Should Surgical Technicians Circulate

madmad · Jan 15, 2005

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.

My husband is a CST, and CFA, and an LVN. He has to tell his new RNs and New Circulators how to and what to ALL THE TIME (thats what working together is all about) isn't it? But when you say CST can't and shouldn't cir. because they have NOTHING TO LOSE, makes me wonder what kind of NURSE you must be to work with. I have been an LVN for over 25 years working ER and ICU, and I spend time TEACHING RNs basic/advanced nursing skills, (how to draw ABGS, start IVs, clear lines, read monitors,etc.), and they inturn TEACH ME THE WHYS and WHAT FORS. So I agree every department has room to LEARN AND WORK TOGETHER, pitch in when needed, learn all you can OTJ and hope you don't run into the RN WALL that tries to keep all others beneath them. Glad to know there are RNs out there that KNOW WHAT THE REAL WORLD IS LIKE, and enjoy working with SKILLED Co-WORKERS (certified, licensed, or REGISTERED)! Just had to speak up, sorry if I offend, my husband is in this fight now with our STATE ASSOCIATION, getting the Scrub Techs Licensed, so they aren't UNDER THE RN, but THE DR. !!!!!!!!!!!!!!!!!!! That way the RN isn't CARRYING the unlicensed. :rolleyes:

stevierae · Jan 15, 2005

My scope of practice REQUIRES me to be capable of assessing a patient, there is a big difference between assessment and diagnosis (which I believe RN's arent allowed to do either).

As shodobe pointed out earlier, nursing scope of practice varies according to state law.

In CA, where he and I both practice nursing, LVNs are not allowed to assess patients--period. It is not within their scope of practice. They have their own regulatory body; we have our own--the CA Board of Registered Nursing. LVNs also cannot be used to fulfill the minimum safe staffing ratios mandated by CA law (AB 394.) Those are strictly RN to patient ratios.

Re: diagnosis--no, RNs do not diagnose MEDICAL conditions. What we DO--every day--is assess, then form a NURSING diagnosis based on those assessments so that we can create an individualized care plan for each and every patient we have--and understand how to intervene and evaluate whether that care plan and those interventions resulted in a positive outcome. If we assessed and planned correctly, and continually modified our care plan and interventions, there is no reason that the outcome should be anything BUT positive. It's a dynamic--constantly changing based on the patient's changing condition--and our continual assessment of the patient's condition, and the formation of NEW nursing diagnoses based on those changes-- and the patient's individual needs.

madmad · Jan 15, 2005

I don't believe that Techs will replace RN circulators in Illinois.
Yes, Techs shouls follow and learn the circulating role, as well as RNs should follow and learn the scrub role.
We are a TEAM.
And, in short, NO - under no circumstance should a surg tech circulate.
All patients deserve an RN.
I will not get into it, because it would be hard to be diplomatic and also would be lengthy, but just for one little thing, what kind of education and understanding do techs have about proper positioning, nerve protection, and ulceration prevention??
-Dave

My husband is a CST, and CFA, and an LVN. He has to tell his new RNs and New Circulators how to and what to ALL THE TIME (thats what working together is all about) isn't it? But when you say CST can't and shouldn't cir. because they have NOTHING TO LOSE, makes me wonder what kind of NURSE you must be to work with. I have been an LVN for over 25 years working ER and ICU, and I spend time TEACHING RNs basic/advanced nursing skills, (how to draw ABGS, start IVs, clear lines, read monitors,etc.), and they inturn TEACH ME THE WHYS and WHAT FORS. So I agree every department has room to LEARN AND WORK TOGETHER, pitch in when needed, learn all you can OTJ and hope you don't run into the RN WALL that tries to keep all others beneath them. Glad to know there are RNs out there that KNOW WHAT THE REAL WORLD IS LIKE, and enjoy working with SKILLED Co-WORKERS (certified, licensed, or REGISTERED)! Just had to speak up, sorry if I offend, my husband is in this fight now with our STATE ASSOCIATION, getting the Scrub Techs Licensed, so they aren't UNDER THE RN, but THE DR. !!!!!!!!!!!!!!!!!!! That way the RN isn't CARRYING the unlicensed.

Fiona59 · Jan 15, 2005

Well, I guess we require a lot out of our LPNs up here in the Great White North. I know that training and scope of practice varies greatly from province to province.

We are trained to do physical and neurovital assessments, write careplans (reams and reams of them while training), evaluate our outcomes, be knowledgeable enough about our meds to be able to evaluate them and discuss them with the Dr.'s in LTC or the charge in Acute. About the only thing I haven't been able to do (that I was trained to do) is hang IV meds and ng insertions.

