledge with regard to surgical procedures and aseptic technique, is the fact that you actually believe the patient was in no harm because you didn't do anything below the dermis. If you broke sterile technique you could have done very much harm. If your sutures don't hold you could have done very much harm. I understand that you were supervised the whole time, and therefore feel that you are somehow absolved of a good deal of responsibility, but I still feel you make a poor judgment in accepting the opportunity to do these things - even under supervision.

I'm sorry, if I sound really harsh, but you did ask and you now have my 2 cents. Just ask yourself how you would feel if you or one of your loved ones was the one laying on the table that day.

Before I get flamed yes I know that everyone has to start to learn somewhere, but even rookies have undergo preliminary education in aseptic techniques, gowning and gloving appropriately etc.

[GadgetRN71, ASN, RN]

Yes, you were out of line..maybe not legally because I'm not sure what your state says about suturing etc. But from an ethical and moral standpoint, not cool. I don't care that you did all this stuff supposedly under the MD, because many surgeons have complete disregard about the proper ways to do things. That's why the OR nurse's primary role is to be an advocate for that patient. We don't work for the doctor. Ultimately, we work for that patient and their wellbeing.

I'm not surprised the charge nurse banned you from the OR and that surgeon needs a smack upside the head for bringing you in there in the first place. I'm sure this sounds harsh, but really, what you did was foolhardy, dangerous and selfish.

[Fun2, BSN, RN]

Was this your first time to scrub in, or have you been taught proper technique?

[USAF RN]

ok, whoa. Perhaps i misrepresented the situation. Yes, I have had orientation to the OR, this wasn't my first time scrubbing in, I have been trained in suturing and had all the proper documentation to state all of that, not to mention this wasn't my first time de-epithelizing either. I'm just not a CNOR or RNFA.

all of that being said, my underlying question was: are RNFA's the only people (RNs) who can handle tissue without going outside SOP. I was properly trained in all of this and supervised, the patient DID know i was in there. i just wanted to know the rules, legally.

thanks for all the opinions, i would agree with most of you, perhaps i should have explained all that the first time.

[Argo]

With the initial info I say no. With the new Info I say your fine since your "competent " I would check your. State guidelines and hospital policies though.

[USAF RN]

Just an FYI, as I suspected I checked with the State Board and there is no rule against this as long as the documentation of training is there. thanks for all the opinions.

[Rose_Queen, BSN, MSN, RN]

My question to you, since there are no rules against it per the BON, is whether hospital policy was followed. For anyone to scrub and assist at my facility, they are required to go through hospital orientation and receive permission from the nurse manager as well as from the supervising physician. Observers (student nurses, nurses from surgical floors, etc) must have permission from the patient, surgeon, and nurse manager preferably the day before.

[shaomai]

I would presume that the hospital has a credentialing process through the medical staffing office. Do you have priviledges at that facility to "practice"? Was the patient informed of your observations even after the fact?