Why do we have circulation nurses in the OR?

[swpm]

Seriously, what do they do that couldn't be done just as well by a moderately well trained tech?

They don't do any patient care. Paperwork in preop. Standard questionnaire. Check wrist bands. I do the IV, or sometimes there's an IV team that goes around and does them.

In the OR, they'll hold cricoid for an RSI, or place a Foley, or put on SCDs. Maybe help flip the patient for a prone case (maybe).

Instrument counts. More paperwork. Page answering for scrubbed surgeons.

Sit at the computer surfin' the net or playing solitaire.

Occasionally get something from the Pyxis for the scrub or a surgeon or even me. Call report to the PACU.

I am perplexed at why this job must be performed by someone as highly trained and well paid as a nurse. The most junior ward nurse has more patient care responsibility and actual work to do.

And yet ... OR nurses seem to be held in as high regard as ICU nurses. This actually sort of irritates me. ICU nurses rock, they've saved my ignorant or oblivious ass more than once in the unit; OR nurses just seem to lounge around and screw with the thermostat while adding little value to the OR.

Am I missing some fundamental, critical function? Why are they there?

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[BLADEMDA]

Seriously, what do they do that couldn't be done just as well by a moderately well trained tech?

They don't do any patient care. Paperwork in preop. Standard questionnaire. Check wrist bands. I do the IV, or sometimes there's an IV team that goes around and does them.

In the OR, they'll hold cricoid for an RSI, or place a Foley, or put on SCDs. Maybe help flip the patient for a prone case (maybe).

Instrument counts. More paperwork. Page answering for scrubbed surgeons.

Sit at the computer surfin' the net or playing solitaire.

Occasionally get something from the Pyxis for the scrub or a surgeon or even me. Call report to the PACU.

I am perplexed at why this job must be performed by someone as highly trained and well paid as a nurse. The most junior ward nurse has more patient care responsibility and actual work to do.

And yet ... OR nurses seem to be held in as high regard as ICU nurses. This actually sort of irritates me. ICU nurses rock, they've saved my ignorant or oblivious ass more than once in the unit; OR nurses just seem to lounge around and screw with the thermostat while adding little value to the OR.

Am I missing some fundamental, critical function? Why are they there?

JPP AKA Mr. Soprano sir may we answer?

Blade

 

[swpm]

JPP AKA Mr. Soprano sir may we answer?

Please don't mistake this for a troll or attempt to start bashing nurses. I am genuinely curious as to how that job came to be filled by a nurse, and not scrub tech #2. An experienced nurse seems to be greatly overqualified for that job (and I've yet to see a new nursing school grad do it).

And I don't want to ask them directly because most are my friends and I'm afraid I'd sound insulting. 🙂

 

[urgewrx]

I concur. They don't really do anything requiring a RN degree.
​

 

[Masseter Spasm]

I used to wonder the same thing. (Why do you need a degree in nursing to fetch instruments, fill out paperwork, answer the phone, and return pages?) I think this has become the standard of care at many places, and I certainly noticed it during residency at my large academic teaching hospital.

I have also had the opportunity to work at several locations where the nurses really greatly improve patient care in the OR. They can start difficult IV's in a pediatric patient during a mask induction. They make the drips for cardiac cases. They help me transport the patient to and from the OR. They provide another set of hands and eyes to optimally position the patient for a craniotomy or spine procedure. Finally, they can work well with a particular surgeon so that he or she can do the procedure as quickly as possible. In an ideal world the OR environment is about teamwork and there are nurses who acknowledge this responsibilty.

I think the reality is that at many locations OR nursing is seen as an easy job. (A sanctuary for the burned out from the medical-surgical ward or ICU.) We should do more to recognize the efforts of those who truly take care of patients. Otherwise, the standard will be technical support.

 

[Monty Python]

Seriously, what do they do that couldn't be done just as well by a moderately well trained tech?

