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.
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."
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 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!
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.
carcha, it is amazing how ONE tech out of thousands will give new RNs the impression that they are all like this. It sounds to me if this is the case where she works, the nurse manager is weak and let's her get away with alot and the RNs have no backbone. I personally think this response is a joke and this isn't really happening because it wouldn't anywhere I have been. We'll see if she responds to any of our threads. A good Tech will be a great asset to any department, if they have the right attitude, but a "high on the horse" attitude stops at the door here. Hell will freeze over before I ever "ask" a tech to scrub in with them! Mike
The question that was posted was: Should RNs be required to have scrub knowledge prior to circulating. My response basically was yes.
I feel everyone in the OR needs all the skills required to be competent in the OR.
I have no problem with RNs, and I work VERY well with everyone in the room, my role as First assistant is different than that of the basic scrub tech. It IS my responsibility to know and be sure my scubber and Nurse have everything we could posssibly need. My Problem lies with the hiring of NEW GRADS into an OR setting when they have no real clinical experience. Most of these RN Grads have only had one or 2 days in the OR if any. I work privately for a surgeon as his assistant so yes he trusts me to mix our meds before he would trust anyone else. I do nothing that is out of my "scope of practice" I do everything under the supervision of my Surgeon, and everyone respects my knowledge and the fact that they know our cases will go as smoothly and efficiantly as possible.
I didn't misunderstand anything you said, it just scares the **** out of me some of the things that you say you do. Do you know ANYTHING about the meds you're mixing. Do you know their classifications, side effects, adverse reactions?? The surgeon can supervise (actually have yet to see a surgeon supervise a med being mixed, and it's usually me and the RN) but the person mixing should ALWAYS know about the drugs.
I feel everyone in the OR needs all the skills required to be competent in the OR.
Then where are they suppose to GET these skills at if you say THIS:
Most of these RN Grads have only had one or 2 days in the OR if any.
That's what orientation is for. People cannot necessarily come into a specialty dept. as an expert. People have to learn somewhere.
I didn't misunderstand anything you said, it just scares the **** out of me some of the things that you say you do. Do you know ANYTHING about the meds you're mixing. Do you know their classifications, side effects, adverse reactions?? The surgeon can supervise (actually have yet to see a surgeon supervise a med being mixed, and it's usually me and the RN) but the person mixing should ALWAYS know about the drugs.
Then where are they suppose to GET these skills at if you say THIS:
That's what orientation is for. People cannot necessarily come into a specialty dept. as an expert. People have to learn somewhere.
Why is this scary to you?
Yes I do happen to know what I am mixing, I know its classification and side effects of the drugs I am using. I also realized the dangers of mixing wrong. I was taught not only in school but by the surgeon I work with. Which is why he trusts me to more so than someone who is reading it off of a preference card.
Also if the "tech " is responsible at the table to know what they have and all of its possible side effects, the surgeon has to be confident they know what they are giving him. It boils down to trust. Everyone has gotten completely off the actual subject here. My post was ment to encourage RNs to learn to scrub and who better than someone with knowledge and the trust of the people they work with, I taught Surgical Technology for 2 years and some of my students have become great techs and wonderful First assistants and yes some of them are now RNs and tell me often they apreciated my help because it has helped thier skills in the OR.
Leyona , PhD, MS, ADST (just in case you all felt I have no education behind be)
What does the initials "ADST" stand for? I have heard of ST, CST and just plain SA but not those. Education is nice but unless it is appropriate to the job you are doing it is meaningless. That said and all, it is still the responsibility of the "RN" to mix ALL drugs and unless I am mistaken it is NOT within your scope of practice to do this EVEN if the surgeon is standing right on top of you. I think you are the one who got off of the subject and made it quite plain that you felt superior to the RNs that were working with you. Sorry, that is just my perception.
stevierae
1,085 Posts
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."