What's the biggest difference between a scrub and circulating RN?

I have been Scrubbing for 20 years. I became an RN two years ago ! Scrub role . As you know now . We are at the sterile field. You would have to know the instruments, the steps of each surgery. To anticipate the Surgical team etc . As a circulator. We help set up the room , get additional supplies for the case . Before and during case ( if need be ). Interview the patient before they enter the room . Arrange the room and equipment for patient care. Administration of med onto sterile field . Two separate roles . 

20 hours ago, MF1679 said:

I have been Scrubbing for 20 years. I became an RN two years ago ! Scrub role . As you know now . We are at the sterile field. You would have to know the instruments, the steps of each surgery. To anticipate the Surgical team etc . As a circulator. We help set up the room , get additional supplies for the case . Before and during case ( if need be ). Interview the patient before they enter the room . Arrange the room and equipment for patient care. Administration of med onto sterile field . Two separate roles . 

Hello! I have some questions for you because we kind of have a few things in common.

I completed a semester of an MSN educator program, but decided that my heart wasn’t in it … not at this time in my career anyway … I really just want to get back to scrubbing; I was first trained as a cath lab scrub, but after becoming an RN, all anyone wanted for me to do anymore was to circulate! So I’m happy to change my specialty to the OR, and I will be enrolling in a surgical tech program.

How did your institution respond to you becoming an RN? Did it change your role as a scrub or provide different opportunities for you?

My apologies to mountainhike1999 - I am sorry to divert your thread this way!

The two roles cannot function without one another. The circulator plans the cases of the day right at the start and gets all the equipment and supplies and instruments needed for the case (although most times the disposables and instruments come up in a case cart). The circulator does the Pre op consult with the patient and liaises with the surgeon and anesthesia then arranges the OR room / theatre and all equipment and furniture and ensures that the room is cleaned and ready for the patient. Then helps the scrub RN or Tech open all instrument pans, sterile disposables, fluids and medications to the back table. By that time the patient is usually brought into the room , so the circulators focus shifts entirely to the patient and their well being. Getting the patient safely onto the table, secured safety straps, putting on SCD's , providing warm blankets and then participating in the anesthesia Time out. All while documenting everything on the computer. In spare moments, the circulator counts with the scrub and dispenses any other meds etc and might open more disposable supplies to the back table. Foley' catheters are then placed, after assisting the anesthesia provider with induction and securing the airway. We then position the patient appropriately for the surgery to be performed .This is usually done with the surgeon or one of the residents (where I work) . The surgical site is clipped if need be, then prepped. The scrub RN and surgeon/ resident then drape the patient and throw off all the cables and suction hoses etc and the circulator plugs these in and then assists with leading the Time out. Surgery begins and the circulator then plays catch up with all the documentation on the computer as well as completing any actual paper records , all while listening attentively to what is going on at the surgical field. Usually then have to update the family via text, start calling to get the next patient "made ready" for pre-op and planning equipment and supply needs for the following case. 

When I am in the scrub role, I check my cases listed for the room for the day and anticipate what I might need. I check the case cart to ensure I have all the instruments for the first case as well as all the disposables. I open the custom packs with my circulator and add all disposable items in addition. I usually then go and scrub at the sink outside the OR, but maintain a view of the back table through the scrub sink window. I then gown and glove myself and start arranging the back table, Mayo stand, irrigation warmer etc . My circulator or any other techs/ RN's in the room will then open my instrument pans and we will check indicators, integrators and the condition of the instruments and the blue wraps that they often come in. I set up the back table and arrange all the instruments and other sterile items in a manner that I know exactly where they are without even looking. I count with the circulator, receive any additional meds and fluids and then arrange everything on my Mayo in order for the start of the case.I will usually drape the microscope then if we are using one. I gown and glove the surgeons, residents & medical students and help with the draping and tossing off the cautery cables, drill cables, suction hoses and check that everything is working. Participate in the Time out and then start handing items to the surgeons in the order that I anticipate they will need them. Local anesthetic, Raytec sponge and skin knife then followed by Bovie. I will request additional instruments and sterile items as the surgeons needs are made known and check these with the circulator . I will receive specimens and label them and preserve them on the back table. I will dispense medications as needed to the surgical site. I will assist retracting, irrigating , suctioning as requested by the surgeon. I mentally keep track of every item that goes into the wound from my mayo and table. I maintain surveillance over the whole sterile field and all members of the sterile team to ensure that they do not contaminate themselves or the sterile field and when this happens, I deal with it to salvage the situation and ensure no risk to the patient .I prepare all the sutures at closing time, perform the count with the circulator and then assist with passing sutures at closure, performing several additional counts and then prepare the dressing and drains (if we are putting any in) . 

