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It is incumbent on OR nurses to act as nurses, not technicians
Speak out
It is incumbent on OR nurses to act as nurses, not technicians I wish to speak out for the AORN Mandate for the Registered Nurse as Circulator in the Operating Room. It is my contention that operating room nurses are grossly negligent when they elect to scrub while the technician circulates. In my experience, the justification for this appalling situation has been that operating room nurses enjoy scrubbing. These nurses should be reminded that they are employed to care for the patient's welfare and not for their own satisfaction. The AORN Mandate does not state that the nurse cannot scrub. It does state that if only one nurse is assigned to a case, the nurse circulates while the technician scrubs. Another reason frequently given for abandoning responsibility is that the nurse trusts the technician because she is familiar with his or her capabilities. These nurses should
Joanne M Terrion, RN, is a student in the baccalaureate program at the University of North Florida, Jacksonville. A part-time OR staff nurse at Baptist Memorial Hospital, Jacksonville, she formerly was an O R staff nurse at Akron General Medical Center, Akron, Ohio.
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be reminded that trust does not supersede legal liability and responsibility. Historically, the scrub technician came into being because of a shortage of nurses. To alleviate the shortage in the operating room, many hospitals emulated the military services by training nonprofessional people to scrub. This has led, over the past 25 years, to the present problem. It is time for operating room nurses to assume their proper role in protecting the patient's welfare. We must inform hospital administrations that there no longer is an acute shortage of nurses. We must charge them with negligence in allowing financial considerations to cloud their concern for patient welfare. It is less expensive to hire scrub technicians than to hire qualified nurses. We must encourage colleges and schools of nursing to return operating room rotation to their curriculums. The operating room is a paradise of learning for student nurses. We were negligent in allowing this vital rotation to be so easily phased out. With an increase in student rotation through the operating room, it becomes obvious that more student nurses will choose to work in the operating room after graduation. Thus, the need for a larger number of technicians will be alleviated. In the work situation, if we are making out case assignments, we should always assign a nurse as circulator. This will be met with resistance at first, but personal feelings and friendship should not supersede our obligations to our patients. If there are not enough
AORN Journal, September 1976, V o l 2 4 , No 3
509
nurses to circulate, the schedule should be cut back. Meeting adequate staffing needs is hospital administration’s responsibility. The operating room supervisor should not compromise the patient’s welfare because administration has not fulfilled its obligation. On a personal level, close evaluation of the AORN Mandate makes it evident that the nurse is the only operating room staff member qualified to fulfill all of the designated roles of the circulator. If the nurse is scrubbed, she cannot recognize and intervene in stress situations with the patient and team members because she is too busy passing instruments. She also cannot keep a close watch on team members to observe breaks in technique or violation of asepsis. Only the nurse has current knowledge of the legal liabilities of surgery. The nurse is legally responsible for the technician. If she is scrubbed and concerned with the mechanics of the procedure, she cannot properly observe the technician’s actions. These legal responsibilities cannot be overemphasized. The nurse should be constantly aware of the fact that the technician cannot be sued for negligence or malpractice. Consequently, the nurse could be sued for not supervising the technician. This one aspect alone should be enough to insure that the nurse is always the circulator. The circulator supervises others. I question the ability of a nurse who is scrubbed to supervise or even to be more than tangentially aware of the actions of a circulating technician. In conclusion, I feel that the nurse is the only operating room team member qualified to perform the duties of the circulator. We, as operating room nurses, must fulfill our obligations to our patients. We must put the patient’s welfare before our own personal preferences. We can return operating room nursing to its rightful place in nursing today. It is up to the operating room nurses to prove that the operating room is a nursing, not a technical, area. This can only be done when the operating room nurses perform as nurses and not as technicians.
Carter, winner of Mary Mahoney Award The Mary Mahoney Award for outstanding contributions to minorities in nursing was presented to Carolyn McCraw Carter, RN, MSN, at the national convention of the American Nurses’ Association (ANA) in Atlantic City, NJ. One of nursing’s highest honors, the award is named for Mary Eliza Mahoney, the first black graduate nurse in the United States, and recognizes efforts on behalf of equality and freedom for all members of the profession. Currently assistant professor at the College of Nursing and Health, University of Cincinnati, Carter designed and is implementing a minority nurse project funded by the Center for Minority Group Affairs, National Institute of Mental Health. The seven-year project will develop mental health manpower by recruitment and retention of minority students in nursing and by aiding their completion of training programs for careers in psychiatric nursing. As of September 1975, there were 23 black students in the project and 57 other minority students enrolled at the college. The goal is the graduation of 65 minority students. Mary Eliza Mahoney received a diploma from the New England Hospital for Women and Children, Roxbury, Mass, in 1879 and spent more than 40 years as an outstanding nursing practitioner. The award was established in 1936 by the National Association of Colored Graduate Nurses in recognition of members who had made outstanding contributions to nursing. ANA has given the award since 1951 when the National Association for Colored Graduate Nurses was dissolved and ANA assumed its functions.