They don't do any patient care. Paperwork in preop. Standard questionnaire. Check wrist bands. I do the IV, or sometimes there's an IV team that goes around and does them.

Am I missing some fundamental, critical function? Why are they there?

Some circulator functions are limited by law, hospital policy, or insurance requirements to licensed RNs, such as taking verbal orders, obtaining meds, obtaining narcs, obtaining/checking/hanging blood, starting IVs, etc.

While this is personal speculation, I would also assume no hospital would like to be accused of allowing a patient to be without an RN always caring for them (as would be the case in the OR, if techs circulated).

 

[core0]

Some circulator functions are limited by law, hospital policy, or insurance requirements to licensed RNs, such as taking verbal orders, obtaining meds, obtaining narcs, obtaining/checking/hanging blood, starting IVs, etc.

While this is personal speculation, I would also assume no hospital would like to be accused of allowing a patient to be without an RN always caring for them (as would be the case in the OR, if techs circulated).

When I was in the Army techs circulated. There was one RN for every four rooms or so. Worked fine. In the civilian world I would guess that there is an advantage to having a license present. You need an RN for meds as well (yes even the Bacitracin in the wash).

David Carpenter, PA-C

 

[deleted59964]

i dont think OR nurses and ICU nurses are held in equal regard - but then I'm an ICU nurse so I'm biased🙂 Before I did ICU I worked in OR (assisting the anesthesiologist) - where I worked, the most senior OR nurse mostly circulated, and the junior scrubbed. The idea was the "students" needed to learn to scrub, and any equipment or patient flow issues were dealt with by the senior OR nurse who was circulating. I tend to agree though that it's a waste of resource.

 

[Planktonmd]

Some circulator functions are limited by law, hospital policy, or insurance requirements to licensed RNs, such as taking verbal orders, obtaining meds, obtaining narcs, obtaining/checking/hanging blood, starting IVs, etc.

While this is personal speculation, I would also assume no hospital would like to be accused of allowing a patient to be without an RN always caring for them (as would be the case in the OR, if techs circulated).

Yes , this comes from the famous statement:
"Relax, there is a nurse by your side" 🙂

 

[armygas]

When I was in the Army techs circulated.

I am in the Army and techs do not circulate, they scrub. Army OR Nurses all are BSN-RN nurses.

Mike

 

[Stimulate]

Not only do our circulating nurses do nothing to help us out, I am happy if they don't actually HINDER what I am trying to accomplish. They do not help with armboards or tucking arms ("positioning is anesthesia's responsibility"), they don't put in IVs (they have paperwork to do), they don't call report (again that is anesthesia's job, they don't help with cricoid pressure (anesthesia's job), and they don't hand you the endotracheal tube (not in their job description).
They will however on occasion lift up the blankets to put in a foley and send all of your sterile A-line kit's contents on the floor.

In my opinion a high school graduate could perform this job but perhaps the circulators at my institution are more worthless than the norm.

 

[urgewrx]

Not only do our circulating nurses do nothing to help us out, I am happy if they don't actually HINDER what I am trying to accomplish.

Sounds like you work in New York.

 

[CremeSickle]

They Call report to the PACU

They do? Sheesh, i roll em over with the surgery resident and then I give report!

The OR RNs seem, very helpful to me and the surgeon. I dont know if they need to be RNs but whatever, as long as the job gets done.

 

[core0]

I am in the Army and techs do not circulate, they scrub. Army OR Nurses all are BSN-RN nurses.

Mike

Fayettenam circa 1988. We were lucky if we had one RN for the whole OR. The floors were one RN, 2 LPNs and 5-6 CNAs for 30 patients. Glad to see things have changed.

David Carpenter, PA-C

 

[rmh149]

Fayettenam circa 1988. We were lucky if we had one RN for the whole OR. The floors were one RN, 2 LPNs and 5-6 CNAs for 30 patients. Glad to see things have changed.

