Should Surgical Technicians Circulate

carcha · Apr 30, 2004

Hey, Lonman, lighten up. This posting is a fair debate on the roles of all the OR team and we all should be comfortable about posting topics of interest to all of us. As an RN I get so fed up with or techs who feel "we are all the same". When OR techs go to university to get their degree, take both the responsibility and accountability, then yes we are all the same. Until then guess what, although both u and I may be as good as each other, may be the most wonderful OR nurses who walked the planet but RN's are the qualified nurses in overall charge of patient care. Your reply is so interesting as another thread, not the or, recently highlighted the plight of an RN in charge of a unit who was held accountable for a mistake an LPN made. Granted the LPN was fired however as the accountable professional in overall charge the RN was also blamed. Your negative attitude is uncalled for.

Lonman · Apr 30, 2004

Sorry if anyone feels that I was making negative statements. I feel I was not and I agree with you that this board is for discussions.

The question was about ST's circulating in the OR and all I did was respond. Perhaps those who might get offended are in denial of the truth??

Reminds me of the fear that some RN's have regarding the ST's getting licensed.

BTW, I am in the USA, how do they do things regarding regulating the ST where you work? In the USA, it is not standard practice (meaning mandatory)that the ST be certified, let alone registered or licensed. There are those hospitals that do require an ST to be certified but hardly any state requires registration and licensure.

This is a matter that continues to baffle the ST's of the United States. We, the State Assemblies of Surgical Technology continue that plight. Wouldn't you??

Anyway, I feel that this is getting off the subject.

Again, should ST's be allowed to circulate..YES if the need is there.

POPRN · May 1, 2004

Actually,for those who felt threatened, the Illinois bill that goes in effect in July is not intended to "replace existing RN's". It is actually the 1st attempt to get more regulation in this field that many of you love to phrase, "unlicensed professionals". Isn't it about time that surgical technologist become licensed?? As you the RN's love to say, don't you wnat the best qualified help??
As for the main issue on this thread about circulating, in the accredited programs we are taught the role of circulating except the paperwork involved. Surgical Technologist love what they do and could care less about doing paperwork. We believe in the concept of TEAMWORK and that the patient is our number one priority in OUR DOMAIN, the operating room. OUR DOMAIN, refers that we are specialist. We are trained for the operating room setting. Not the Registered Nurse who is a jack of all trades. RN's get OJT when it comes to the operating room. They also get OJT when it comes to the RN's scrubbing procedures, doing what the trained specialist is trained to do.
The bottom line regarding should we circulate should be this. If there is a need for institutions to utilize CST's then yes, as for the paperwork involved, that what OJT is for..Right? Some hospitals make it work and it works for them just fine. For others, the need may not be there.
There should be more emphysis on teamwork in the OR then the "in charge" mentality that I routinely see regarding RN's and CST's.
I can honestly say that after 14 years at my workplace, our CST's and RN's, and SA's all work together and there isn't just 'ONE' in charge. We don't have that mentality. I also don't see that in other hospitals in this area.
Do I circulate, yes, do I do the paperwork and documentation? No, not when the need is not there. Do I have the skills? Yes, I have learned OJT from the many talented staff that I work with. Sounds familiar doesn't it??
RN's, a cut above the rest??? Not hardly.

Oh my goodness...where I work. The CST's can be a 2nd circle with the RN. they mainly open and count and then they are "supposed" to stay and help the RN, by going and getting supplies and whatever is needed to do the case.

CST's are not allowed to give meds. Teamwork is a good concept. but without a captain, where is the team??? as the RN in the room. I have to know when to send for the next patient. make all the phone calls. answer dr. beepers, give messages that include lab values, telephone orders etc... A CST does not have the training to do that nor do they have the legal ability! they don't have a license to lose!!!!! How can you circulate without the paper work? that is part of the job. I have found the CST very proficent in the clinical aspect of their job. The RN should be aware of the clinical aspect as well as the legal and ethical aspects.

sorry to sound off.

orrnlori, RN · May 1, 2004

Oh my goodness...where I work. The CST's can be a 2nd circle with the RN. they mainly open and count and then they are "supposed" to stay and help the RN, by going and getting supplies and whatever is needed to do the case.
CST's are not allowed to give meds. Teamwork is a good concept. but without a captain, where is the team??? as the RN in the room. I have to know when to send for the next patient. make all the phone calls. answer dr. beepers, give messages that include lab values, telephone orders etc... A CST does not have the training to do that nor do they have the legal ability! they don't have a license to lose!!!!! How can you circulate without the paper work? that is part of the job. I have found the CST very proficent in the clinical aspect of their job. The RN should be aware of the clinical aspect as well as the legal and ethical aspects.
sorry to sound off.

Exactly. Anyone of my nursing assistants can fetch or open items to the field or tie up staff. If that what we are talking about. So I guess you call that circulating Lonman? It's not. As stated above, there's much more to circulating than that, but if you are an instructor then you know that. I work with some great and professional scrub techs, and I work with others who you have to go find to get cases started. I personally think scrub techs should be tested and licensed. As it is right now, scrub techs work under my license and I am responsible for them in every sense of the word. When push comes to shove, who do you think is ultimately responsible in the OR. Not the tech.

Marie_LPN, RN, LPN, RN · May 1, 2004

The techs at my facilitiy do not work under the RN circulator's license. They work under the Asst. M. of Operative Service's License.

