Thinking of being a circulator?...Think twice.

[OR Dude]

Thinking of being a circulator?...(especially for new RN grads)...consider carefully. If you will only circulate, and you will be working in an OR with surgical technicians, or scrubs, who do not have a nursing background, then you may find yourself answering to, not supervising, surgical technicians, who may harbor resentments towards you being "the nurse".

In these OR settings, there is often a hierarchy: surgeon, anesthesia (often the CRNA, who is the advance practice nurse, and who knows far more about the patient's vital signs than the RN circulator), then comes the surgical technician, or scrub, and at the bottom of this hierarchy, the RN circulator.

In such OR settings, when the surgeon asks, "How is the patient doing?" The surgeon wants anesthesia (CRNA) to provide the information, not the RN circulator, who could possibly not have a clue, especially if said circulator had to leave the room for an instrument, said scrub forgot to pull prior to the surgery.

If the patient needs meds, such as for blood pressure, heart rate, etc., the CRNA is the advance practice nurse, and will be administering such drugs. Basically, they are the primary nurse in the room. As a circulator, you will be the secondary nurse. You will be charting, helping position the patient, going get stuff from outside the OR (which was forgotten, or is unexpectedly needed), checking the paperwork (consents, H&P, etc.), and setting up the OR with the scrubs.

When the surgeon, CRNA, or scrub politely asks (or yells), "I need...!" It's your job to fulfill their needs...not the other way around.

In such OR settings, don't think, "I'm the RN! I'm in charge of this operating room." No. You are not in charge of the operating room. The surgeon is the captain of that ship, or operating room. Then comes anesthesia (usually CRNA). Then the scrub, who is working with the surgeon, and anticipating, or relating the needs of the surgeon. Then comes you...the RN.

So why have a RN in the operating room? Because some states mandate their be a RN in the operating room, as a circulator, who may assist (often assisting the CRNA, when the patient crashes) during emergencies. But, laws are not written in stone. Could these state mandates change? Sure. In Australia, the nurse (RN) works in the position as a scrub, and the surgical technician works as the circulator.

So do operating rooms need registered nurses (barring state mandates)? In my humble opinion, No. Registered nurses are not needed in the operating room. Surgical technicians can easily perform the duties done by a circulator. They do it in Australia. Just a matter of time, probably, until RNs are phased out of the OR.

So, thinking of being a circulator? Consider what career growth and potential you may have. Want to be a RNFA? Your gonna have to learn suturing and instrumentation...scrub work...that's their area of expertise. They don't teach such things in nursing school. Want to be a surgical nurse practitioner? Helps to have scrub experience...otherwise you are in the same position of not knowing the basic suturing and instrumentation. See the trend? Career advancement in the operating room is rooted in knowing how to scrub if you're a RN. Even if you want to be the OR manager. Never scrubbed? Then let's see how much respect you will have among your subordinates.

Sure there are all RN ORs, in which even the scrubs are nurses. But scrubbing is the badge of honor.

Still thinking of being a circulator? Good luck.

[Rose_Queen, BSN, MSN, RN]

Sounds like you work in a toxic environment. I work in a fairly decent OR if you take out the fact that we're short staffed and call pay hasn't budged in years. We're a team. There's no us vs. them or hierarchy. If you're unhappy, you need to be the change. Whether that's finding a new OR or a new specialty is up to you.

[Amistad, RN]

Whoa. It sounds like you've had a very bad experience. Ive had a good experience so far. I just started in the OR 3 months ago and one of my favorite parts of the job is that I feel like I am an equal among the team. It takes the orchestration of every single team member from pre-op holding, through surgery, and in post-op to take a patient safely through surgery. That includes environmental services and sterile processing technicians too! I feel that everyone in my workplace is respected. I would highly recommend to anyone to work in the OR... I love it.

I do agree with you OR dude that scrubbing is important. I think learning to scrub has made me a better circulator as far as learning to anticipate what the surgeon needs. I would be disappointed if they stopped using RNs in my workplace to scrub.

[OR Dude]

Actually, my current work environment is not toxic. I've worked in various ORs. This is my opinion, after working in the OR for over 15 years. Team work? Yes. There is team work. But there is a hierarchy. Do you think as a RN you are equal to the surgeon? Or anesthesia (CRNA)? Or the scrub? Who gives the orders? The hierarchy dictates who gives the orders. That's not toxic. That's the structure or hierarchy of the OR. Respectfully I submit.

[OR Dude]

I agree working in an OR, wherein you are taught (on the job training) to scrub, provides valuable learning experience. Validating my point...a badge of honor (and insight into the surgical field). And, I'd agree an all nurse OR does provide a more egalitarian OR environment. But my focus was on working strictly as a circulator, and my opinion that the basis of OR nursing is scrubbing, in terms of career advancement.

