What Is An OR Tech?!

core0 · Feb 3, 2008

I have seen it mentioned several times on this forum, but I am unaware of what their education and role truly is in the OR. What are they allowed to do?! Are they nurses performing in a different function?! Are they licensed professionals?! Certified?! Can a surgery be done with just doctors and nurses instead if requested?! I always thought it was just doctors and nurses in the OR. How do doctors and nurses feel about OR techs?! TY to all who reply.

An OR tech is a generic term for an unlicensed assistive personnel (UAP) that works in the OR (usually in the scrub role). In the past most of OR techs were either trained by the surgeon or the hospital. Currently most OR techs are graduates of a surgical technology program and are certified not licensed (I may be incorrect here as its been some time since I've been a CST). They generally worked under the RNs license under the nursing delegated practice act depending on state law. For more information on CST's:

http://www.ast.org/

As far as how nurse feel about OR techs there are a number of post here on the subject. The CST is essentially an economic move as their wages are generally less than RNs. Also given the shortage of OR RNs its doubtful you could fully staff all ORs any more.

As far as asking for an RN instead of a CST you can ask but this ain't Burger King. As has been discussed on other threads:bugeyes: the patient can make requests but it is within the purview of the OR to refuse them. There may be ORs out there where no RNs scrub (although I've never run into that). There are definitely ORs where RNs may not scrub a particular specialty. You have to ask yourself is it in your best interest to pull someone into the room that has never scrubbed that type of case? Or is it fair to pull someone out of open heart surgery (to use and example) forcing that room to use someone who is not experienced in that type of surgery.

David Carpenter, PA-C

Batman24 · Feb 3, 2008

I am not having surgery so this was really more of a general question. I take it from your reply that nurses and docs would be comfortable using an OR tech versus a licensed nurse as well. I didn't realize this was standard procedure. It makes me a little leery that the hospital can take unlicensed people and put them in an OR situation. I don't mean that to offend any OR techs so I hope none take it that way.

I know someone that recently went to the doc and the doc bought the receptionist in the room to chaperone. She sent the woman out because it just didn't feel right. The doc was okay with it, but did explain that this was something he did often. Yikes.

ShariDCST · Feb 7, 2008

i am not having surgery so this was really more of a general question. i take it from your reply that nurses and docs would be comfortable using an or tech versus a licensed nurse as well. i didn't realize this was standard procedure. it makes me a little leery that the hospital can take unlicensed people and put them in an or situation. i don't mean that to offend any or techs so i hope none take it that way.
i know someone that recently went to the doc and the doc bought the receptionist in the room to chaperone. she sent the woman out because it just didn't feel right. the doc was okay with it, but did explain that this was something he did often. yikes.

speaking as a cst, or "or tech" as we are sometimes referred to, i would ask that you please don't confuse "unlicensed" with "unqualified". no more than you would assume that any other medical personnel whose credentials and education include "registration" or "certification" instead of "licensing." i have been a cst (certified surgical technologist) for almost 15 years, and i am every bit as professional as any other trained and qualified individual at what i do. the credential of certification does not come easily, is closely supervised and guarded by our own professional organization - the association of surgical technologists, located online at www.ast.org and is at this point being supplemented by a licensing program as well in several states. this varies on a state by state basis at this point, but all change comes with time and effort, and it's being done as i write this in many states. it will become the norm when all states become more educated about who we are, as the ones who are offering licensure now have done.

but changing my credential doesn't change my education, experience and proficiency at what i do. although our past history over time has included more ojt prepared individuals, that is now rarely if ever the norm. formal education, including didactic, skills labs and clinical practice are part of every csts educational experience. mine took 2 years. some programs are shorter, but all must follow basic educational guidelines by our professional organization to be accredited, thus allowing their graduates to qualify to sit for the certification examination. if you can properly prepare an asn rn in that period of time, then it shouldn't be surprising to take that long to prepare an or professional. certification at this point is recognized nationwide - once we are certified, we are legally allowed to practice in any state, where rn's have to have their licenses on a state-by-state basis. this is not to say that either one is inferior or superior to the other - just that there's a difference. when licensing becomes a norm for us, we will have to do the state-by-state procedure as well. more and more institutions who employ us are making the certification a basic requirement for employment - there are not many left that do not.

