Will circulators be RNs in the future?

Specialties Operating Room

Published

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?

We dont even operate without 4 RN's in the room. For us here in my workplace only RNs care for the patients throughout their perioperative experience. The only non nursing staff who touch a patient here is the porter who helps move the patient from the table. We also do not have non nursing medical staff enter the room once the procedure has begun. For me thats the future of nursing.

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Specializes in ICU,ER.

I have worked in the OR for over 20 years, first as a scrub and the past 14 years as an RN circulator. The perception among some is that we are glorified gophers whose main job is to run after things the surgical team needs. I heard this comment made by an RNFA who was explaining to me why she enjoyed first assisting so much more than circulating. I was quite taken aback by her attitude in spite of her saying that wasn't HER opinion, but that she felt that it was the surgeons who looked at the circulators that way. Only someone who has actually circulated knows what we do and why only an RN is qualified.

And yet.....I feel in many ways my role is being narrowed down due to the the actions of other members of the surgical staff and outsiders who seem to be taking on my duties. For example---sales reps who open sterile implants and know they are not allowed to but my charge nurse won't put her foot down. An RNFA who duplicates the things I either am about to do or have already done (give report to the PACU nurse when transferring a surg. pt from the OR), interview and do the same pre-op assessment, teaching, etc. in the holding area that is done by the circulator but doesn't document it anywhere so I must do it over again because I have to chart it in the computer.....scrub techs who place foleys and prep my patient, saying they are just helping speed things along without getting my OK. I am not critical of their help, but that basically leaves me with very little to do but sit at the computer, run for supplies and do the dirty jobs that are suddenly mine because I am a nurse----the code browns----then everyone disappears. If I am not aggressive and stay ahead and on top of everything, I would really feel insignificant. I really miss scrubbing and try to get assigned to scrub as much as possible but there's very little opportunity for that since becoming a nurse.

I've decided going to RNFA school would get me back in the area of patient care I would like to be and away from the computer where it seems more and more nurses spend the majority of their time. Sorry so long-winded----this is just my viewpoint and I don't mean to demean anyone. But we nurses must remember we are the patient's advocate---their voice--and stand together and not let anyone usurp our rightful authority. I have had a tech get uppity with me because I asked her to count her sponges with me instead of just say there were 10. I have also worked with some awesome scrub techs that have taught me a lot. But just last week one of them tried to intimidate me into taking the patient to the OR before the surgeon had seen and talked with her. She was making a decision that was not her place to make. I refused and she got nasty and said that this is why we have doctors yelling about long turnover times. The anesthesiologist heard it all and backed me up 100% and told me this particular doc would have been livid if I had not waited and that this tech needed to be written up because all this was said in front of the patient. Does anyone else feel they like this----like if we don't take a stand, there are plenty of others ready to step in and try to do our jobs as we are pushed further away from the patient care and left at the desk and computer?

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Specializes in CRNA, Finally retired.
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.

Actually, I've been in the OR for 25 years. I've never seen the circulator make the call that the patient is ready to go to the PACU. I've never seen a circulator act on a patient who he/she believes has suffered an insult to the brain after arterial clamping. I've been in the OR solely for 25 years - extremely disappointed that the OR nurses are delegated to chores that require nothing from their nursing degree. When I was at the big city teaching hospital, it was surgical techs that set up the complicated neuro cases, passed the instruments, etc. and the RN's that circulated. I was still a student then and spent more time watching the case rather than the circulator. Nursing care started when the patient arrived to neuro ICU. Believe me, as a former nursing administrator, I watch very carefully what the OR nurses do.

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Actually, I've been in the OR for 25 years. I've never seen the circulator make the call that the patient is ready to go to the PACU. I've never seen a circulator act on a patient who he/she believes has suffered an insult to the brain after arterial clamping. I've been in the OR solely for 25 years - extremely disappointed that the OR nurses are delegated to chores that require nothing from their nursing degree. When I was at the big city teaching hospital, it was surgical techs that set up the complicated neuro cases, passed the instruments, etc. and the RN's that circulated. I was still a student then and spent more time watching the case rather than the circulator. Nursing care started when the patient arrived to neuro ICU. Believe me, as a former nursing administrator, I watch very carefully what the OR nurses do.

Have you ever been a circulator? We've had a number of techs go back to school to be nurses and were amazed at how difficult the job was and the things we do that few realize. They too were under the impression that we were nothing but glorified gophers until they actually stepped into the job. Or maybe it's the hospital you work at. We had a cardiac case go bad last week. I was the one doing the chest compressions and dictating jobs until the surgeon could get back into the room.

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Specializes in Telemetry, OR, ICU.
Have you ever been a circulator? We've had a number of techs go back to school to be nurses and were amazed at how difficult the job was and the things we do that few realize. They too were under the impression that we were nothing but glorified gophers until they actually stepped into the job. Or maybe it's the hospital you work at. We had a cardiac case go bad last week. I was the one doing the chest compressions and dictating jobs until the surgeon could get back into the room.

Why do some CRNAs hate on RN Circulators? :uhoh21:

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Why do fools fall in love?

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Specializes in CRNA, Finally retired.
Why do some CRNAs hate on RN Circulators? :uhoh21:

Whoa - I NEVER even IMPLIEDthat scrub techs should circulate! I just think that there should be a new kind of nurse especially trained for the OR. Trained to the point that they don't require a year of orientation. Able to graduate on Friday and go to work on Monday in a circulator role. Do you need a university education to work in the OR? And poor England. No wonder your system is going broke if you have 4 (?) RN's in the room for every procedure. I didn't realize that there was any antagonism between CRNA's and RN circulators. I enjoy our bantering and comraderie. However, I'm still waiting for a convincing explanation that we need to take RN's away from the patients on the floors because they are the best people to assume the circulator role in an OR. I think its really unfair for the institutions to have to assume the cost and the liability of training their own people. Perhaps nursing SCHOOLs should be doing that job.

