What's up with RNs who refuse to scrub?

[stevierae]

This trend, at least in the Western states, is starting to irritate me more and more, the more I see it. I have been an OR nurse for over 20 years; scrub and circulate all areas; have done all kinds of trauma. Nowadays I only work as an OR nurse on a travel assignment once a year, to keep up my skills. The rest of the time I work as a legal nurse consultant and as an IV nurse educator.

So, what's up with these new RNs in some (not all) ORs who don't scrub, and won't learn? To me, it's like doing only HALF your job, and leaving your colleagues who DO scrub left to do their share PLUS yours. I really want an answer to this.

One time I went to a job interview to see if I could pick up some occasional per diem work at a local OR. Just for this stupid little per diem job, in an OR that is not even a trauma center, and does pretty much just VERY basic surgeries (i.e., lap choles, arthroscopies, breast biopsies, TAH-BSOs--you get the picture--) I was interviewed by the director PLUS the "charge nurses" of those areas--that is, general surgery, GYN, and ortho--all new grads. Out of the blue, the director asked, during the course of the interview, "What makes you angry?" I said, "OR nurses who refuse to scrub." Every one of the charge nurses stared at the floor. I realized, then, that NONE of them could scrub, nor would they ever learn. I knew I wasn't going to be getting that job!!! (I also knew I did not WANT that job.)

The funny thing is, scrubbing is fun; sometimes, you really bust your a** running around circulating big cases and scrubbing is a very welcome break, where you can almost let your mind go on autopilot--well, you can if you know what you are doing. Those prima donna charge nurses never will.

Oh, by the way--I always take my OR travel assignments in California, and ALL the OR nurses in those facilities scrub and circulate all areas. Are California OR RNs just better, more well-rounded RNs than the RNs in the rest of the Western region? I don't live there, but I teach there quite a bit, (as well as doing the aforementioned annual travel assignment) and I am beginning to suspect that this just might be the case. What is the trend like in the rest of the country?

[shodobe]

From reading your post I can see you appreciate the OR helping you out. Where I work there is really no appreciation but expectation. I think if they were to say thank you once in awhile our staff wouldn't gripe so much. Also I spent to many years and sleepless nights going to other departments to help them out and believe me it was "bailing" them out. Most of the time it was pure incompetence and poor staff training on very basic nursing functions, a-line setups, cvp,etc. I will not refuse in extreme emergencies because I stay at the hospital when I am down south and the house supervisors know this. We now have cluster float areas and L&D is our only one. ER and ICU/CCU interchange. Mike

[angelzeyez]

OK...all you OR nurses out there. Personally, i think it is wonderful for an RN to have the opportunity to scrub. I work as a certified surgical technologist in a level one trauma center here in the Northeast. We have more RN's than scrub techs and our RN's do have the opportunity to scrub...not all the time, but they do get to scrub. We have a few who refuse because they have done it for 20+ years and are just tired of standing in one spot all day ( can you blame them?) We also have new graduates from our OR program for RN's who are just too afraid to "step up to the plate" and play. From a surgical tech standpoint, I would much rather have a circulator who scrubs than someone who does not. It makes for a smoother case because he/she can anticipate my needs as well as my surgeons' needs. It truly does make you more well rounded in the operating room. I hope to someday complete my RN training and I also hope than when I do I will still have the opportunity to scrub, because I love it!

As far as why there are so many surg techs out there compared to OR nurses? It has nothing to do with CST's being cheaper...it has everything to do with the younger generations seeing that they can make a better profit doing less work in areas other than the medical field. Hospitals need to pay medical staff more appropiately and have a good retention plan for those already employed. Just something I have personlaly noticed in my area.

[JasonGreen]

Originally posted by angelzeyez

From a surgical tech standpoint, I would much rather have a circulator who scrubs than someone who does not. It makes for a smoother case because he/she can anticipate my needs as well as my surgeons' needs. It truly does make you more well rounded in the operating room.

I agree with this statement 100%

[jude11142]

I am an LPN, enrolled in RN program. For 12 yrs, I worked as a scrub tech. I have to say something positive about techs........most do know the difference between a hip retractor and a weitlander. I have worked with many excellent techs who could bounce from a simple hernia repair and jump right into a transplant or crani etc.............I was not and the techs I worked with were not mindless people who could let their mind drift off. You have to be on the ball.........you must anticipate what the surgeon needs/wants before they even know. When things go bad, you are right there, and must be able to keep up. I think that being a circulator vs scrubbing is a choice.......but believe that all circulators learn how to scrub........obviousely techs cannot circulate, but I have on occasions set up cases, flipped sutures/sponges etc........made sure the right instruments were pulled etc........it is much easier to teach on to circulate than it is to teach one to scrub.

I don't believe that anyone meant to "put down" a scrub techs role, but I felt that as a one-time tech.......who hopes to get back into OR as an RN and scrub......it is important to realize that techs not only go through a rigorous program that teaches much more than how to pass instruments. The tech is a vital part of the surgical team and usually here in CT, our surgeons respect us and love teaching us about surgeries, what they are doing and why and so on.