if you are curious about the credentials, education and proficiency of or professionals known as csts, then i suggest you take a look at our association website, (www.ast.org) where there is a plethora of information regarding our educational requirements to begin and to stay in our profession. continuing education is a requirement of maintaining our professional credentials, no matter what you call them. all medical professionals have continuing education as a requirement for maintaining their professional credential, no matter what they are.

it might be interesting to note that many nurses, either straight out of nursing school, or after years of floor nursing experience in hospitals, must undergo significant periods of time in orienting to the or and programs i have seen can vary anywhere from 6 months to a year. the education that many of them get is from us - the csts - especially when it comes to the scrub role, where we excel. i have been a happy and effective preceptor to several nurses who have learned a great deal and become confident scrub nurses in the process. circulating nurses of course are in charge of educating them to the role of the circulator, but we are the pros when it comes to the scrub role, and if you check out the website i have mentioned, you will see that we are not uneducated slackers that have been pulled in off the street and handed a scalpel to pass to the surgeons. there is so much more to our jobs than that, and so much more is required of us to be able to practice what we love to do. the or is a closed world in and of itself, separate from the rest of the hospital. if the or is having staffing issues, it cannot pull nurses from other floor units to sub in for a while, like you could pull a nurse from med/surg to work in another unit. only or trained and qualified staff can cover for each other.

there are of course, good and bad examples of every profession - mechanics, nurses, waitresses, doctors, plumbers, csts - you name it. if you have a bad experience with one of those individuals, i would encourage you to not paint the entire profession or occupation with the same brush. learn more about us, what we do and why we are there. i think it will be an enlightening experience for you.

and yes, most people automatically assume that everyone in the or is either a nurse or a doctor - not true. we are sort of an "invisible profession" in a lot of ways, so it's not surprising that more folks don't know who we are or what we do - or what it takes to make us qualified to do it.

Batman24 · Feb 7, 2008

TY for explaining. I appreciate it and feel much better after being educated on your role. I really didn't know this job even existed until I came into this forum. I am going to look at the site you posted because the OR really does interest me. Would you mind my asking what the salary range is for a surgical tech?! Are there advancement opportunities in this field?! How are the hours?! Thanks again for your time.

ShariDCST · Feb 7, 2008

ty for explaining. i appreciate it and feel much better after being educated on your role. i really didn't know this job even existed until i came into this forum. i am going to look at the site you posted because the or really does interest me. would you mind my asking what the salary range is for a surgical tech?! are there advancement opportunities in this field?! how are the hours?! thanks again for your time.

you're quite welcome. i appreciate your feedback also. i am always happy to do what i can to educate the public on our work and position in the medical professions. as i said before, not knowing we exist is a common condition, and i do what i can to fix that!

if you visit the ast website, you will find some of the information you are seeking, especially salary information. they do a survey from time to time to find out just what our salary ranges are, and they are posted on a page that lists them on a map on a state by state basis. salary ranges can vary a good deal from state to state, just like nurses' salaries can, and even within different areas of the same state. for instance, i have 14 years experience, and 2 years at my present position and i make a shade over $18.00 an hour.

the hours can vary a great deal also, depending on what type of facility you choose to work at, what sort of shifts are available, and the need or lack of need to take call backs. it can be as regular as a 40 hour week in a free standing outpatient surgery center that only does elective procedures monday through friday - to plenty of overtime at large general hospitals that run 24 hour ors and three shifts 7 days a week, and everything in between. the potential is as varied as you want to make it. travel assignments can add a whole new perspective to the career, with much better pay, short term assignments wherever you want to go in the country, with living expenses such as rent and utilities furnished, and travel expenses either paid up front or reimbursed. the sky is truly the limit. some techs go into instrument sales, running spd departments or instrument processing departments in major hospitals. they can become tech educators. resource people in the ors, and on and on. the job can take you wherever you want it to if you put the effort into it.

