What does "First Scrub" mean to you?

Specialties Operating Room


I just got a call from the highest ranking circulating RN in our rather small, rural hospital's OR (with an excellent general surgeon and many outreach specialist's with privileges). Apparently, a surgical tech (the only male) was "promoted" to first scrub today. The decision to create this position was a secret, and prior to today, had never existed.

A couple of questions for anyone good enough to help me with this:

1. Does this position require special education or certification?

2. What, exactly, is the job description and responsibilities of this position?

The RN's and other scrubs are inflamed (understatement), and think the opportunity for this job should have been opened up for all to be considered. We are unionized, and this is the standard policy....however, this is a non-union position that was created. This gentleman was "cherry-picked" by the general surgeon. Yes, he is a very good surgical tech. Many of the employees back there would be considered very good employees. Toes have been stepped on....feelings have been hurt..... The surgeon made this announcement by stating to all in the "theatre", "You'll have to call **** "Mr." now, because he's just recieved a promotion!" Let's just say that emotions are running high!:eek:

The general surgeon acts confused, like "Why can't we praise someone who does a good job?", as if this guy makes the whole OR run!

We would appreciate any and all input to help us understand this role!:)


231 Posts

Hi Dee,

I think that first scrub might be your hospital's aka first assist. There are several routes to becoming a FA which should involve extra education and certifications. If you check out the AORN's web site you will see that RNs are able to acquire this certification as well as surgical techs with maby a year or two more of education. Also included as first assist are of course MDs, PAs with specialized training and midwifes again with the training.

As I understand it responsibilities include: placing retracters, hemostasis (via clamps, cautery and suturing), also closing the layers, exposure, and keeping the field clean. They are valuable and cost effective especially to smaller hospitals as larger hospitals use residents and hospitalists to fill this roll.

I can identify with the sore feelings running through your OR, and the fact that the role was "created" well, that doesn't bode well for management. However, he may have done approached management with this idea and they may have realized the effect it would have on budget and said go for it. Remember there are many sides to a story, especially with rummors runing rampid, like they tend to do in the hospital setting, especially with close-knit staff like OR, L&D, ER or ICU.

As for the surgeon, well to tell you the truth, I think that most of them are not involved with hospital staffing and position concerns. You are right in saying that "as if he runs the whole OR", because my bets are he doesn't. Although he may have encouraged the new position's creation, it is ultimately up to nursing services and HR to create a new role. I think that it is a great idea and if some of the staff approach management with the idea using the budget as a wager, they may be able to even help finance their own education and it would utimately lead to possible new positions and roles. Of course I could be wrong, management can be finicke about this sort of thing too.

I personnally would try to support this guy in his new role, think about how he may be feeling about this right now, yeah, he has the surgeon on his side, but his co-workers are upset, this could cause hard feelings on his side as well, feeling unsupported. I would think that it is not his fault that this happened this way, of course the guy could be a snake ya never know, but try to give him the benefit of a doubt and say Congrats! I say this from experience, hard feelings just make it harder for everyone to come to work without tension in the air. You know what I mean.

Just my 75 cents, maby more than you asked for, but I hope it helps anyways.

Good luck!


310 Posts


I don't know where you are located, but the reference to the "theatre" sounds like the UK-- like the above poster this new position sounds like first assitant to me.

The hospital should, or needs to create, a job description for this person. What are scrub techs allowed to do under the current position description, unless this person has additional qualifications he should not have a more extensive scope of practice than other ST's.

I know that the ST association is promoting first assistant scrub techs, but I don't know what the requirements are- I think certification as an ST, plus the completion of a first asst. course.

Since your facility is a union one, seems to me the RNs and other ST's have grounds to file a grievance, since this position was not posted. Is this person only functioning as an assistant for this surgeon?

Sound to me that this surgeon needs to hire this person, and pay him out of his pocket.

As for the surgeon saying that you have to refer to this person as Mr. --puhleezze!! That is just ridiculous! He is still just an employee, even if he has been "promoted".

If you are in the UK--do they refer to surgeons as Mr, not doctor? Even so, surgical physicians assistants are certainly not addressed with a formal title.

Sarah, RNBScN

477 Posts

What are surgical tech's? What are their qualifications? We don't have them in Ontario. We have RN's who scrub and circulate. We also have RNFA's who are just about finished their course certification through a college (BCIT) British Columbia Institute of Technology. In Canada compared to the US RNFA program is less intensive from what I have read. The US program is far more advanced than the requirements in Canada.


231 Posts

:o Dee, I must apologize, when I first read your post, I missed the part stating that you are a unionized hospital. I have never worked or have been associated with a union hospital and really don't understand the union's place when it comes to new positions. I know that in other hospitals at least in my area, it is advised to post any and all new positions, however, many go under the table and all of a sudden they appear already filled.

So I hope there is no hard feelings on my behalf, and it sounds like it may be possible to have "grounds to file a grievance" as Spice had mentioned.

Good luck with this touchy situation!


16 Posts


When i was in Ontario there were a few different titles for the surgical tech's such as; ORT's (operating room technicians), scrub techs and surgical techs. MOST were RPN's who had taken a course to allow them to work in the OR. there were a few still working from "way back when there were no staff and we just trained any warm body that applied" (staff nurse's words not mine, of course she was also quick to add that some of them were the best scrub "nurses"/ techs that the OR had...) anyway that's all i know about that :)



310 Posts


OR techs are unlicensed personnel who scrub, and function under the direction of a registered nurse, usually the circulating nurse in the room. There are formal certificate programs, generally offered through community colleges--techs who graduate from these programs are eligible to take the certification exam offerd by their organization.

Many techs are hired and recieve on-the-job training at the hiring hospital- they are typically not eligible to take the certification exam.

Hospital administrators like using techs because they are paid less than RNs, and in some parts of the country OR nurses are in short supply.


1,260 Posts

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

My definition of a "first scrub" is the person who either has the responsibility of passing instruments or is across assisting the surgeon. This does not mean tying and suturing, that is reserved for the "first assist". I think there is a big difference between them. I have been doing this for 25 years and where I work all the RNs do everything except suturing and tying. We have a problem getting second surgeons and also the list of procedures that require a second surgeon is very small! Good luck, Mike


18 Posts

OUr hospital sounds like Mike's. The person in the scrub position is the "first scrub" and person assisting is the "second scrub." WE very rarely have second surgeons and only one group of surgeons have PAs. Most of our ORTs are graduates of accredited programs; we have a couple who learned OJT. Most of our RNs scrub in one capacity or another. I've never heard of a ranking among scrub personnel. One surgeon may like one more than another, but I agree that if a surgeon thinks this guy should make more money then he should hire him. why create problems for the whole OR.

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