Unlicensed OR personnel

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What has become of OR nursing? None of the RN's scrub anymore. I think this makes for horrible patient care and really diminishes our profession. Our whole OR is staffed with a 50/50 mix. I know that in the state of California there are RN's who can't find work! We have new grads who don't get the opportunity to learn to scrub and get a large part of their OR knowledge from the scrub techs! It's so frustrating and demoralizing! I have only been in the OR for about 15 years and am shocked at how much I have seen it change in the short amount of time! Does anyone else feel this way?

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Specializes in Trauma Surgery, Nursing Management.

Yes, I feel the same way. Most if not all of the nurses on my team LOOOOVE to scrub, and they rarely get the opportunity to do it. ST's are utilized just as much at our hospital because they require less pay than nurses. Although this may help the bottom line for the hospital, I believe that is a travesty for our nurses who want to learn. I agree with your comment about the new grads getting most of their OR knowledge from the techs. This CAN be a slippery slope: some of our techs think that because they know more about instrumentation (and the utilization thereof) than the RN's in the room, that this gives them free reign to tell the nurses how to do their jobs. I have seen it time and again. Several years ago, I actually had a tech TELL me to go and get a lidocaine UroJet (the surgeon was not in the room) because she wanted to prep and place the foley. I stood there and looked at her, blinking. I said, "You need to back up on that yellow brick road, Dorothy cause you are NOT a doctor, you cannot arbitrarily order meds of any type, shape or size, I do not take med orders from you and you can't put in a foley...this ain't The Emerald City." She never did that again. I think she went back to Kansas.

I am working with another difficult tech now who tries to tell the docs how to do surgery. Dude. Seriously? You been doin' this for all of 2 years. I think the attending knows the steps-thanks, but if he needs you to remind him how to bend a tibial plate since he has done it at least once a week for the past 25 years, we will beg for your input.

These examples are extreme ones. I have worked with MANY techs who saved my butt and the doc's! Don't get me wrong, they are indeed valuable. I wish that "the powers that be" realized how much nurses NEED to learn the finer points of scrubbing.

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Specializes in Peri-Op.

I was a CST and am now a RN and circulate when I am not managing. I can and do scrub still but there is only 1 other RN of my 10 staff RNs that have the ability to scrub and knows instrumentation.

To be quite honest, most RNs I have met are either too lazy or could care less about learning to scrub or learning instrumentation. When I do get one that wants to scrub I always let them. They are few and far between these days though.

Personally I prefer to circulate, even if I have a dolt for a scrub tech just for the fact that I can talk them through the case if needed and I know what I am looking for when they ask for something. There is not a 5 minute wait for something...

It is pretty fun messing with the non-scrub RNs and asking them for an Otis Elevator.... This is the name of the company that makes and maintains our elevators, the kind that carry people up and down. You dont know how funny it is to send someone running for it. Typically this makes them try and learn a little more so they dont look like a dingleberry next time.

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Otis Elevator... LOL.. that's funny!

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Having 2 RNs in the room is a wonderful day. You always have an extra pair of hands and an extra active critical thinker. I find that RNs pitch in and get the work done efficiently and expeditiously. No lines are drawn at what's your role is, where by virtue of a tech's more narrowed scope, you just don't get that. There are really good techs, but I've never hand them remember a warm blanket without being asked or plug in compression boots for me when I am doing something else. They don't know to perk up when the heart rate goes up and you're close to extubation, so you might need an extra pair of hands to hold down a two hundred kilo-er. It's a no brainer, two RNs in the room and the patient gets better care, but not cheaper care, which is high on a hospital's list of needs.

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Specializes in O.R., ED, M/S.

After 33 years in the OR and only having one Tech, really an LVN, in all those years and working with an ALL RN staff that was required to learn to scrub as a condition of employment, OR nursing is going down the toilet. Now, don't get me wrong there are many good, qualified scrub techs out there, but give me an ALL RN team any day of the week. I just can't help it, OR nursing was started with the idea that there would be all RNs in the suite, not techs. Give me the old days when techs were mentioned for the OR and laughter would break out. I would give anything to go back to those days. I only have a few years left before i retire and hope that I can live out those days in peace, because there are many days that I have to bite my tongue to stop a primordial scream! The bottom line is for management to hire as cheap as possible, quantity versus quality. This is why I only post every few months because anyone who has graduated in the past few years or so and works in the OR just doesn't get it. I stopped beating my head against the wall a number of months ago and haven't regretted it.

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Specializes in OR, Nursing Professional Development.

I'm going to take the unpopular view here. I LOVE the STs I work with. Maybe it's because I've never had the experience of working in an RN only setting, maybe it's because of the teamwork and the way we staff. I've also learned a lot more from the ST who's been there since before I was born than I did my entire 9 month orientation. Maybe it's because the nurses don't support the new RNs as much as the STs support them (which is one of the many reasons I left days- the teamwork was much less, and it wasn't uncommon to find those who weren't doing cases at the time warming the seats in the lounge). We also have an "extra" person in the room- 2 STs/1RN, so the ST who isn't at the table is helping the RN.

Hypothetical question for you- if STs were required to be licensed, would you feel the same as you do now?

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In my region surgical tech is an associates degree program and they are licensed in WA, OR required certification.

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There is no license, only certification.

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I don't know, scrubs are a very good asset to have, as long as they have been taught properly. I am a scrub tech who's surgical technology teacher was a RN, and before that a CST. She not only taught about what was going on in the sterile field, but what is going on with the paitent during surgery. That has been very helpful throughout my scrub tech career. I am now going back for my RN, to further my knowlege base.

I have been a preceptor to a lot of student from different scrub tech schools, and all I can say there was definatly a lot of difference in how the student was prepared. I enjoyed teaching, but some people really shouldn't be scrub techs. You ask a question on why we are doing this surgery and they stare at you like a deer in the headlights. These take forever to train and they never "get it". Others can rattle off the different reasons. Those are the keepers and will do well.

If you have a good team of nurses and techs, the day can go very well. If one of the team is weak, the day falls to pieces and the surgeons get really grumpy. It can go both ways, the scrub tech can be weak and the RN has to step up to the plate. Like the scrub saying they have everything that they need, then every other second asking for something that they forgot. Then the poor nurse has to run around, then they look like they dont know what they are doing. However, there are some very weak nurses, sitting around, playing on the computer(not charting, yes I have seen some nurses playing solitare or surfing the net) Not paying attention to the field or the paitent, looking at the scrub with a deer in the headlight look when they ask her to grab something....Being in the OR is a team effort and everyone needs to step up to the plate.

I live in a rural area, so the RN's will get to scrub, not as much that they would like, but they do. I know I will miss scrubbing, but I really want to broaden my horizons.

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Healthcare has gone a through a long trend of job titles. Get used to it. CRNAs now make up a long majority of Anesthesia Providers than Anesthesiologists compared to 20 years ago. In many states NPs are the Primary Care Providers, Orthopedic surgeons do less foot surgeries due to the growing field of Podiatry. Sorry to break to you folks, new fields and specialties are going to be growing in all areas of healthcare. Who would have ever guessed that “nurses” would be administering anesthetics, writing prescriptions, etc? People that say they would rather have an RN scrub over an ST (who has gone through specialty training and met competency requirements) would be like saying “I don’t want an advanced practice nurse giving me medicines without a doctor’s supervision since she didn’t go to medical school.” Yes, having an ST over an RN is cheaper just like going to an NP over an MD. So are we then going to say, "what you pay for is what your going to get"? Why don’t we focus more on the patient and less of our egos?

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