David Carpenter, PA-C

Sounds like ward 6-A and 9-A. 🙂

Sound familiar?

 

[rmh149]

Our OR nurses spoil us. They help us position the patient, place the monitors, and hold the tube and LTA for us. If we use a stylet, they will pull it. The first day I was there I was a little puzzled because there was a person on either side of the bed waiting to help me after they did half my job.

Of course they run to get meds and fluids for us.

If you wanted, they will even give the patient versed in pre-op (given you have spoken to the patient already), take them to the room without you, move them over, place leads, start the BP...and call you in the lounge when they are ready. SPOILED!

 

[serenity]

Our OR nurses spoil us. They help us position the patient, place the monitors, and hold the tube and LTA for us. If we use a stylet, they will pull it. The first day I was there I was a little puzzled because there was a person on either side of the bed waiting to help me after they did half my job.

Of course they run to get meds and fluids for us.

If you wanted, they will even give the patient versed in pre-op (given you have spoken to the patient already), take them to the room without you, move them over, place leads, start the BP...and call you in the lounge when they are ready. SPOILED!

SOUNDS GREAT
Where are you located??,I would love to do academia there.
At my place circulating RNs are hit or miss,some are nice and will help you others will just shrug you aside.
There main job is to run around for sutures and anything a surgeon wants,you'd be lucky if they get fluids for you.

 

[Planktonmd]

Not only do our circulating nurses do nothing to help us out, I am happy if they don't actually HINDER what I am trying to accomplish. They do not help with armboards or tucking arms ("positioning is anesthesia's responsibility"), they don't put in IVs (they have paperwork to do), they don't call report (again that is anesthesia's job, they don't help with cricoid pressure (anesthesia's job), and they don't hand you the endotracheal tube (not in their job description).
They will however on occasion lift up the blankets to put in a foley and send all of your sterile A-line kit's contents on the floor.

In my opinion a high school graduate could perform this job but perhaps the circulators at my institution are more worthless than the norm.

They are more friendly in private practice, actually some of them are very helpful and pleasant.

 

[armygas]

Fayettenam circa 1988. We were lucky if we had one RN for the whole OR. The floors were one RN, 2 LPNs and 5-6 CNAs for 30 patients. Glad to see things have changed.

David Carpenter, PA-C

I was also in Fayettenam circa 1988-1991......... were you in the OR?

 

[core0]

I was also in Fayettenam circa 1988-1991......... were you in the OR?

No I worked ER and ICU as a medic as well as some time with the 57th. I was up there once a month or so to do intubation's. You may have been one of the ones training me. That was definitely a squared away OR. One of the surgeons I work with now was there as a resident. Still says they had the fasted turnover he's ever seen.

What a trip down memory lane. Google the 57th and you get this:
http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoID=1709162842
Somethings haven't changed much.

David Carpenter, PA-C

 

[core0]

Sounds like ward 6-A and 9-A. 🙂

Sound familiar?

Exactly. Fortunately most of the patients are healthy soldiers. When I got out of the Army I couldn't believe how sick the floor patients were.

David Carpenter, PA-C

 

[jetproppilot]

JPP AKA Mr. Soprano sir may we answer?

Blade

Feel free.

Please keep this thread LIGHT.

I've pondered the OP's question many times myself, since the operating room circulating RN seems to be a menial position, as far as clinical responsibility goes.

But regardless of that, great circulating RNs are worth their weight in gold.

Who gives a s h it that they don't perform any clinical prowess.

Yes, in our current society, only TRUE ROKKSTARRS are recognized.

Tyler.

Bono.

KORN.

TOOL.

But, geez. I'm 42 years old. I'm realizing the superficiality of our world.

And how meaningless the alleged ICONS really are.

And, as sad as it makes me, that includes PHIL HELMUTH/JOHNNY CHAN/DANIEL NEGRANEAU.

Yes.

Believe it.

There are ROKKSTAR circulators.

