RN's scrubbing in on c/s???

Specialties Ob/Gyn

Published

The supervisor in my LD dept is trying to get rid of all of our surgical techs and is wanting the RN's to train to scrub in on c-sections? Personally I don't want to, I don't think that is within the nsg scope of practice, what do you think?

I take care of the baby in the OR during a C/S. I am not too stupid to scrub or circulate BUT we only had 680 births last year. There isn't the repetion needed to become proficient. Sometimes, it will be months from the time I go for one C/S to the next. I don't want to forget something in a stat situation. I do a few other things...L/D, L/d triage, nursery-including special care of whatever gestation decides to be born at our facility and stabilize the little ones until they can be transferred, post-partum, gyn, antepartum, PACU for C/S, maternal transport to other facilities. There are oodles of competencies to keep up. I don't think I can add OR and be safe and proficient. I have to hear EVERY EVERY time we have a C/S at night how we OB nurses should just do these ourselves. Truly, I have enough to do and I would do so few that I don't think I could be safe.

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I take care of the baby in the OR during a C/S. I am not too stupid to scrub or circulate BUT we only had 680 births last year. There isn't the repetion needed to become proficient. Sometimes, it will be months from the time I go for one C/S to the next. I don't want to forget something in a stat situation. I do a few other things...L/D, L/d triage, nursery-including special care of whatever gestation decides to be born at our facility and stabilize the little ones until they can be transferred, post-partum, gyn, antepartum, PACU for C/S, maternal transport to other facilities. There are oodles of competencies to keep up. I don't think I can add OR and be safe and proficient. I have to hear EVERY EVERY time we have a C/S at night how we OB nurses should just do these ourselves. Truly, I have enough to do and I would do so few that I don't think I could be safe.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Just a quick note. I do agree that everyone needs to be properly trained to do anything. I have done dozens and dozens of crash C/S in my career and once you get the hang of it, no problem. I guess it is a matter of confidence and skills and believe me once trained that confidence will be there. Where I work they use Techs in L&D, but the RNs have to be trained to do C/S in a pinch. The OR has bailed out L&D many times in the past but there are times when we just can't do it. In that department it is imperative to be able to scrub and to delay because of this does put two lives in jeopardy.

that is why having a qualified certified tech in house and anesthesia/doctor at hand 24/7 is critical. Having this, I see no need to push RN's to accept this HUGE responsiblity, on top of everything else we do. Imenid and Betsy said it well; we have enough on our hands and plenty of competencies to maintain as it is. I am not interested in endangering two lives anymore than the next nurse. Therefore, I am not interested in crosstraining to do THIS on top of everything else I am responsible for. They dont' pay enough to make me interested, either. Huge increase in liability at my pay? No thanks.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Just a quick note. I do agree that everyone needs to be properly trained to do anything. I have done dozens and dozens of crash C/S in my career and once you get the hang of it, no problem. I guess it is a matter of confidence and skills and believe me once trained that confidence will be there. Where I work they use Techs in L&D, but the RNs have to be trained to do C/S in a pinch. The OR has bailed out L&D many times in the past but there are times when we just can't do it. In that department it is imperative to be able to scrub and to delay because of this does put two lives in jeopardy.

that is why having a qualified certified tech in house and anesthesia/doctor at hand 24/7 is critical. Having this, I see no need to push RN's to accept this HUGE responsiblity, on top of everything else we do. Imenid and Betsy said it well; we have enough on our hands and plenty of competencies to maintain as it is. I am not interested in endangering two lives anymore than the next nurse. Therefore, I am not interested in crosstraining to do THIS on top of everything else I am responsible for. They dont' pay enough to make me interested, either. Huge increase in liability at my pay? No thanks.

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

I am still trying to figure out what the "huge responsibility" is. I have worked at 3 different hospitals where either the OR does the C/S or L&D does them with either Techs or RNs scrubbing. Also when I stated we "bailed" out the L&D on several occassions I meant just that, sorry if that ruffles some feathers. I think knowing the history here would make it a lot clearer, but there is too much to relate. I did C/S for the first 15 years here and that is with an ALL RN staff, no such thing as a Tech then. The problem now with L&D doing all the sections is it takes away an RN from the patients on the floor, so they hate to have to do them. When the tech calls off then it takes two RNs to do a section and that just compounds the problem. I think what I am saying is it takes very little skill to "scrub" a section, once you are properly trained, and I think the problem lies with what the RN is supposed to do during the case? I was trying to talk about skill level and the rest of you were trying to explain responsibility, whatever. Also, Marie team work can go both ways, I can't tell how many times over the years I have gone down to L&D and scrubbed a section for them because their Tech didn't show up and they were up to their armpits in patients, this out of the goodness of my heart and I didn't want them to struggle. I think that is pretty good team work. I think it is great you have a L&D dept that can function on it's own without backup. Our's have been doing this on their own for 13 years and still they have problems, they are lucky there are a bunch of us "older" RNs that still know how to do these sections, in my sleep! Kind of curious what your Techs do when not scrubbing? Mike

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

SHODOBE: do you work in OB?

If you did, you would then know it's a litigious enough area w/o that added responsibility/competency to keep up. I would need say no more.

