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RN's in the scrub role

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I am hoping that my future-fellow nurses will help me out here. I am writing a persuasive paper for my leadership class and want to persuade people that OR nurses should be trained to scrub. That it should be included in their orientation to the OR. The OR that I have been as an ST for the past 12 years does not include much, if any, scrubbing. The nurses may get one or two days and that is all. What I am looking for are your comments and opinions about why you, as a circulating nurse believe you should or should not be trained to scrub. Please also let me know if you are CNOR.

Thank you from a future OR nurse!! :balloons:

I appreciate so many great replies, but lets try not to slam the surg tech shall we? I have been a scrub tech for 15 years total, I have an associates degree, not a 9 month certificate. I am a Level III scrub tech. (We have a competency leveling system that determines the what we are able to do in the OR and also puts us at a higher pay scale.) I am a Laser Officer, I have been through a course in wound closure offered by our surgeons and the suture company. I serve as a preceptor for tech sturdents and new employees. When a new RN comes off orientation they always assign us together to help the room operate smoothly. The days that I am not assigned to scrub in a room, I will help with turnovers and starting cases. My RN's appreciate that I take the initiative to help position the patient, offer to do the prep, plug in equipment as the case gets started, etc. I could go on but won't. So let's remember the question and not slam the tech. Thanks. By the way it will be my many years of scrubbing that will make me an awesome OR nurse.

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Not an RN, but where i work, the RNs are trained to scrub. All of them can scrub.

All of our RNs are CNOR as well.

I am hoping that my future-fellow nurses will help me out here. I am writing a persuasive paper for my leadership class and want to persuade people that OR nurses should be trained to scrub. That it should be included in their orientation to the OR. The OR that I have been as an ST for the past 12 years does not include much, if any, scrubbing. The nurses may get one or two days and that is all. What I am looking for are your comments and opinions about why you, as a circulating nurse believe you should or should not be trained to scrub. Please also let me know if you are CNOR.

Thank you from a future OR nurse!! :balloons:

I am a CNOR..... have been scrubbing alot lately only because I show an intrest and ask to all the time.......it is a definate asset to scrub makes a better circ.

I am CNOR and RNFA but I have very little scrub experience and I would love to have a seasoned scrub (RN, LPN, or ST) teach me how to scrub. It think it would make me a better circulator and assist. In my hospital we mostly use OR techs to scrub and the RNs were used to circulate and monitor on the CS cases.

shodobe

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

I am CNOR and RNFA but I have very little scrub experience and I would love to have a seasoned scrub (RN, LPN, or ST) teach me how to scrub. It think it would make me a better circulator and assist. In my hospital we mostly use OR techs to scrub and the RNs were used to circulate and monitor on the CS cases.

I would hope that you are not wasting your time working at this hospital. You need to find somewhere that will allow you to practice as an RNFA. To answer the question posted, I am CNOR and have been scrubbing for 28 years. We have an all RN staff, except for the token tech we have, and ALL new hires are required to learn how to scrub. If you are a strong circulator and a poor scrubber you will not work at our hospital, no exceptions!. All RNs should scrub and if you go through the past threads you will come across a rather long response from a variety of people. Happy hunting, Mike

Mary, for my part the answer is simple. I am a perioperative nurse. Basically this means I apply theory and practice in all aspects of OR care. I am as competent in scrubbing for an AAA, as I am in assisting the anaesthetic provider during a craniotomy. I am as efficient in circulating for a laparotomy as I am in organizing the operating list for the day for ENT. Any OR nurse who is unable to perform all his or her or duties cannot truly call themselves a perioperative care provider. So therefore my opinion is there is no excuse for someone to work in the or and not scrub. To me it should be mandatory.

mcmike55

Specializes in surgical, emergency. Has 40 years experience.

I agree that working in the OR, you should be able to do both.

Where I work, in a small rural hospital, it was decided that it was not economic to have an all RN surgery, therefore, having the RN scrub.

A registered nurse must be the circulator, so, if you have a RN scrub, that's two RN's in the room (easy math, right?)

For us, it's just not economic.

We have done it, and I thought it was fun, we rotated cases, etc.

I have been in surgery for 20+ years, and I love to scrub, but don't do it enough to take on the really big cases. But I'm good enough to do hernias, some ortho, etc.

I totally respect scrub techs and the job they do, and hope that they respect me and my job. It's kind of like the old saying about walking a mile in another man's shoes....mutual respect.