And they can MAKE OR BREAK an operation's vibe.

C'MON, DUDES.

You know this is true.

Gotta circulator that knows the game, makin' the surgeon/anesthesiologist feel comfortable, smalltalk abound, knows where everything is, knows where to find everything, knows who-to-call-when-something-is-awry, is where he/she needs to be when beckon calls.......

a true ROKKSTAR.

Just as....no.....MORE IMPORTANT THAN Tyler. Bono. Korn. Tool.

Please DOUBLE THE ABOVE RN's SALARY.

Cuz the difference between a ROKKSTARR circulator and a LAME A SS circulator is night and day.

Makes or breaks the vibe of the room.

Does that person need to be a Registered Nurse?

Absolutely Not.

I COULD TRAIN MY NANNY, A TWENTY ONE YEAR OLD FROM COLUMBIA, TO BE A GREAT CIRCULATOR.

So I guess thats my answer.

Paying an RN salary for the circulator position could be reconsidered.

In Jet's delusional reality.

 

[armygas]

No I worked ER and ICU as a medic as well as some time with the 57th. I was up there once a month or so to do intubation's. You may have been one of the ones training me. That was definitely a squared away OR. One of the surgeons I work with now was there as a resident. Still says they had the fasted turnover he's ever seen.

What a trip down memory lane. Google the 57th and you get this:
http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoID=1709162842
Somethings haven't changed much.

David Carpenter, PA-C

Naw wasn't me training you thats for sure, I was an enlisted soldier at the time and had to have surgery at Womack that's why I asked if you were in the OR.

 

[rmh149]

Exactly. Fortunately most of the patients are healthy soldiers. When I got out of the Army I couldn't believe how sick the floor patients were.

David Carpenter, PA-C

An orthopods dream..... Healthy people jumping out of planes.

 

[armygas]

What a trip down memory lane. Google the 57th and you get this:
http://vids.myspace.com/index.cfm?fuseaction=vids.individual&videoID=1709162842
Somethings haven't changed much.

David Carpenter, PA-C

Damn,

That video made me cry like a baby and put me right back in Dogwood, I would escort critical patients in the back of the 57th's blackhawks (those guys have beens there like 4 times) to BIAP for flight out to germany. Damn, what you see with the patients and managing them on the back of the bird is a challenge to say the least.....

Thanks for that link, that was awesome!

 

[proclivity]

I concur. They don't really do anything requiring a RN degree.
​

urge certainly has a point. No use in paying someone this much money if you can get it done for much less. It's not not like there aren't 4 doctors in there or anything. Perhaps we could just cut down on how many are in there.....but the second a doc needs something and no one is there, "Houston, we have a problem."

I do agree ICU nurses are the most highly trained, on the job of course. They don't come out of school like that. Just like a surgeon or anesthesiologist doesn't come out of school like that.

 

[rmh149]

I know that OR nurses are expensive....what, 50-72K tops. However, if you think about how important they are in making sure all the T's are crossed and i's dotted....and making sure the room turns over swiftly, I think the hospital feels more comfortable making an RN the standard professional doing the job.

There are a line of RN's that want to do that job....they dont have much turnover compared to other fields of nursing.

Keep in mind, its all about the money...and what you get is what you pay for. The hospital depends on the OR for the cashflow...investing a little more in the one managing the room that brings in 1000's per day is well worth it.

I think OR nurses should get paid bonusus depending on the amt of profit the room makes for the hospital....if there was a way to logistically manage that.

 

[SouthSideSteve]

There are a line of RN's that want to do that job....they dont have much turnover compared to other fields of nursing.

The OR and PACU are where nurses go to die. If I wern't going back to school I'd be there myself.

 

[CremeSickle]

I would add ER nurses in with ICU nurses are top in the hospital. I had 3 save my ass in the ER rotation (and my attendings) and when i was an ICU nurse i couldnt handle it in the ER at all. People in the ICU are all pre-diagnosed most of the time (from the ICU RNs perspective) where there is some serious critical thinking going on in the ER with unknown pts. I saw ALOT of true physician/RN collaboration in the ER.