I'll say it again, the healthcare dollar is stretched to the limit and the appropriately trained healthcare worker has to be fully utilized for the taxpayer and the insurer's (never sure how to spell that word) benefit.

stevierae · Jan 16, 2005

My husband is a CST, and CFA, and an LVN. He has to tell his new RNs and New Circulators how to and what to ALL THE TIME (thats what working together is all about) isn't it?

I don't want to start a fight here--I can, and DO, work with anybody, and I am far from territorial--but if your husband is an LVN, then he works in CA. Now, CA has some of the savviest operating room nurse in the nation (hey, just look at shodobe and me, LOL!!)

All kidding aside, I have always found that those ORTs and even--(what did you call him--a CFA?--I am sorry, but in the operating rooms in which I have worked all over CA, I have never encountered a CFA--everywhere I have worked we have either PAs or RNFAs--) CFAs or ORTs who tell people that they "have to tell the RNs what to do" tend to be legends in their own minds.

Operating room RNs in CA tend to know their stuff--we HAVE to, as we are required to keep up a fair amount of continuing ed just to maintain CA RN licenses--and, truthfully, most of us were scrubbing and circulating before most ORTs and those who first assist--regardless of the "alphabet soup" surrounding their names--were BORN.

madmad · Jan 16, 2005

I don't want to start a fight here--I can, and DO, work with anybody, and I am far from territorial--but if your husband is an LVN, then he works in CA. Now, CA has some of the savviest operating room nurse in the nation (hey, just look at shodobe and me, LOL!!)
All kidding aside, I have always found that those ORTs and even--(what did you call him--a CFA?--I am sorry, but in the operating rooms in which I have worked all over CA, I have never encountered a CFA--everywhere I have worked we have either PAs or RNFAs--) CFAs tend to be legends in their own minds.
Operating room RNs in CA tend to know their stuff--we HAVE to, as we are required to keep up a fair amount of continuing ed just to maintain CA RN licenses--and, truthfully, most of us were scrubbing and circulating before most ORTs and those who first assist--regardless of the "alphabet soup" surrounding their names--were BORN.

... He is working in Texas. Texas LVN Certified First Asst.)/Certified Scrub Tech. Who is also an Instructor at local College, program to certify scrub techs. He is a lead preceptor at the OR where he still works PRN CALL for heart room. He is ACLS and CPR Instructor. I think I could trust ANY SURGICAL PT under his care, as circulator, scrub or first asst. He isn't an RN, and that still ruffles some of the "OLD HENS FEATHERS". I don't think he is an EXCEPTION either! I know most of the RNs, LVNs, CSTs,STs and Surgeons he works with ... they all work like EDUCATED PROFESSIONALS TOGETHER, and an LVN in Texas(ER,L&D,ICU,MED/SURG) can S.O.A.P. a patient without and RN in the bldg. as long as we have a Doctor to cover us. We too have to "know our stuff" and that includesEVERYTHING ABOUT OUR PT AND THEIR TOTAL HEALTH. Our responsabilty, NOT some other LVN or RN !! Is is that much different in other States? Or is it JUST RNs in the Operating Room??? Just asking an honest question? Hope i word this better than i did the last. I think better than i type. LOL )

shodobe · Jan 16, 2005

The last time I looked, CFAs were not recognized in the state of California and probably won't be in the near future. I don't know about Texas but in California your hubby would be working under me as a CST and nothing more. I have only encountered one so-called FA and I wasn't sure what his job was and when I questioned this I was told, " that's the way it has been for a long time"! I really don't think what he was doing was legal, but hey what do I know! I think it is great he has all of these creds but still he works under the direction of an RN, at least in California. This debate will rage on and on for ages and there is no real answer to it. To each their own, but you still have to have order to any situation or anarchy reigns supreme! There are bosses and there are worker bees, I am a bee under my director and the CNAs and STs and others on my shift are the worker bees for me. It works out real well because when the s**t hits the fan I am it, the responsible person. Each state has their own "scope of practice" as they see fit and I personally would like to see it the same across the land. There would be no more squabbling over who's best at what and who has the better qualifications or education to do whatever. If the "scope of practice" was standardized throughout the nation there would really be nothing to argue about, but unfortunately there are too many states living in the past and this would be too much trouble. Got to go for now, just finished my 16 hours of call and I really need some sleep. Mike

ps, I have been scrubbing for over 28 years and do come from a time when STs didn't even exist outside the military, so I do have a very strong opinion of their existence. I work at a facility where we are an AL RN staff, no techs( lucky us ).

stevierae · Jan 16, 2005

... He is working in Texas. Texas LVN Certified First Asst.)/Certified Scrub Tech. Who is also an Instructor at local College, program to certify scrub techs. He is a lead preceptor at the OR where he still works PRN CALL for heart room. He is ACLS and CPR Instructor.