Mike, you use all RN's that's great, I wish we could afford to do that.

shodobe

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

I have a Director that is from the old school and will only hire RNs to fill positions. She has never had a problem with administration and economics. The tech we have is fairly good but lacks in a lot of skills. I am not sure why she was hired. I think it was to fill in a quick fix when she couldn't find a RN at the time. I and my fellow RNs are in a unique situation that most RNs will not find. I am sure as soon as she retires, techs will be a thing of the future. Other places I work at PT have techs and I am use to them and have no problem. The problem I see with the original question is one that it shouldn't be a situation where RNs should be allowed to scrub, it is one that techs should be allowed in the OR in the first place. I am old school and RNs were always in the OR and techs worked in surgi-centers and such. RNs should have stood their ground many years ago and not allowed techs to take jobs that were always theirs. This was before unions and no such luck with upper management. I think that if it was tried today in the union era, the door would be shut and techs would have a very difficult time getting thier foot in the door of most ORs. It all boils down to economics, cheap labor for cheap dollars. This is not to snub their skills, but when you can pay someone half of what an RN gets, why not. Sorry for ranting on but it is a little ridiculous to think I would have to ask permission to scrub a case over a tech. Mike

Thanks, great reply. This is the kind of reply I am looking for.

Mary, for my part the answer is simple. I am a perioperative nurse. Basically this means I apply theory and practice in all aspects of OR care. I am as competent in scrubbing for an AAA, as I am in assisting the anaesthetic provider during a craniotomy. I am as efficient in circulating for a laparotomy as I am in organizing the operating list for the day for ENT. Any OR nurse who is unable to perform all his or her or duties cannot truly call themselves a perioperative care provider. So therefore my opinion is there is no excuse for someone to work in the or and not scrub. To me it should be mandatory.

callbabe

Specializes in operating room. Has 37 years experience.

I am CNOR and RNFA but I have very little scrub experience and I would love to have a seasoned scrub (RN, LPN, or ST) teach me how to scrub. It think it would make me a better circulator and assist. In my hospital we mostly use OR techs to scrub and the RNs were used to circulate and monitor on the CS cases.

You have to have x number of years scrubbing to even apply.This is very scary to think that you are across from the surgeon and clearly do not have the scrub experience it takes to pass on a case, let alone 1st assist.

I am a 30 year RN. I have scrubbed,circulated, and 1st assisted in all aspects in the OR. I am also CNOR,RNFA, I think in the absence of a second surgeon on a case, 1s choice should be a experienced,RNFA, second choice would be an experienced RN scrub. Lets face it our patients deserve the best.

You do need a good nurse scrub to precept you on cases. You need to be a proficient scrub on any case you plan on 1st assisting on. Your surgeon needs this level of expertise, and your patients deserve nothing less.

I have been a First Assist for 13 of the 17 years I have been scrubbing and NO I am not a RN. I make as much or sometimes more than the RNs in the room. I can circulate circles around most of the RNs they grab off the street to fill some policy that states an RN must be in the room.The RNs come to me and ask what we need, I am usually the one to pull all equiptment the supplies, meds and mix then prior to the case because they give me some new grad fresh out of nursing school and expect me to be able to teach them. I have no problem with the teaching part, but when an RN walks into the room and is learning to scrub or circulate with me, she better be ready to do it herself.. I am a great teacher but I think you have to get your hands dirty to learn. Circulators: No sitting back reading a book or magazine after the case starts, you better be standing at my back table ready & willing to learn and LISTEN>>> Watch what's going on and be ready to anticipate the needs of the scrubber, myself and my surgeon. No different than my job. I have the experience in the OR and feel everone deserves to learn and if you are willing; keep asking, keep begging and if your free, ask a Tech to let you scrub in with them.

Talk with the general surgeons about helping out on small cases.

So in response to the question: YES all of us should be crossed trained to be able to function in any area of the OR. NO EXCEPTIONS...

A patient shouldn't be in danger or die because they don't have properly trained staff in place.

This topic has been done to death----do a search.

No need for any circulator to "stand" behind anyone's back table--listening is our most important skill, and we need to be listening and anticipating needs for anesthesia and the surgeons as well--not just for the scrub. Most circulators are, or should be, damned good scrubs--back in the day, we had to learn to scrub FIRST before we could ever circulate--that way we could anticipate (without being asked, and without having to STAND behind anyone's back table) what they would need--because we'd been there before, and would be there again. When I scrub, I try to make sure I have everything I could possibly need for the case in the room, so that the circulator isn't out of the room half the time, getting things that I forgot (and that were, indeed, my responsibility to remember.)

I have no problem with my circulator sitting and reading a magazine or whatever---he or she is on her feet enough, and will be on his or her feet in an instant if need be. We all have finely tuned listening skills, and we are all capable of glancing at a back table occasionally to see if laps, NS, suture etc. need replenishing.