 

[core0]

Damn,

That video made me cry like a baby and put me right back in Dogwood, I would escort critical patients in the back of the 57th's blackhawks (those guys have beens there like 4 times) to BIAP for flight out to germany. Damn, what you see with the patients and managing them on the back of the bird is a challenge to say the least.....

Thanks for that link, that was awesome!

I was in Panama during the festivities there and the local Medevac refused to come in because they were taking fire 😱. Gen Steiner called back to Bragg and put the 57th on the plane. By the time they had used up all of the local units helicopters theirs were in country. Never saw them back down from a mission, no matter how stupid. The other thing is the only unit I saw that compared with them for maintenance was the 160th. If the crew chief said it was ready it was. We did a mission in Honduras where the pilot pulled 140% of maximum power coming out of an LZ. Bird never even hickupped.

The Blackhawks are a lot better than the Huey's. If you only have two patients its down right roomy. Even with four its pretty doable. I flew with them stateside so it was mostly head injuries and ortho off the drop zones as well as some MAST work.

David Carpenter, PA-C

 

[core0]

An orthopods dream..... Healthy people jumping out of planes.

Definitely. The ortho clinic was incredibly busy. We had a formula. For every 200 troops on the drop you would have one major ortho injury, two head injuries and 10-15 minor injuries. We would regularly have what would be called mass casualty events at other hospitals. When they did the practice jump for Panama they dropped 2500 paratroopers. We had to use the Cafeteria of triage. Think we treated about 200 that night on top of the regulars.

The people I felt for where the surgery residents. We would have to residents to cover everything. That meant every other night call. On weekends they would start working on Thursday night and finish Monday afternoon. We would cringe if you had to call a consult on Sunday. The ones I talked to loved it though. This was pre work rule of course.

David Carpenter, PA-C

 

[Stimulate]

I know that OR nurses are expensive....what, 50-72K tops. However, if you think about how important they are in making sure all the T's are crossed and i's dotted....and making sure the room turns over swiftly, I think the hospital feels more comfortable making an RN the standard professional doing the job.

There are a line of RN's that want to do that job....they dont have much turnover compared to other fields of nursing.

Keep in mind, its all about the money...and what you get is what you pay for. The hospital depends on the OR for the cashflow...investing a little more in the one managing the room that brings in 1000's per day is well worth it.

I think OR nurses should get paid bonusus depending on the amt of profit the room makes for the hospital....if there was a way to logistically manage that.

What bothers me is that obviously some are worse than others, correct? So if this is such a high demand job (it is at my hospital because they don't work 1 out of 2 weekends like all other RNs) then clearly the worst OR nurses would be easily replaced, right? Everyone knows who the terrible circulators are...I have seen a couple of them reprimanded by their own managers on more than 1 occasion. So why don't they just bounce them back to floor nursing or better yet just fire them and replace them with an eager and helpful person.

Part of their laziness is that many of us are trainees and the circulators don't feel they need to respect us. They truly can ruin your day especially if they have a bad attitude and/or try to HINDER your progress (delay turnovers, etc).

I have felt more liberated in what I can do to combat this problem this year (my last year of residency). A few approaches involve:
a) killing them with kindness (rarely works but when it does it is great. this is usually my first approach)
b) ask them to do things for me and if they say "I am too busy" I will respond with some classics such as "Remember Patients before paperwork" or "We (the surgeons and I) can stand here and wait until you aren't busy before we proceed any further with induction". That line almost always works.
c) another very powerful tool is to obtain and familiarize yourself with the job description of a circulator nurse from your hospital's Human Resources department. This strategy will addresses the "that is not in my job description" excuse. Most people don't know their job description so this provides you with an opportunity to educate them. Knowledge is power baby!!!

Just my 2 cents.