The OR really requires great teamwork and reliance on ones fellow team mates to ensure that efficiency is maintained , that the patients well being and safety are upheld and that a great cohesive collegial team spirit is encouraged through good communication. I love scrubbing but do circulate a shift between scrub shifts just to maintain my efficiency in running my list and running my theatre smoothly.  Make sure that when you graduate as a RN you get into a hospital that encourages their nursing staff to scrub as many hospitals use surgical techs due to cost savings. Most of the large university hospitals that I know here on the west coast have RNs that scrub and it is a hiring requirement now that all nurses hired learn to scrub and then scrub a few times a week at the least. Best of luck. 

On 8/11/2022 at 2:18 PM, graceandharmony said:

How did your institution respond to you becoming an RN? Did it change your role as a scrub or provide different opportunities for you?

There are economic realities here. Scrub tech wages are lower than RNs, so generally there are few scrub opportunities for RNs at most hospitals - the extra cost isn't justifiable. And even OR internships may not even offer learning opportunities to scrub or if they do, they are just tokens so you get get an idea of what the experience is like versus actual attempts at full training. 

My personal beliefs make no difference in hospital practices. Cheaper to keep more scrub techs around so nurses scrubbing are not needed. However the bean counters at hospitals may not have enough scrub techs to avoid staffing issues. As a traveler I can tell you that having nurses that scrub make the charge nurse's life a lot easier to plug holes in the schedule, not just overall, but also just for things like breaks and lunches. So the reality is I'm more employable as I'm more valuable to managers (in some travel assignments I scrub a lot, in others, never - yet having that skill set gives managers more options and depth). Less important to staff hiring decisions perhaps.

And even from a strict circulating point of view, really understanding what the scrub does can help you expedite your cases and help ensure you do what needs to be be done to make surgery happen smoothly for all key players. Good circulators can learn this without actually scrubbing though, but it is a slower process and some never learn at all. So I personally think everyone should cross train for both roles.

Just to throw a wrench in a lot of belief systems here, we think that scrubs are the lower trained roles and circulators are the higher trained staff, right? I worked in England for a year and it is completely the opposite there.

I worked in OR's for almost 40 years and never saw RN's in scrub roles.  There are AD programs specifically for techs making them more qualified for that position.  They are quick to orient, can run central services in a pinch. Why should hospitals pay an RN to do a tech job? 

2 hours ago, Rose_Queen said:

Because techs aren't being created to meet the demand, plus it makes for a much more flexible staff when RNs are capable of scrubbing.

Why would an RN want to be in  a tech job?  If you want to be a technician, go get a tech degree an save the nursing faculty for folks who want to be nurses...it would help alleviate the faculty shortage.

3 hours ago, subee said:

I worked in OR's for almost 40 years and never saw RN's in scrub roles.  There are AD programs specifically for techs making them more qualified for that position.  They are quick to orient, can run central services in a pinch. Why should hospitals pay an RN to do a tech job? 

I became an RN . Who were a Certified Surgical Tech . I’m utilized a lot . For the latter. Here in NYC and surrounding areas. Tri-state as well. It’s a plus when we can . Now RNs without the background in the OR. Will have to find a facility that will train them to do Scrub roles.Staff  Surgical Techs are becoming scarce. So a-lot of Hospitals require RNs to now Circulate and Scrub !