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

[jamiebell]

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???

[jamiebell, RN]

It has been difficult to address this issue. 90% of the staff have only worked at this one facility and don’t know any different, they don’t want anything to change. They do a great job but I know it’s a legal liability.  I have made some staff and even some of the doctors upset with me, but  I believe in in doing the right thing, striving for excellence, continued growth, and education. Do your job for the patients and staff that trust you, ask the difficult questions, and stand up for there best interest. 

[OR_RN]

I think someone mentioned this before, but have you tried contacting the CST governing body? Not sure who that is in your state. You could anonymously ask for their policies for scope of practice so you have it in writing. 
 

Its really difficult to deal with people who let things slide to make their lives easier, but we ultimately are there for the patients, and don't work for the surgeons. At least at my hospital. There are going to be times we disagree and don't see eye-to-eye, but if you're doing it for the patient and their safety I would hope your management would back you up. Good luck and hopefully your co-workers see why you're concerned with this issue. 

[CST-CSFA]

I have over 10 years of OR experience. I have worked in multiple facilities. I hold both my CST and CSFA. I can tell you with 1,000% certainty that the scope of practice for a CST and CSFA are vastly different even though many people try to lump them together. A CST is not to manipulate nor handle tissue in any manner at all. A CSFA however can make incisions, insert trocars, inject locals, suture and approximate tissue, along with other many invasive tasks. Becoming a CSFA is a very time consuming and educationally intense course. It should not be taken lightly. Unfortunately from what I’m reading from this thread people don’t understand the vast difference and the fact that yes, it does matter and yes, there are different scopes of practice for a reason. AST is the accrediting body of CSTs and has a clearly defined scope of practice. They frown on these behaviors. ASA is the accrediting body for a CSFA and they clearly state what the scope of practice is. New York has passed into law and clearly defines what a CST can do. Indiana clearly states what a CST can do and what a CSFA can do. Depending on your location there is literature out there if contacting AST doesn’t resolve this issue. The hospital policy is nothing more than a piece of paper if your state has something in place saying a CST can NOT do what they have been. Unfortunately with CSTs holding certifications instead of licensure it’s not like they can be taken away. I hope this information helps and sheds some light for the others who don’t believe this is a thing. It’s no different than a CMA or LPN working in the scope of RN. Maybe if more people actually remembered what being in healthcare was about it wouldn’t be such a *** show all the time. Good for you for sticking up for the patient!

[Nursetom1963, BSN]

Very interesting thread!  Here's a thought; write up an incident report (I assume you have a system for it) send it in, keep the tracking number or a copy, and drop it.  You did your part.  And if you are ever asked (by an inspecting agency) you can point to your IR and say "I told them"