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Specializes in Telemetry, OR, ICU.
Whoa - I NEVER even IMPLIEDthat scrub techs should circulate! I just think that there should be a new kind of nurse especially trained for the OR. Trained to the point that they don't require a year of orientation. Able to graduate on Friday and go to work on Monday in a circulator role. Do you need a university education to work in the OR? And poor England. No wonder your system is going broke if you have 4 (?) RN's in the room for every procedure. I didn't realize that there was any antagonism between CRNA's and RN circulators. I enjoy our bantering and comraderie. However, I'm still waiting for a convincing explanation that we need to take RN's away from the patients on the floors because they are the best people to assume the circulator role in an OR. I think its really unfair for the institutions to have to assume the cost and the liability of training their own people. Perhaps nursing SCHOOLs should be doing that job.

  • AAS in Surgical Technology 1995 [i.e. CST, AKA Scrub Tech]
  • AAS in Nursing 1998 [i.e. ADN]
  • BSN 2004

  1. Telemetry Floor [i.e. RN w/Cardiac patients]
  2. ICU [i.e. CCRN, including weekend nights Charge RN]
  3. OR [i.e. Circulator/Scrub Nurse]
  4. Presently, a full time civilian Circulator & USAR CCRN.

Subee, I still say about 50% of the CRNAs have an attitude against Circulators. I do appreciate the CRNAs & had hoped to be accepted for the US Army Graduate Program in Anesthesia Nursing. Every soldier nurse anesthetist I've ever worked with was a team player & did not belittle me d/t being a Circulator.

Pssst, AORN is too strong of an organization to let anyone run the RNs out of the OR. BTW, I've never heard of a 12 month orientation for new Circulators. The longest I've ever heard was 6 months. My orientation was barely a month, yet I was a Scrub Tech for 3 years.

:p

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Specializes in Telemetry, OR, ICU.
And I would appreciate it, if just once, in this section of the forum, when other people answer why someone other than an RN can't circulate, that they don't take it as an opportunity to insult and degrade other positions in the OR, like past discussions have.

Good point! I have a deep appreciation for Scrub Techs, since I was one from 1995-1998. I have a deep appreciation for what the Circulator does, because I am a Circulator. I admire the Anesthesiologist & Surgeons for what they do. I admire the other nurse in the OR, too, the one that happens to have an MSN, specialized in Anesthesia Nursing.

*I definitely appreciate the CAs constantly taking specimens to the lab, getting blood products, helping with lifting & turnover, etc.

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25 years ago when I was orienting as a circulating nurse, my preceptor put in in perspective for me on the first day. "You are the patient's sensory system while they are asleep. You get to know their individual needs by asking good questions in the holding area and reading their chart, then you watch everything and everyone that comes in contact with them from the time they go to sleep until you give report to someone else."

I don't ever turn my back to the field for this reason. (I love rolling computer carts!) If a surgeon or any other member looks across the field, I am watching. It's hard for a surgeon to question a nurse's role when they have this connection to their patient.

The changes that have occured in the OR relative to technical make it easier to lose your focus but nurses will always be needed if we continue to be the patients eye, ear, and nerve endings.

I think nursing school gave me both the knowledge and the intuitive skills that are unique to nurses. Until better preparation come along, every OR needs at least one nurse who fulfills this task.

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Specializes in CRNA, Finally retired.
Good point! I have a deep appreciation for Scrub Techs, since I was one from 1995-1998. I have a deep appreciation for what the Circulator does, because I am a Circulator. I admire the Anesthesiologist & Surgeons for what they do. I admire the other nurse in the OR, too, the one that happens to have an MSN, specialized in Anesthesia Nursing.

*I definitely appreciate the CAs constantly taking specimens to the lab, getting blood products, helping with lifting & turnover, etc.

Corvette Guy, Goodness gracious. There is no need to be defensive on this issue. I'm not putting the role down. Of course we need everyone on the team in the room. I think, however (speaking as former administrator here) that hospitals deserve to get a nurse in the OR that is specially trained for that job. It doesn't imply job shrinkage but rather, a specialist position. As for the poor guy who was thrown to the wolves after six weeks training, how could anyone possible know where all the equipment is after six weeks anywhere? If you are the only nurse in the OR on a late night case, how can any hospital expect you to be able to locate a specific, hard to find ANYTHING when you've hardly had time to find the bathroom and the patient is under anesthesia. As someone who has watched a lot of nurse come and go over the years, we've never let anyone take call as the lone RN before six months - it takes a long time to break in someone from the floor when they will be the lone RN on call. Why can't we have an OR specialist who learned their job in school - not on the institution's time?

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Specializes in Telemetry, OR, ICU.
Corvette Guy, Goodness gracious. There is no need to be defensive on this issue. I'm not putting the role down. Of course we need everyone on the team in the room. I think, however (speaking as former administrator here) that hospitals deserve to get a nurse in the OR that is specially trained for that job. It doesn't imply job shrinkage but rather, a specialist position. As for the poor guy who was thrown to the wolves after six weeks training, how could anyone possible know where all the equipment is after six weeks anywhere? If you are the only nurse in the OR on a late night case, how can any hospital expect you to be able to locate a specific, hard to find ANYTHING when you've hardly had time to find the bathroom and the patient is under anesthesia. As someone who has watched a lot of nurse come and go over the years, we've never let anyone take call as the lone RN before six months - it takes a long time to break in someone from the floor when they will be the lone RN on call. Why can't we have an OR specialist who learned their job in school - not on the institution's time?

Okay, I now have a better understanding of your perspective.

:)

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