Joanne M Terrion, RN
510
AORN Journal, September 1976, Vol 24, N o 3
It is incumbent on OR nurses to act as nurses, not technicians I wish to speak out for the AORN Mandate for the Registered Nurse as Circulator in the Operating Room. It is my contention that operating room nurses are grossly negligent when they elect to scrub while the technician circulates. In my experience, the justification for this appalling situation has been that operating room nurses enjoy scrubbing. These nurses should be reminded that they are employed to care for the patient's welfare and not for their own satisfaction. The AORN Mandate does not state that the nurse cannot scrub. It does state that if only one nurse is assigned to a case, the nurse circulates while the technician scrubs. Another reason frequently given for abandoning responsibility is that the nurse trusts the technician because she is familiar with his or her capabilities. These nurses should
Joanne M Terrion, RN, is a student in the baccalaureate program at the University of North Florida, Jacksonville. A part-time OR staff nurse at Baptist Memorial Hospital, Jacksonville, she formerly was an O R staff nurse at Akron General Medical Center, Akron, Ohio.
&
be reminded that trust does not supersede legal liability and responsibility. Historically, the scrub technician came into being because of a shortage of nurses. To alleviate the shortage in the operating room, many hospitals emulated the military services by training nonprofessional people to scrub. This has led, over the past 25 years, to the present problem. It is time for operating room nurses to assume their proper role in protecting the patient's welfare. We must inform hospital administrations that there no longer is an acute shortage of nurses. We must charge them with negligence in allowing financial considerations to cloud their concern for patient welfare. It is less expensive to hire scrub technicians than to hire qualified nurses. We must encourage colleges and schools of nursing to return operating room rotation to their curriculums. The operating room is a paradise of learning for student nurses. We were negligent in allowing this vital rotation to be so easily phased out. With an increase in student rotation through the operating room, it becomes obvious that more student nurses will choose to work in the operating room after graduation. Thus, the need for a larger number of technicians will be alleviated. In the work situation, if we are making out case assignments, we should always assign a nurse as circulator. This will be met with resistance at first, but personal feelings and friendship should not supersede our obligations to our patients. If there are not enough
AORN Journal, September 1976, V o l 2 4 , No 3
509
nurses to circulate, the schedule should be cut back. Meeting adequate staffing needs is hospital administration’s responsibility. The operating room supervisor should not compromise the patient’s welfare because administration has not fulfilled its obligation. On a personal level, close evaluation of the AORN Mandate makes it evident that the nurse is the only operating room staff member qualified to fulfill all of the designated roles of the circulator. If the nurse is scrubbed, she cannot recognize and intervene in stress situations with the patient and team members because she is too busy passing instruments. She also cannot keep a close watch on team members to observe breaks in technique or violation of asepsis. Only the nurse has current knowledge of the legal liabilities of surgery. The nurse is legally responsible for the technician. If she is scrubbed and concerned with the mechanics of the procedure, she cannot properly observe the technician’s actions. These legal responsibilities cannot be overemphasized. The nurse should be constantly aware of the fact that the technician cannot be sued for negligence or malpractice. Consequently, the nurse could be sued for not supervising the technician. This one aspect alone should be enough to insure that the nurse is always the circulator. The circulator supervises others. I question the ability of a nurse who is scrubbed to supervise or even to be more than tangentially aware of the actions of a circulating technician. In conclusion, I feel that the nurse is the only operating room team member qualified to perform the duties of the circulator. We, as operating room nurses, must fulfill our obligations to our patients. We must put the patient’s welfare before our own personal preferences. We can return operating room nursing to its rightful place in nursing today. It is up to the operating room nurses to prove that the operating room is a nursing, not a technical, area. This can only be done when the operating room nurses perform as nurses and not as technicians.
Carter, winner of Mary Mahoney Award The Mary Mahoney Award for outstanding contributions to minorities in nursing was presented to Carolyn McCraw Carter, RN, MSN, at the national convention of the American Nurses’ Association (ANA) in Atlantic City, NJ. One of nursing’s highest honors, the award is named for Mary Eliza Mahoney, the first black graduate nurse in the United States, and recognizes efforts on behalf of equality and freedom for all members of the profession. Currently assistant professor at the College of Nursing and Health, University of Cincinnati, Carter designed and is implementing a minority nurse project funded by the Center for Minority Group Affairs, National Institute of Mental Health. The seven-year project will develop mental health manpower by recruitment and retention of minority students in nursing and by aiding their completion of training programs for careers in psychiatric nursing. As of September 1975, there were 23 black students in the project and 57 other minority students enrolled at the college. The goal is the graduation of 65 minority students. Mary Eliza Mahoney received a diploma from the New England Hospital for Women and Children, Roxbury, Mass, in 1879 and spent more than 40 years as an outstanding nursing practitioner. The award was established in 1936 by the National Association of Colored Graduate Nurses in recognition of members who had made outstanding contributions to nursing. ANA has given the award since 1951 when the National Association for Colored Graduate Nurses was dissolved and ANA assumed its functions.
Joanne M Terrion, RN
510
AORN Journal, September 1976, Vol 24, N o 3