The policy for an RN in the circulator role--NOT just "in the room--" is dicatated by our professional organization (governing body) AORN, and is also law in every state that I am aware of. Every patient deserves a Registered Nurse. It's the law--not someone's whim for a need for "warm bodies."

This topic has been done to death----do a search.

No need for any circulator to "stand" behind anyone's back table--listening is our most important skill, and we need to be listening and anticipating needs for anesthesia and the surgeons as well--not just the scrub. Most circulators are, or should be, damned good scrubs--back in the day, we had to learn to scrub FIRST before we could ever circulate--that way we could anticipate (without being asked, and without having to STAND behind anyone's back table) what they would need--because we'd been there before, and would be there again. When I scrub, I try to make sure I have everything I could possibly need for the case in the room, so that the circulator isn't out of the room half the time, getting things that I forgot (and that were, indeed, my responsibility to remember.)

I have no problem with my circulator sitting and reading a magazine or whatever---he or she is on her feet enough, and will be on his or her feet in an instant if need be. We all have finely tuned listening skills, and we are all capable of glancing at a back table occasionally to see if laps, NS, suture etc. need replenishing. Also, the circulator has to be always one step ahead in getting the NEXT case ready, putting things away, answering the phone (which sometimes rings incessantly) and stocking the room prn--so she is rarely kicked back for any great length of time reading. If she has a few free moments to read, why begrudge her that?

The "need" or "rule" for an RN in the circulator role is dicatated by our professional organization (and governing body) AORN, and is also law in every state that I am aware of. Every hospital OR creates its guidelines and P&Ps according to AORN Standards of Care and Guidelines. Every patient deserves a Registered Nurse. It's the law--not someone's whim for a need for "warm bodies."

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

I have been a First Assist for 13 of the 17 years I have been scrubbing and NO I am not a RN. I make as much or sometimes more than the RNs in the room.
Money doesn't mean squat when it comes to pt. safety, and people being within their scope.

I can circulate circles around most of the RNs they grab off the street to fill some policy that states an RN must be in the room.
Grabbed off of the street:rolleyes: Come ON!

The RNs come to me and ask what we need, I am usually the one to pull all equiptment the supplies, meds and mix then prior to the case because they give me some new grad fresh out of nursing school and expect me to be able to teach them.
If i were an RN, i would want another RN to teach/precept me. OF all people they would be able to train me according to my scope of RN practice.

I am a great teacher but I think you have to get your hands dirty to learn. Circulators: No sitting back reading a book or magazine after the case starts, you better be standing at my back table ready & willing to learn and LISTEN>>> Watch what's going on and be ready to anticipate the needs of the scrubber, myself and my surgeon
This reeks of self-entitlement.

No different than my job.
Yes it is. Check your state laws, and your facilities polies, you'll see the difference.

I have the experience in the OR and feel everone deserves to learn and if you are willing; keep asking, keep begging and if your free, ask a Tech to let you scrub in with them.
Experience is one thing, reality is another. You're not RN, no matter how many years you've done your job, and there are certain things in an OR that only an RN can do.

A patient shouldn't be in danger or die because they don't have properly trained staff in place.

Or staff that is doing things they should not be doing (like being a non-RN circulator)

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

(Our facility puts new RNs circulating first, then scrubbing.)

shodobe

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

Marie and stevierae, you guys just kill me! She does sound like she is full of it and she better not do anything that isn't in her scope of practice. NO, you do not get to crosstrain as an RN would and yes, you are working under the direction of the circulatorRN and not on your own. Also, your job description has to be completely different than the RN or your nurse manager needs to drastically revise it. This is not a discussion on a person knowing their place but that the person knows what they can do legally. Everything Marie and stevierae stated was correct and should be followed to the letter of AORN standards. Maybe it is different in Hawai'i since they seem to be so laid back. Happy New Year to all!

Marie_LPN, RN, LPN, RN

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

The mixing meds thing has bothered me since i read it. I mean, what meds, what are the effects, compatabilities, etc.? I do not believe anyone should be mixing meds or messing with meds unless they have the knowledge of what they're mixing, drawing up, etc.

(And ideally, that person should always be a nurse.)

Leyona, I can truthfully say that you and I would not work well together. Your attitude is just awful. Your negative attitude toward Registered Nurses reeks of either bitterness or jealosy. All I can say is if ever we were to work together Leyona I would inform you whose boss in the room and it wouldent be you. However as the hospital I work in will only employ Registered Nurses I guess that will never happen.

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