be aware though that it is not for the faint-hearted. physical endurance is a major factor that plays into your success. long cases requiring many hours of standing in one place for several hours at a time can be the norm depending on what service you work in. others require less. lifting, pushing, pulling, carrying and other physical skills are required to be able to be successful as well. if you get woozy at the sight of blood other than your own, it might be a good idea to rethink it. smells can be disturbing too, if you have sensitivities to odors. my first surgical experience as an observer i had to leave the room and come back four times because of the odor of the bovie (cautery) smoke! :icon_roll but i kept going back in and finally got past it. i had no idea it was going to be an issue until it happened, but i pushed myself to get back in there and tough it out. i got over it enough to be able to function quite well - but some things just overwhelm everyone. oil of wintergreen in your mask can be a lifesaver! :nuke:

good luck on your quest for knowledge and please feel free to contact me - either here or through email - if you want to know more.

bioniclewoman · Feb 8, 2008

Iv'e been lurking on here wondering why there wasn't more talk about CST's and thinking it strange that nurses scrub in. I have worked in a busy OR for a year now and have only seen a nurse scrub in twice. Only the techs do this at my hospital.

core0 · Feb 8, 2008

Iv'e been lurking on here wondering why there wasn't more talk about CST's and thinking it strange that nurses scrub in. I have worked in a busy OR for a year now and have only seen a nurse scrub in twice. Only the techs do this at my hospital.

Its mostly a matter of economics and availability. Both can scrub but you need a license to circulate. A CST is 1/2 to 2/3 the salary of an RN all other things being equal. Also there is a tremendous shortage of OR nurses. AORN reported the average age as 44 in 1999. In some regions more than 50% of OR nurses are over 40. replacing these nurses as they retire will be hard enough.

David Carpenter, PA-C

ShariDCST · Feb 8, 2008

iv'e been lurking on here wondering why there wasn't more talk about cst's and thinking it strange that nurses scrub in. i have worked in a busy or for a year now and have only seen a nurse scrub in twice. only the techs do this at my hospital.

well, i imagine the first answer anyone else would give you is that this is a nursing forum more than anything, and i am here because i have some nursing school background, but also because i am involved on an intimate level with patient care.

nurses scrubbing in on cases is dependent mostly on institutional staffing levels and personnel policies. it depends on their requirements too. i have worked in another capacity in an outpatient surgery center where they did not even hire csts to scrub at all - it was an all rn facility. being a cst though did give me some insight to what was going on there with no csts on staff as scrub personnel, and i have to tell you, what i saw there was pretty scary. i saw allegedly trained rns scrubbing in on cases and doing things that would have had you or i thrown right out of school. and there was nobody there to tell them otherwise because they all pretty much trained each other. not that there are not good scrub nurses out there - there certainly are. likewise, i've worked briefly with a few scary techs in my time as well.

but what it boils down to is economics and facility knowledge of who and what we are. we don't get paid as much as rn's and they can spread nurses out farther that way. oddly enough, back in the day when operating room technicians were first coming into play after korea and viet nam, as the civilian versions of themselves as medics, they did the circulating and the nurses did the scrubbing. it has evolved into a complete about-face because the nurses do more direct hands-on patient nursing care as circulators and are the responsible parties when it comes to taking care of the paperwork and being responsible for what goes on in the room under their licensure. i find it a bit incongruous that we are supposed to be working "under" the nurse's licensure, but we work for the surgeons directly - not the nurses. perhaps our own licensure will take care of that soon - many states are working on it right now.