Yanno, I don't ask OR nurses to circulate a lady partsl DELIVERY, do I? Hey, Why not have THEM recover our babies in central OR?

Because: it's not what they are trained to do and can't maintain competency as they would not do it enough to do so. Make sense?

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Specializes in Rehab, Step-down,Tele,Hospice.

No.. I was referrring to SKILL, not responsibility. When the OB nicks a bladder it takes some SKILL to be able to retract and throw the correct suture in the correct bleeding area. It takes SKILL to be able to assist, hand instruments, suction and suture all at the same time. (it also helps to be large breasted as you eventually run out of hands and can hold the retractor with your chest while maximing visual space and handing instruments.)

It takes SKILL to tell the 2 nd year resident who is scrubbing what the best suture will be for that particular patient.

Its kinda funny b/c most of the nurses who find out I have an OR background almost always roll their eyes and say" Oh, OR nurses are so one dimensional, can't do a thing outside the OR" Guess it's all in the perception.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
Guess it's all in the perception.

Evidently. :chuckle

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Perception indeed. Many other nurses and surgeons can be heard saying OB nurses are stupid and lazy, too.......

It is all in the perception.

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Specializes in Case Mgmt; Mat/Child, Critical Care.

Wow, I guess I'm a little confused here, shodobe..... I don't understand how you can question that there is, indeed, a very large responsibility when scrubbing?

I know I wouldn't feel comfortable scrubbing. Circulating, totally another matter, but no way do I feel comfortable scrubbing.

I'm guessing you are an OR nurse....do you circulate, scrub, or both? Obviously with scrubbing, you need to know technique, instruments, proper handling of such, loading the drivers, suture, etc, etc, etc. So, if a nurse who doesn't do this routinely/regularly...suddenly is called upon to do this....you see no issue of responsibility here? Interesting.....

Also, I'm not sure I'm getting this "tone" of "c/s are boring" and we "bail out" L&D. It really seems kind "diva-ish" to me. Last time I checked, both the OR nurses and L&D nurses are employed by the same hospital....if you are assigned to go do a c/s, and your job is a scrub nurse...how is that "bailing" anyone out? Or maybe you think you're bailing out a crashing baby, doing them such a huge favor as to assist in an emergency procedure?

And, quite frankly, I would think scrubbing or circulating for surgeries of any kind would be "kinda boring" after awhile...I mean once you've seen one gallbladder/spleen/appendix....day in, day out....you've seen them all.

As they say, to each their own. That's why it's so lovely to have so many different areas to choose to practice in!

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I used to work in a high-volume OB unit (around 600/month) and we used OB techs (I don't think they were certified scrub techs) as scrubs - we usually had 2-3 at night. When these OB techs weren't scrubbing they were doing blood glucose fingersticks, drawing labs, filing things in charts, getting supplies, during the day and occasionally at night they did bed baths, took pts to pp... I have to admit I did see them sitting around talking at night a lot, but there were some nights that the nurses got to do that to. Overall they were a joy to work with and made our jobs a lot easier. I've seen us do 17 sections in one day so it was definately cost effective to employ them as opposed to extra nurses. (When we go back on a section we have 1 RN circulator, 1 RN baby nurse, and 1 OB tech. With no OBT we would have to have 3 nurses readily available and sometimes we have trouble finding a baby nurse to go back for 15 or so minutes to do the baby!) Several of our nurses were former OB techs and if we were in a pinch they were usually eager to scrub or helped the scrub get stuff ready for crashes.

There are a lot of things that techs can be trained to do that would be useful on an OB unit and I'm surprised that they aren't considered cost effective. Personally I always wanted to learn to scrub (that is why my new job is as an OR nurse!!), but I can't imagine why is should be a requirement of the job - especially in a place that does 680 c/s a year!

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I used to work in a high-volume OB unit (around 600/month) and we used OB techs (I don't think they were certified scrub techs) as scrubs - we usually had 2-3 at night. When these OB techs weren't scrubbing they were doing blood glucose fingersticks, drawing labs, filing things in charts, getting supplies, during the day and occasionally at night they did bed baths, took pts to pp... I have to admit I did see them sitting around talking at night a lot, but there were some nights that the nurses got to do that to. Overall they were a joy to work with and made our jobs a lot easier. I've seen us do 17 sections in one day so it was definately cost effective to employ them as opposed to extra nurses. (When we go back on a section we have 1 RN circulator, 1 RN baby nurse, and 1 OB tech. With no OBT we would have to have 3 nurses readily available and sometimes we have trouble finding a baby nurse to go back for 15 or so minutes to do the baby!) Several of our nurses were former OB techs and if we were in a pinch they were usually eager to scrub or helped the scrub get stuff ready for crashes.

There are a lot of things that techs can be trained to do that would be useful on an OB unit and I'm surprised that they aren't considered cost effective. Personally I always wanted to learn to scrub (that is why my new job is as an OR nurse!!), but I can't imagine why is should be a requirement of the job - especially in a place that does 680 c/s a year!

Our OBT's are a Godsend. I do NOT want to be trained to scrub! I love circulating and am glad that we had to start doing our own sections. It was a real nightmare at first (for us and the OR) but when all was said and done, it was great, not to mention it is wonderful for our patients as well.

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