Well, he certainly sounds like he knows his stuff--and is, indeed, exceptional. As I've said in previous threads, I have worked with some outstanding OR techs, and I continue to learn new stuff from the young ones all the time--they often have clever ways of setting up their back tables that immediately make me think, when I see them, "Hey! That's the way I'm doing it from now on!" They tend to be whiz kids around spinal instrumentation and total joint systems, too--they are very mechanical.

That's pretty cool that your husband teaches surgical technology, BLS and ACLS. Obviously he is a smart guy, and they--both the hospital where he works, and the college-- are lucky to have him.

Did he by chance get any of his training in the military?

shodobe · Jan 16, 2005

I am back after a good nights sleep. I agree with stevierae that certain programs are lucky to have people like your hubby. I guess what I was really getting at was I have worked with some very good, competent Techs, at another facility, and I have learned a few things from them. I only get to scrub about half the time so I like to see how others do their cases. We can all learn from each other and shouldn't put ourselves above another. There are rules set out to guide and unfortunately some try to circumvent these by setting their own. States are probably the worst ones because they allow stuff to happen without monitoring them. I am not new to this game and still like to reflect back to the "good old days" when only RNs worked in the OR, but that isn't the case anymore. The situation has changed dramatically over the past 10-20 years especially with the severe nursing shortage where hospitals need to come up with alternatives. The Scrub Tech role has been a god-send to the OR because of the new training that has been initiated over the past few years. Techs are not just taught, "this is a kelly", DUH! Their programs are more intense and longer now. I do see one day where states will licsense(?) and not just give certs to these programs. I am getting towards my twilight years, not for at least 15 years, and realize change is in the air, why fight or worry about it. I will stay in the OR for many years to come and do realize that my role will be one of directing and leadership. I think most OR RNs will have to realize that and stop fighting the changes that are coming. I still hear grumblings from RNs about Techs scrubbing certain cases but they have to realize that staffing constraints only allow them to scrub and nothing else, so what to you do with them? I myself sometimes gets irked when I read or hear someone expounding on how great they are or they can do this or that and can't understand all of these rules. That's the problem, not understanding their role in the scheme of things. I'll stop now, just rambling but I think you get what I am trying to say.I have another 24 hours of call to get through, wish me luck! Hi, stevierae. Mike

stevierae · Jan 16, 2005

I have another 24 hours of call to get through, wish me luck! Hi, stevierae. Mike

Hi, Mike--I'm tellin' ya, this call stuff is going to kill you one of these days. Let the young folks take the call while you do fun stuff like play with your dogs and take your wife cool places.

shodobe · Jan 16, 2005

Today isn't so bad, so far! I have a case scheduled later today for an exlap. Patient ate so we can't do it for awhile. Being so far away from home I really don't have anything else to do but take call. I think this will be my last year down here and I will start to look closer towards home. Eight years is a long time. The call isn't as bad as it looks because we do a majority of cases during the day and hardly ever come out after 11pm. It does seem to me that the weekends I am on we do alot and the other weekends they do very little. I guess I am just a magnet for punishment. Take care, talk to you later. Mike

clare lewis · Jan 16, 2005

Wow, you lot, I bet none of u have worked in a theatre in the UK. I can only imagine your reaction. I have worked in places where health care aides, with less then a few week experience have been circulating for me. Do I agree with it, heck no but it happens and more then you would believe. However looking at both sides of the coin, I do not think it would be fair on the tech as their role limits them to basic duties and as circulator you have to have access to all domains of the room. And as you say all patients have the right to a qualified nurse managing their care. Im laughing here trying to imagine you lot in an english theatre,.

I'm too laughing with carcha on this one. Things are done a lot different here in England. Our Rn's and ODP's are usually scrubbed and the role of circulating assistant is often that of a non-registered nurse (HCA). However, most of our HCA's have many years experience and are very compitant at this role. Many of you may disagree with this, but I would much rather reley on an experienced HCA or ODP than a newly qualified RN any day. Three years training does not make you an expert at something, but continual training, development and experience can, even if your not registered.