Batman24 · Feb 8, 2008

Just curious-Would you ever go back to NS and become a RN, Shari or do you love this job and not want to leave it?! It might be worth it to you from a financial standpoint if that was a concern. It also sounds like you could step into a circulator role fairly easily after that. TY again for answering all the questions. This has been interesting. I always wondered if OR nurses had additional training because it's a different bird. :)

ShariDCST · Feb 8, 2008

just curious-would you ever go back to ns and become a rn, shari or do you love this job and not want to leave it?! it might be worth it to you from a financial standpoint if that was a concern. :)

you aren't the first one to ask me that question, but the answer is always the same. no. i tried nursing school (pn) and in spite of being on the dean's list at the time i had to leave for health reasons (pregnancy related hypotension) i was finding that it really wasn't my cup of tea after all. i had wanted to be a nurse since i was old enough to know what nurses were, but i think in that period of time, i learned a lot i didn't know about it, and knew that it really wasn't for me after all. i can't pinpoint exactly what it was that turned me off to it - i just had a gut feeling and an overwhelming sense of dissatisfaction with the whole setup.

while i was in pn school though, i became friends with a gal who was in their cst program and upon learning more about her program, developed an intense and immediate desire to know more. i wasn't able to pursue it for some time, because of the birth of our daughter - which happened to occur at the same time my class was doing their ob rotations, so that was kind of cool. and then 21 months later, here comes our son, so that didn't put me in any position to pursue higher education for quite some time. :cry:

i have found that since i made the opportunity for myself to go back to school with two teenagers, a husband, a house, a dog, a part time job as well as full time school, that it was worth every single minute and i really do enjoy my work. the or holds an intense, abiding interest for me, and i'm sure it always will. i work with nurses all the time of course, and watching the things they are actually required to do when circulating in the or, i am quite content with my role there. i have never been one to deal well with a ton of paperwork, especially under that kind of pressure time-wise, and the other running and fetching, in addition to that actual nursing duties, which are much different from "floor nursing" that most nurses experience. i admire their ability to do their jobs, and have an innate respect for nurses as a whole, but i have found the role i am quite happy with, and hope that i am lucky enough to be able to continue doing the job i love for as long as i can be a member of the workforce. i do know that there will always be a need for us. so i have no qualms about finding employment, no matter where i happed to end up.

besides, at my age, i've had enough of school for one lifetime! i don't think spending 3 or 4 more years of my life in school would serve me very well in achieving what i already have - a respected (although somewhat unknown to the general public) profession, as well as a job i truly love. finances notwithstanding - i don't make that much less than the rns at the facility where i work. i've seen their starting and mid-range pay rates, and it's just not worth the extra headaches at this point in my life to make a few more bucks and not be as happy. besides, travelers make mega bucks and my needs are simple and i don't require the "best of everything" in material goods. hopefully i'll be able to pursue that avenue again someday. right now, i need to stay put.

thanks for asking though!

ShariDCST · Feb 8, 2008

i always wondered if or nurses had additional training because it's a different bird. :)

i missed this point when i read your reply, and wanted to address it briefly. if i can! you said that or nursing is being a different bird - my comparison is like comparing robins to eagles. not in the nature of the beast - they are both birds of course - but in their distinct differences. or nursing is not "nursing" in the broadest concept of the word that most of the general public perceives as "nursing" per se. it is not day to day long-term patient care with the same patient population on a regular basis. it's a totally different world, and requires a complete set of additional skills that are taught on the job during an rn's orientation to the department. this process can take anywhere from 6 months to a year or more, depending on the facility and the type of work they do. a good nursing background in an icu or even the er would be a good place to come from. there is a sense of urgency and immediacy in the or that generally does not exist on other units. the patient is in the or for the duration of their pre-op, operative and postoperative recovery phases, and then they leave that department and are cared for by other staff for the rest of their recuperation. it is indeed a whole different kind of work, but or nurses do it and for the most part do it very well and i love 'em all!

i have "second circulated" cases myself - the rn is still in charge of the room from the nursing standpoint, and i was more of a helper to her and to the scrub staff in the room. being a cst myself gives me a unique perspective on their needs and the procedures necessary to satisfy them. some facilities have second circulators and others do not. in some, it depends completely on the needs of the procedures being done. most often this would occur when a surgeon brings his own private scrub nurse or tech, and we are not needed to scrub the case ourselves, but are assigned to the room for the day and we help with the nursing part as we are allowed by facility regulation and the laws in general the govern our practice. it's a nice break sometimes to get to stand on the other side of the table - but i love the one i get to do the most, and that is to scrub.