Congratulations to those nurses who receive on the job training as a scrub. Does your training equate to the surgical technician's training from their academic program? That's a personal question, which can only be answered by the individual.

Nonetheless, my humble opinion remains: the registered nurse's role is not vital to an operating room. The operating room can exist without a registered nurse, and barring state mandates, surgical technicians can replace a registered nurse in the operating room.

Also, if you are a registered nurse, and you want to become a RNFA, surgical nurse practitioner, or OR manager, then it is preferred that you have scrub experience, and preferably having gone to school for surgical technician, then become a registered nurse. On the job training may not provide the background experience to advance into these other career prospects.

Thus, scrubbing is the cornerstone to working or advancing in the OR.

Thinking of being (working strictly as) a circulator?...Think twice (especially a new grad RN).

[Amistad, RN]

I'm glad to hear that your work environment is not toxic. I have to respectfully disagree with your point that nurses are not vital to an operating room. Nurses use evidence based practice to promote patient safety in the operating room. We coordinate the administration of blood products. We pass medications off onto the sterile field. We interview the patient and note concerns for the patient such as PT/INR for patients on blood thinners. We prevent injury from improper positioning, electrical sources, or burns. We are the ones who say "hey doc, lets wait another minute for the prep to dry prior to draping to prevent an OR fire". We oversee the room with patient safety in mind and with background knowledge as a nurse. I would say our position is vital and not replaceable.

Just my two cents!

[showmethemoney]

Amistad has described most of the role of an O R Nurse. However the other information is vital;

1-The level of education of an OR Nurse- not technician who only scrubs- is now a BSN. In addition we also have an additional level of expertise defined in the CNOR level of practice. Scrub tech education is limited and not patient centered. It is anatomy and technical orientation to how to provide what the Surgeon needs and how to clean it.

2-There is a scary and infuriating phenomenon that plays out when there is a newer RN circulator and a seasoned Scrub tech. The scrub will be able to lead the RN ad usually manipulates the situation to make themselves look and feel more important.

I have been an RN for 30 years and worked in the OR in all roles for 25 years. We rarely had scrub techs so the RNs learned both roles.We are a team that relies on each other but frequently we act like a dysfunctional family.

RNs in general take enough crap from people. I resent people who don't share their knowledge and choose to use it as a weapon. That is what the scrubs learn to do and victimize the new nurses and sometimes are abusive by blaming the nurses(while they are out of the room) for what they themselves forgot to provide. It is never pretty when I find out someone is trying that on me.

The best validation for seasoned circulators is when a scrub achieves their RN and now has to learn the circulator role. What goes around comes around.

[jeckrn, BSN, RN]

Ninety percent what we do circulating almost anyone can do. The other ten percent is the reason we have RN's in the room. As others have stated we see the big picture and not focused on what the present task being preformed at the moment. I describe an OR team like a ship. The surgeon is the Captain, anaesthesia is the Navigator, scrub tech is the Engineer, and the circulating nurse is the Executive Officer (XO). The XO is the second most important person on a ship because without the XO' s coordination the ship would not move.

RN's are taught the why not the how. SCD' s are a good example, techs know they are needed by most do not know they need to be on before induction.

I do agree with the original poster and new grads should not go to the OR, then again I do not think a new grad should go to any specialty area since they need to learn the skill of nursing not the book of nursing which what a new grad knows.

[dcwang]

I'm a nursing student and hope to be an OR nurse. Just started as a tech at a major teaching hospital and I love it. It's a whole different world.

[OR Dude]

I'm glad to see a healthy discussion. I would like to add, many see the role of a circulating nurse as being the purview of a registered nurse. However, as I mentioned, look south to our Aussie friends and see the roles reversed...the tech being the circulator, and the scrub being the nurse (registered). The roles are so easily reversed, if only you change your location. It works there. Blood/drug administration (most often done by the advanced nurse in the OR, CRNA, here in the good 'ol USA); and, the other tasks (such as prepping the patient, passing meds/instruments to the sterile field, etc. are done by our Aussie surgical technician brethren. So easily is it to switch roles...which still leads to the conclusion...a registered nurse, serving as circulator, is not needed in the OR. For the 90% of a circulator's duty, yes, I agree, anyone can do, and for the other 10%, the advanced practice nurse, CRNA, is available and more than capable of performing. Let's not be so geocentric...no worries, mates.

[jeckrn, BSN, RN]

You can not compare what nurses do in other countries to what we do in the US. After serving with nurses from several different countries most do not work at the same level as we do. When I took a soldier to a German ED he was triaged by the ED doctor not the nurse. The doctor preformed almost all the duties which an ED nurse would do. I am not saying we are better than nurses from other countries but just have a different scope of practice.

[OR Dude]

No disrespect intended...sincerely. Can't compare?...comparisons are made all the time, and made with different parts of the world all the time. Sorry, but I beg to differ.