Scope of practice in the OR, am I the only one that sees a problem with this?

Nurses General Nursing

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I have been an RN in the OR for 16yrs. I was a surgical tech for 6 years while putting myself through nursing school.  As a scrub tech at a teaching hospital, your scope of practice was cut and dry.  I am now currently in school for my RNFA. About a year ago, I got married and moved. I now work at a much smaller hospital. 90% of the staff (CST & RN) have ONLY worked in that operating room. I find myself struggling with the CST/STs that practice outside of their scope. (Suturing, making incision, putting in ports, stapling across bowel) Just to mention a few things. I have spoken to the OR manager about the scope of practice for a CST/ST. I get no answers from them as to why the scrub techs are practicing as a first assist without proper training or credentialing. I have informed the manager these behaviors are still happening. The response I have gotten, “Under direct supervision of the surgeon“. Do the surgeons know that the scrubs are not qualified to execute these tasks? Or have they just done whatever they had to, to get through the surgeries? None of the CST/ST have first assist training. I know there is legal liability when staff are working out of there scope of practice. I have been there over a year and nothing has changed! The other RNs say you have to pick your battles and nothing is going to change because of poor management. Any suggestions???

     As an OR/CVOR RN for almost 30 years and having practiced in numerous states as travel staff, I can tell you there are many regional variations in this area.  However, advocacy is central and foremost to a circulating nurse’s role.  If a qualified surgeon wanted to perform procedures outside of their facility privileges, would you speak up?  Kind of the same thing, yes?  
    The fact is, I (and most experienced OR nurses), am well aware of what a CST’s scope of practice is and these examples are way outside those guidelines.  I also understand what you’re up against with the department’s culture and admire your courage in speaking up.  With that said, realistically,  I seriously doubt that this will result in anything other than difficult working relations for you there.  My advice is to move on to somewhere you can work without this moral/ethical tug of war and before you are set up by a disgruntled coworker(s)-I’ve seen it happen.  Good luck

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Specializes in Operating room RN, CST, RNFA student.
On 4/5/2021 at 4:42 PM, Wedgepressure said:

Honestly,  it sounds like your making mountains out of mole hills.  Inquiring about the CSTs scope isn't really in the purview of your scope.  To me this really doesn't affect you or your license in any way and it's not even something that needs to be addressed by you. 
 

As a the circulating RN in an operating room, it is your duty to ask questions and voice any concerns you may have. You are the patient advocate. Once they go to sleep they cannot speak for themselves. They trust you as the nurse “the gate keeper” of the operating room to make sure they are safe. Yes, it is my job to know everyone’s scope of practice in the operating room!

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Specializes in Operating room RN, CST, RNFA student.

As a the circulating RN in an operating room, it is your duty to ask questions and voice any concerns you may have. You are the patient advocate. Once they go to sleep they cannot speak for themselves. They trust you as the nurse “the gate keeper” of the operating room to make sure they are safe. Yes, it is my job to know everyone’s scope of practice in the operating room!

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Specializes in ICU/Burn ICU/MSICU/NeuroICU.

Never worked OR as an RN. 

Every other nursing job has protocols. The protocols are what protects our license. Should be protocols in place for those CST/ST's doing whatever. Or, those protocols may say it's supposed to be an RN or have such and such training. Check those. And yeah. . .pretty important. As a Nurse, you're supposed to be aware of protocols. Ergo, you'd also know if they were being ignored. 

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On 7/30/2021 at 10:58 AM, OR_RN said:

... The scrub tech works under the RN license in my state. ...

I'm curious, which state is this?

And is it only the scrub tech that works under the RN's license?  Or does this apply to other licensed assistive personnel as well?

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Specializes in Operating Room.
21 minutes ago, chare said:

I'm curious, which state is this?

And is it only the scrub tech that works under the RN's license?  Or does this apply to other licensed assistive personnel as well?

I'm in California. As far as I know, they are the only people on the team working under the RN's direct supervision in the OR.

I've attached the current California CST laws for you to look over. It specifies their scope of practice, but does not include suturing. It says they can cut and prepare suture, but to me that does not include the act of suturing.

Try to Google "scrub tech laws" in your state to see if they outline their scope for you. I'm curious to see if this differs in other states.

https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB2062&showamends=false

 

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1 hour ago, OR_RN said:

[...]

I've attached the current California CST laws for you to look over. It specifies their scope of practice, but does not include suturing. It says they can cut and prepare suture, but to me that does not include the act of suturing.

[...]

https://leginfo.legislature.ca.gov/faces/billCompareClient.xhtml?bill_id=201320140AB2062&showamends=false

I believe the bill that you reference here was returned unsigned by the governor. 

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Specializes in CCL RCIS.
22 hours ago, jamiebell said:

As a the circulating RN in an operating room, it is your duty to ask questions and voice any concerns you may have. You are the patient advocate. Once they go to sleep they cannot speak for themselves. They trust you as the nurse “the gate keeper” of the operating room to make sure they are safe. Yes, it is my job to know everyone’s scope of practice in the operating room!

From your statements on the forum you come off as someone difficult to work with.  

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Specializes in Operating Room.
3 hours ago, chare said:

I believe the bill that you reference here was returned unsigned by the governor. 

I think that was an amendment, but I think this is the current bill passed. I could be reading it incorrectly, but it says "passed"

https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201120120AB2561

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3 hours ago, OR_RN said:

I think that was an amendment, but I think this is the current bill passed. I could be reading it incorrectly, but it says "passed"

https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201120120AB2561

This was also returned unsigned by the governor.

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Specializes in Operating room RN, CST, RNFA student.

Georgia, I have also looked up scope of practice for CSTs  in GA. It reads almost word for word as California CST. Only with advanced education/first assistant programs are the CSTs able to suture, place Instruments, cut tissue, or permanently alter tissue. I simply asked management to clarify and put in writing that the scrub Tech‘s are allowed to perform first assisting tasks without advanced education. I’m not just talking about holding retractors or maybe cauterizing tissue. I’m talking about making incisions and placing trochars in the abdomen. Apparently, legal would not put that in writing and risk management has addressed some of the issues that were taking place. I am the patient advocate and I wanted to make sure I was covered legally. Nowhere else I’ve ever worked was this an acceptable practice. I never made a formal complaint or wrote anyone up. I just asked for clarification in writing. 

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Specializes in Operating Room.
1 hour ago, jamiebell said:

Georgia, I have also looked up scope of practice for CSTs  in GA. It reads almost word for word as California CST. Only with advanced education/first assistant programs are the CSTs able to suture, place Instruments, cut tissue, or permanently alter tissue. I simply asked management to clarify and put in writing that the scrub Tech‘s are allowed to perform first assisting tasks without advanced education. I’m not just talking about holding retractors or maybe cauterizing tissue. I’m talking about making incisions and placing trochars in the abdomen. Apparently, legal would not put that in writing and risk management has addressed some of the issues that were taking place. I am the patient advocate and I wanted to make sure I was covered legally. Nowhere else I’ve ever worked was this an acceptable practice. I never made a formal complaint or wrote anyone up. I just asked for clarification in writing. 

It would be like you performing surgery and no one asking why. There is a surgeon there for a reason - they have the training to do so and it is in their scope to perform the procedure after years of training. For a CST to perform surgery (suture, cut tissue) would be what I consider out of their scope, and it is absolutely our job as the RN to question this. I wouldn't think of you as being difficult at all for sticking up for patient safety. You're right that we are there for the patients and we are their spokesperson while they are under anesthesia. If we don't, who will? 

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