What's the easiest job in the operating room?

Scrubby · Jul 16, 2009

I would say that the easiest job in the OR is the anaesthetic nurse. They assist with intubation, extubation and during the case most of the ones at my work will just sit in the break room and walk around aimlessly doing nothing. They get really annoyed when we ask them to help with circulating, they never organise bringing the patient into the OR, they stay on their side of the room with the anaesthetist and pretty much ignore us.

Fun2, BSN, RN · Jul 18, 2009

I think there is no right answer... Everyone is different, every case is different, every position is different, and every facility is different.

Marie_LPN, RN, LPN, RN · Aug 16, 2009

I'd never say that any job is easy in the OR, the OR is not where the easy jobs are.

Jeff RN · Aug 24, 2009

No offense Shari, but have you circulated? OVERALL, circulating is a lot harder than first assisting or scrubbing. Yes, there are tough cases to scrub, but OVERALL, circulating is the hardest. I look forward to the days that I get to scrub all day. Scrubbing is usually fun. There is so much less responsibility, which is precisely why an RN degree in not required. Most techs have no idea how hard is circulating, despite the fact that they watch circulators in action everyday. I've seen excellent scrub techs become nurses and they are unpleasantly surprised how difficult is circulating. The point is that until you do all three... circulating, scrubbing, and first assisting, you cannot accurately judge which job is the toughest.
As for RNFA training, the course is usually just a few days long, followed by logging hours first-assisting in their hometown hospital. So their training is very little more than that of a circulator.
You're a tech, so you have first-assisted often, and when you do so, you are being the scrub tech at the same time. Now imagine doing only the first assisting part. Unless the patient is crashing or bleeding out, it is an easy job.
I work with an RNFA with 20 years experience. I asked her why she became an RNFA. She told me that she "just wanted to do what was easiest." You may not like her answer, but she was just being honest.
Yes, I realize that it is politically incorrect to say that some jobs are harder than others, but to say that all jobs are OVERALL EXACTLY equal in difficulty is inaccurate.
Tell me what F.A.'s do besides retract, suction, cut, saw, drill, and suture?

The skills involved in scrubbing and first assist are more difficult to learn than prepping, positioning, and having a chat with the patient. Sure circulating has more individual tasks, and you have to be organized, but try scrubbing 4-5 totals in a day without lunch and see who works harder.

MamaCheese · Aug 24, 2009

try scrubbing 4-5 totals in a day without lunch and see who works harder.

Man, I don't want to work where you work. I hope that's not par for the course

linda2097 · Aug 24, 2009

The skills involved in scrubbing and first assist are more difficult to learn than prepping, positioning, and having a chat with the patient.

Wow, you sure make circulating sound easy.

Sure circulating has more individual tasks, and you have to be organized, but try scrubbing 4-5 totals in a day without lunch and see who works harder.

So you are saying that scrubbing is harder than circulating because only circulators get breaks?

core0 · Aug 27, 2009

No offense Shari, but have you circulated? OVERALL, circulating is a lot harder than first assisting or scrubbing. Yes, there are tough cases to scrub, but OVERALL, circulating is the hardest. I look forward to the days that I get to scrub all day. Scrubbing is usually fun. There is so much less responsibility, which is precisely why an RN degree in not required. Most techs have no idea how hard is circulating, despite the fact that they watch circulators in action everyday. I've seen excellent scrub techs become nurses and they are unpleasantly surprised how difficult is circulating. The point is that until you do all three... circulating, scrubbing, and first assisting, you cannot accurately judge which job is the toughest.
As for RNFA training, the course is usually just a few days long, followed by logging hours first-assisting in their hometown hospital. So their training is very little more than that of a circulator.
You're a tech, so you have first-assisted often, and when you do so, you are being the scrub tech at the same time. Now imagine doing only the first assisting part. Unless the patient is crashing or bleeding out, it is an easy job.
I work with an RNFA with 20 years experience. I asked her why she became an RNFA. She told me that she "just wanted to do what was easiest." You may not like her answer, but she was just being honest.
Yes, I realize that it is politically incorrect to say that some jobs are harder than others, but to say that all jobs are OVERALL EXACTLY equal in difficulty is inaccurate.
Tell me what F.A.'s do besides retract, suction, cut, saw, drill, and suture?