A surgical tech at my facility is an LPN who hasn't gotten their license yet. Once they do, they're an LPN (fill in job title here). This way they're under their own license and their own responsibility.

stevierae · May 2, 2004

Actually,for those who felt threatened, the Illinois bill that goes in effect in July is not intended to "replace existing RN's". It is actually the 1st attempt to get more regulation in this field that many of you love to phrase, "unlicensed professionals". Isn't it about time that surgical technologist become licensed?? As you the RN's love to say, don't you wnat the best qualified help??
As for the main issue on this thread about circulating, in the accredited programs we are taught the role of circulating except the paperwork involved. Surgical Technologist love what they do and could care less about doing paperwork. We believe in the concept of TEAMWORK and that the patient is our number one priority in OUR DOMAIN, the operating room. OUR DOMAIN, refers that we are specialist. We are trained for the operating room setting. Not the Registered Nurse who is a jack of all trades. RN's get OJT when it comes to the operating room. They also get OJT when it comes to the RN's scrubbing procedures, doing what the trained specialist is trained to do.
The bottom line regarding should we circulate should be this. If there is a need for institutions to utilize CST's then yes, as for the paperwork involved, that what OJT is for..Right? Some hospitals make it work and it works for them just fine. For others, the need may not be there.
There should be more emphysis on teamwork in the OR then the "in charge" mentality that I routinely see regarding RN's and CST's.
I can honestly say that after 14 years at my workplace, our CST's and RN's, and SA's all work together and there isn't just 'ONE' in charge. We don't have that mentality. I also don't see that in other hospitals in this area.
Do I circulate, yes, do I do the paperwork and documentation? No, not when the need is not there. Do I have the skills? Yes, I have learned OJT from the many talented staff that I work with. Sounds familiar doesn't it??
RN's, a cut above the rest??? Not hardly.

Lonman, I will say this again: Patient assessment cannot be delegated to an operating room technician--whether he is certified or not. We are not talking here about doing paperwork, opening laps , adding suture, counting--we are talking about NURSING DIAGNOSIS and NURSING ASSESSMENTS. Nursing responsibilities cannot be delegated. Most nursing responsibilites, if not all, in an operating room setting, are RN responsibilities. Would I feel comfortable delegating insertion of a Foley to an LVN (LPN?) Sure, if she was experienced in the procedure.

Would I feel comfortable delegating nursing assessments and nursing diagnosis to an LVN or LPN ? Probably not--the patients we deal with really are best dealt with by RNs. They have multi-system problems and, worse yet, potential problems.

Anyway, my professional organization, AORN, has standards that state that patient assessment/diagnosis is an RN responsibility. Standards, as opposed to guidelines, are essentially bare bones, written in stone, do not cross this line RULES. You cannot attempt to change those rules that dictate OR policy and procedure to suit your own needs or interpretations. They dictate minimum standard of care. Who are you to challenge what constitutes minimum standard of care for a surgical patient?

LIke it or not, the circulating nurse is in charge of the room. Surprised? Don't believe me? Ask your boss.

Even in an all RN OR, where the scrub AND circulator are both RNs, the circulator is in charge of the room. The circulator is the patient's advocate. The circulator must anticipate, and respond appropriately to, in a timely fashin, when seconds count, anything that could possibly go wrong with that patient. Can you honestly say you have that capability? Didn't think so.

We have a slogan out here, widely televised and on billboards: "Every Surgcial patient Deserves An RN."

It is not media a hype. It is not publicity. It is a FACT, distributed in the interest of safe patient care.

Oh, and excuse me--I can scrub virtually any specialty,proficiently, and have done so for 30 years--as opposed to some techs who can "only do GYN' or "only do ENT" or "can't scrub a crani, or a spine." Bunch of da** prima donnas.

Wherever I have worked, it was required--one cannot take scrub call, especially trauma scrub call, without being able to scrub whatever comes crashing through the doors.

Marie_LPN, RN, LPN, RN · May 2, 2004

Smelling bad attitudes here. This was educational and interesting at first, now it's a nerve grater. Peace.

suzanne4, RN · May 2, 2004

The techs at my facilitiy do not work under the RN circulator's license. They work under the Asst. M. of Operative Service's License.
A surgical tech at my facility is an LPN who hasn't gotten their license yet. Once they do, they're an LPN (fill in job title here). This way they're under their own license and their own responsibility.

Most surgical techs are CSTs, certified surgical technologists, not LPNs. There are only one or two that have actually been LPNs that I have worked with. The LPN would have had to go through an appropriate program to learn to scrub, it is not something that you learn in nursing school, not in any "normal" program.

suzanne4, RN · May 2, 2004

LPNs have a license but they still function under the license of the RN, no matter what type of facility that you are in, or the type of nursing. The RN is still ultimately responsible, especially in the OR.

Marie_LPN, RN, LPN, RN · May 2, 2004

Most surgical techs are CSTs, certified surgical technologists, not LPNs. There are only one or two that have actually been LPNs that I have worked with. The LPN would have had to go through an appropriate program to learn to scrub, it is not something that you learn in nursing school, not in any "normal" program.

I'm sorry, i should have clarified. For where i work:

The "tech" has to have completed an LPN program (however long that might be, since it all depends on the area/school). But once the LPN is hired in the OR, they are "tech" until they pass boards and get their license. They still have to go through the program of learning to scrub, etc.

In other words, same as what you're describing that a tech needs to go through to be a tech, only our facility requires completion of an LPN program first before learning to scrub.

suzanne4, RN · May 2, 2004

There is actually longer schooling involved to become a CST, then there is to become an LPN. And they are also required to do an internship, before they can be considered done with their program. They will then have to go through a hospital's orientation....................

orrnlori, RN · May 2, 2004

RN's, a cut above the rest??? Not hardly.

Something has just struck me, if what an RN does in the OR is no big deal, then why do others want to do it? If you didn't mean to insult, then why the remark above?