Over the yrs, I have taught many new circulators how to scrub and they in turn taught me things.

This has been my experience.

JUDE

[jude11142]

Originally posted by stevierae

Where the he** do you live, meandragonbrett? And why do you allow yourself to get stuck in a situation where you have so little autonomy? Why not speak up and ASK to learn to scrub, rather than getting stuck in such a rut? To say that RNs who CAN scrub and RNs who CAN'T are equally well-rounded is simply nonsense. Ask any of your scrub techs who THEY would rather have as their circulator, given a choice!! If you don't scrub, you really cannot empathize with your scrub, you cannot really anticipate needs (other than what is clearly visible like laps and needles,) you can't suggest instrumentation that might work in a pinch if the commonly used instumentation is "out for repair" in use in another room or BREAKS while you are using it. If the surgeon nicks some major vessel and the patient starts bleeding out and your scrub yells out "Gimme a vascular stitch," you will have to waste critical time asking, "What kind, what size, on what type of needle" because you, having never scrubbed that type of case, won't be knowledgable of what most likely just happened (that is, what vessel was most likely nicked, and what the consequenses might be.). You CAN'T put yourselves in the shoes of the scrub, because YOU HAVE NEVER BEEN THERE. I firmly believe every OR RN needs to function in both roles; if not, you are only doing half your job.

Stevierae.........good post............I agree totally.

[D.Rollins]

It was interesting reading your submission. I am a BSN student who just finished a rotation in an OP surgery center. I have no experience in an OR setting. I was surprised that several of the nurses scrubbed in addition to circulating. One of the things that I noticed is that the surgeons were always requesting particular nurses to scrub for them. I am not saying that the scrub techs did not do a superb job, but there must be a reason the surgeons preferred the nurses to scrub. If I were going to work in an OR, I would like to learn to scrub. One of the other responses said scrubbing is not taught to nurses, but a lot of things are not taught. You have to learn it from experience. As you said, I believe it makes you more knowledgeable about the entire process.

[jude11142]

Many surgeons call the person who is scrubbing, "my scrub nurse". I don't think that they are aware at times that their scrub is a tech rather than a nurse. When I was a tech, I never presented myself as a nurse. Many times surgeons request certain scrub nurses, but atleast where I worked it wasn't because the scrub was a nurse or not, but because who they want with them assisting knows their routine etc.........

We has what was called "dedicated services" and during my last 3 yrs, I only worked Neuro/ENT, so naturally the surgeons get to know you well as you do them. Sometimes, that isn't a good thing because on the days that you are off, some of these surgeons are really tough on the "new" scrub. All they have to see is a new face and they freak, lol...........

The more that I am reading/writing about OR nursing, I realize just how much I miss it. When I left, I was told that once an OR nurse, always one........guess that may be true.

JUDE

[dish1971]

I agree that RN's should scrub as well as circulate. In the hospital where I trained, RN's tend to circulate more often b/c it's cheaper to have surgical techs rather than RN's. I was lucky-my hospital had an internship that taught me instruments and how to scrub, but then we are not allowed to utilize our skills, and if you don't use them, you lose them. Though I realize that circulating is very important, I would much rather scrub anyday that circulate! If I had know I could learn to just scrub, I doubt I would have gone to nursing school, and unfortunately, I can't afford a pay cut.

[Triagn]

To be an OR Nurse means that you can step into any situation and at least take control until more experienced help can arrive or to have enough knowledge to get you through. You may not be the BEST in each service but you know enough to hang in there and be what you have to be!!!!!

[2bPhD]

After they taught the housekeeping staff how to scrub, the task was no longer considered a skilled nursing technique. After all, anyone can scrub and assist in the OR. Medical students and interns do it all of the time. Nursing time should be devoted to more skilled aspects of care that require the unique background that nurses possess.

[CVnurse08]

Hi,

I know absolutely nothing about this topic but couldn't help but point out that this thread has been going on for almost a YEAR now !!!! That has to be a record !!! That's really neat and I have enjoyed reading it.

[KarenHalse]

I think it is obvious that there are many opinions that we all have. But, from Scrub Techs being cheaper to use that RN's...(and this is not a put down to either), Scrub Tech's are cheaper.

I have worked with some excellent Scrub Tech's as well as lousy one's...also worked with many RN's that scrub and circulate. Being able to scrub doesn't necessarily make you a better circulator. Being able to circulate doesn't necessarily make you a better scrub either.

Most of the RN's I know that scrub would rather scrub than circulate. They seem to think it is easier.

Circulating is not something that is done without thought or education. "but I have on occasions set up cases, flipped sutures/sponges etc........made sure the right instruments were pulled etc........"...is this all you really thought circulating is about...did you say you were in school to learn to be an RN?

We all have an opinion and where I have worked with it is more team work than anything else. That is the way it should be.