If you think that being an FA is holding the retractor where you were told to put it (or it was placed) then yeah its a pretty easy job. On the other hand if you are a real first assist then there is a lot more to it.

1. Keep an eye out on whats happening outside the surgical field. Keep an eye on the patients vital signs, blood loss, etc. Keep the surgeon updated on what is going on.

2. Keep an eye on the time. Remind the anesthesiologist when to give intraop meds and redose antibiotics.

3. Keep ahead of the surgeon. While keeping the field dry plan your next move. Where does the retractor need to be so the surgeon can see? What suture needs to come up next?

4. If there is an emergency what do you need to do to help get control?

5. Keep an eye on anatomic structures that may be outside of their immediate field of vision. Gently remind the surgeon of these structures.

Now do all this with a pair of 3 power loupes on. Do it while locked in an awkward position for three or four hours. The job of a good first assistant is to make the surgeon more effective and allow them to concentrate on the surgery. You have to understand the surgery inside and out. You have to have a knowledge of the surgical anatomy and what to do in a surgical emergency.

Retracting, cutting and suturing are technical tasks. Holding a retractor once doesn't mean that someone assisted anymore than the fact that I got a roll of tape for anesthesia once makes me a circulator.

David Carpenter, PA-C

linda2097 · Aug 29, 2009

David, would you circulate for a living if it paid as much as your current salary?

core0 · Aug 29, 2009

I never said that. I am aware that FA's are supposed to be able to help the surgeon without the surgeon saying a word.
Those are jobs of the anesthesiologist. FA's should stay focused on the field.
Not difficult.
If there is an emergency, everyone in the operating room is going to have a hard time.
After over a decade of working in the O.R., I have yet to see an FA remind the surgeon about anatomy.
Most cases do not require loupes. Most cases are less than 2 hours.
That pretty much applies to everyone in the O.R.

I guess you have all the answers. The difference between us is that you think being a first assist is easy. I know its not. Of course I also understand that other jobs in the OR are difficult also. It may be that the only first assists that you work with are big blue retractor holders. Or maybe they just make it look easy. Bottom line a bad first assist can double the case time just like a bad circulator can. A good one can halve it just like a good circulator can.

The other point that you brushed aside is emergencies. In an emergency all of the other positions have help available. If things get really bad we will have a couple of other nurses helping the circulator. The anesthesiologist will have an another anesthesiologist or may an AA or perfusionist helping. But in the field there is no other help. We might scrub in another attending but there is only so much room for people to work so usually its just the two of you doing whatever you need to be done.

From one standpoint assisting is one of the easier things that I do. Most days I would rather be in the OR taking care of one patient than trying to take care of 10-20. Thats me though other opinions may vary.

David Carpenter, PA-C

linda2097 · Aug 29, 2009

In an emergency all of the other positions have help available. If things get really bad we will have a couple of other nurses helping the circulator.

It depends on the facility and the shift. At nights, for example, there is only one circulator who is also the charge nurse. There is no one to help her. At the field on the other hand, there is the surgeon, FA, and tech.

I am sure that your job as a PA is a difficult. But think how much easier it would be if all you had to do everyday is FA. I should clarify that when I originally implied that FA'ing is the easiest job in the O.R., I was referring to RNFA's who work in the O.R. 100% of the time. PA's and MDFA's on the other hand have a VERY hard job.

Editorial Team / Admin · Aug 29, 2009

Unless you've done all of the other jobs in the OR, I don't think you can have an unbiased opinion of which is "easiest." You only know what you see, but I'm sure there is more going on behind the scenes while you are concentrating on what you have to do. Personally, I believe each position has "easy" moments and "difficult" moments, no matter who you are. Situations change.

linda2097 · Aug 29, 2009

Personally, I believe each position has "easy" moments and "difficult" moments, no matter who you are.

Of course.