Will circulators be RNs in the future?

[opus]

Just wanted peoples feedback. With the nursing shortage predictions getting worse over the next ten years what are people's feelings about the thought that RN circulators may be replaced by unlicensed personnel. Does anyone know AORN stand on this? Do people see something like this happening in the future? What is it about the circulator's job that requires an RN license?

[ianurse0509]

I'm a Circulating RN in the OR and we start IV's quite frequently. Especially in pediatric cases where anethesia is masking the patient. We also may start them if two IV's are necessary, anethesia starting one on one side and us starting one on the other.

We almost always have an OR Tech in the room with us as 2nd circulator. They are wonderful. The knowledge that they have regarding anticipation of the scrubs needs is greatly needed. However, any of my techs will admit that they do not have the education to do assessments or notice if there is a problem going on. They have the basic education which focused mainly on the anatomy of the body and the instruments they'll scrub with. With the exception of a scrub who was a previous CNA, they don't understand many disease processes, effects of medication, F&E balances, ect. I think these are really important things for the circulator to understand.

[subee, MSN, CRNA]

There are actually many times when the RN will need to start an IV in the OR. If anesthesia is having issues with the patient, and they need another line, or you are doing a case that there is no anesthesia person in the room, and they do come up.

Even with peds cases, anesthesia will be maksing the child, and the circulator will start the IV.

The RN is also responsible for doing the assessment on the patient, and this is an RN skill as per the BON. An assessment by an LPN would need to be signed off by an RN.

EMT's also start IV's. That's not nursing. Please give me an example of a nursing assessment in the OR that is based on what you learned in college?

[cocothemonkey]

EMT's also start IV's. That's not nursing. Please give me an example of a nursing assessment in the OR that is based on what you learned in college?

neuro and reflex checks after a carotid.

[grimmy, RN]

from my understanding, and this bears out in the cnor exam questions, the circulator must be an rn because 1) of the pre- and post-operative assessments that are made, 2) manipulation and procurement of controlled meds, 3) assistance with anesthesia (which includes iv push), 4) legal licensure required for signing off documentation, 5) patient advocacy (which includes sterile technique), 6) patient and/or family teaching duing pre-, intra- and post-operative phases.

[MelissaRN]

I for the most part enjoy my job as an OR nurse. The only piece missing is that I can't scrub and haven't come up with a way that I could consistently learn. We have a scrub tech program so they don't have time to drain the nurses consistenly.

The techs where I work make really good money if they have the drive. We have scrubs that have been doing this job for years, are awesome and get paid what nurses starting out get paid. The ones that are paid well are phenominal.

I get a little frustrated when I'm trying to help out the people in the surgical field and another tech will say "oh go do your nursing stuff" I'll run for them. I know she's just being helpful, but I hate hearing "your nursing stuff". The paperwork is frustrating and we all advocate that the paperwork is secondary to patient care.:balloons:

[Sarah, RNBScN]

Where I work the scrubs used to be RNA (Registered Nursing Assistant) and Registered Practical Nurses(RPN'S) and the RN's circulated in the OR. Today, they did away with the RNA (RPN'S) and have RN's scrub and circulate. You rotate the roles each day, different assignment.

99% of the time the patient comes to the OR with an IV, foley, NG, etc...

[subee, MSN, CRNA]

neuro and reflex checks after a carotid.

This is something you do while the patient is in the OR? Where are the surgeon and anesthesia? The PACU nurses do the post-op checks and there's no doubt that you have to be an RN in the PACU. But I never see the OR RN's doing carotid or reflex checks in the OR and don't know what a third person doing a neuro check in the OR itself adds anything. They're always doing their paperwork.

[MelissaRN]

We do neuro checks after the carotid surgery is finished. We have one particular doctor that likes to keep the back table and scrub sterile until the patient is awake and he sees that the patient is moving all four limbs.

[cocothemonkey]

This is something you do while the patient is in the OR? Where are the surgeon and anesthesia? The PACU nurses do the post-op checks and there's no doubt that you have to be an RN in the PACU. But I never see the OR RN's doing carotid or reflex checks in the OR and don't know what a third person doing a neuro check in the OR itself adds anything. They're always doing their paperwork.

How much time have you spent in the OR? You have a warped and incorrect belief on what OR nurses actually do. These checks are crucial after a carotid, patient doesn't leave until all four limbs are moving. Whether the PACU nurse does a post op check is inconsequential. There are many more examples but you just asked for one.

[MelissaRN]

As a nurse we know from schooling what could happen as the result of a clamped off carotid artery (which is what they do during an endarterectomy) so it's essential to know BEFORE leaving the room that the patient wasn't compromised during that time that the artery was clamped off. Not all surgeons will use a shunt or have EEG monitoring brain activity during the surgery.

[ortess1971]

As a surgical tech that is finishing up nursing school, I'm realizing that the thought process is different as a nurse. Circulating is not just paperwork. I used to think paperwork and running for stuff was the whole of what a circulator did. I was mistaken. They are starting to let me "shadow" one of the circulators when the other evening tech is available to scrub, and it has been an eye opening experience for me. The nurses I work with are very firm believers in the patient advocate role. You do learn things in nursing school that give you a broader, more in depth view of a patient. My tech program was great, but it was tailored more to specific surgical procedures and instrumentation. Assessments are vital, positioning a patient correctly is paramount etc. I'm not knocking techs, believe me. Some of the best operating room nurses I know were techs first(a couple of surgeons too!)-but a patient deserves someone in the room who has had the training to take their past history into account, understand lab values and how they can affect surgery,and many other things.

[cocothemonkey]

Watch a cardiac case that goes bad and tell me the patient wasn't lucky to have an RN in the room. A person who knows what to do and why it's being done.