This Week's Discussion: Surgical Techs

1. PLEASE READ THE MINUTES FROM THE VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS:
2. I.E. THE NEED TO REGULATE SURGICAL TECHNOLOGISTS
3. THE NEED IS PRESENT IN MOST STATES
4. THE AST (ASSOCIATION OF SURGICAL TECHNOLOGIST WANT REGULATION

Because many UAPs (uncertified, unregulated and/or unlicensed) work as surgical technologists not just in Virginia but in many places throught the USA and therefore no one really knows who is working / operating in the Operating Rooms, i.e. who is holding your heart? I.e. who is taking down your saphenous to be used as the new graft on your heart bypass?

http://www.dhp.virginia.gov/bhp/bhp_calendar.htm

See especially July 10 & August 11, 2009: Minutes and the 101 Page Draft

PS Virginia just passed the regulation of Yoga instructors. Therefore, Virginia, to ensure "safety" of all patients in Virginia also needs to pass the mandate for "registration" of all "surgical techs" who will work under the direct supervision of the operating room registered nurse circulator and under the "direct supervision of the surgeon."

SYNOPSIS OF ISSUE:

A few comments were made in the crowd at the August 11th meeting about "nurses" in regard to their education. These comments show people's ignorance about nursing programs in general:

1. Three year diploma programs, I feel, were the best way to educate and train nurses because the classes corresponded immediately to the clinical experience i.e. what was taught in class was reinforced stat on the units. Also, there was no summer breaks etc. as there is in BSN programs today so in essence the time frame was longer than three years. When graduation came, the nurses could safely run the patient floors. The instructors were tough and the weak were weeded out! (I was in a three year program and opted out after a year to get married... marriage could have waited, but we were and still are in love) :)

2. Nowadays, to get into from an associate to a BSN etc program, there are multiple prerequisites. Looking back at all my classes from an associate to a BSN program, I probably have my doctorate without the dissertation in regard to the credit hours. I labored to get from one program to another. The associate degree therefore is much longer than just a two year program. I believe that the BSN should be the level of entry for nursing, BUT nursing never solved this issue!

A basic RN skill set is very relative to the area where the RN functions. However, assessing, planning, implementing, and evaluating followed by reassessing and adjusting the plan of care are the essential skills that the RN needs regardless of his or her area of assignment. The knowledge base within which these skills are learned, maintained and added to becomes more specific and complex depending on the specialty...and the operating room arena is a complex specialty consisting of ALL the units in a hospital!

Most OR RNs and techs now join "OR teams" because there are not many like myself who worked as a floater, i.e. worked in all specialties, to keep up their skills. I have saved ALL my nursing books and most papers from my three year program, from my associate degree program and from my BSN program.

Besides Micro, A&P and A&P Lab, Pharm, Path, Nursing Care Plans etc. etc., very importantly, is that nursing teaches "critical thinking" skills, not just following orders, or very importantly, knowing when not to follow orders. I personally have saved many patients life and limb by saying in a politically correct way to a surgeon or to a resident, "Are you sure you want to do this?" or "Let me show you a better way" or "Doctor, you better look at this!" Operating Rooms arenas educate their RNs through many venues. The important issue is that the person is already a RN! The RNs just have to be oriented to skills not to a range of curriculums!

In regard to Surgical Techs and for the safety of the patients in Virginia, TECHs also need the shield of the RN to help keep the balance of what the surgeon wants with what is legal and in the best interest of the patient. When it comes down to it, the surgeon isn't usually in the room when the case is being set up and taken down or even during the case. The surgeon isn't always there supervising the TECH. The Operating Room RN Circulator is there 'supervising the TECH, or at least should be! The Surgical Techs are usually an employee of the OR not of the surgeon. However, today, many surgeons bring their own TECHs in from their office under "Allied Health," i.e. more TECHs who are invisible!

Since, there is No Captain of the Ship anymore, the Surgical Techs have to be under the supervision of the Operating Room Registered Nurse Circulator! The Surgical Tech Association have always wanted to be "regulated through the Board of Medicine." BUT again, if the surgeon is not present in many cases for some or all of the case, then the TECHs, because of their lack of a standardized education and a lack of standardized competencies, have to be "under the supervision of the OR RN Circulator!”

Since to be "licensed" means to have a role, and since the Surgical Techs have no basic roles as evidenced by all information i.e. some are certified, some are not certified, some have training from an accredited school and some have training from a non-accredited, some are trained on the job, and some, as we know, are cleaning floors and then scrubbing in on a case in the OR!

The esquire from the AST association states that there is no "outcome data on certified vs. non certified techs!" I purport that IF Pennsylvania received over 15,000 reports monthly when IT complied to Mandated Reporting ( and now the numbers are higher), that IF Virginia complied to Mandated Reporting, and therefore also mandated from ALL hospitals and clinics, not just Near Misses but also ALL names of Surgical Techs, their role in the OR i.e. their cases, their education, certification, the name of their accredited and non accredited school, and then mandated the Incident Reports from those cases be shared with the state, there would be "OUTCOME DATA"!

FYI: Most Administrative Rules state:
That the task can be performed without requiring the exercise of judgment based on medical knowledge;
That the task can safely be performed according to exact, unchanging direction;
That the task can be performed without a need for complex observations or critical decisions;
That the task can be performed without repeated medical assessments; and
That the task, if performed improperly, would not present life threatening consequences or the danger of immediate and serious harm to the patient.

Can you imagine the massive task the State of Virginia would have IF the state would have to "define" roles for Surgical Techs?

SOLUTION: Mandate REGISTRATION of the Surgical Techs who would remain under the supervision of the Operating Room Registered Nurse Circulator. At least the State of Virginia would know who is working in the operating rooms and etc. and the burden of responsibility would remain with the OR RN Circulator. My suggestion to you would prove to be a very uncomplicated solution, especially in this day and age of "Traveling Surgical Techs" who go from state to state working for agencies who provide them with free housing, bonuses, 401k, health insurance, travel reimbursement and etc!

Lastly, when I was appointed twice the Virginia Legislative Coordinator for the State of Virginia many years ago and then dismissed by my own national organization because a Virginia association said I was too passionate on the subject of the OR RN Circulator Bill HB#270, who would YOU BELIEVE to be the most reliable voice on this critical topic? I speak only for patients!

Years ago, AORN supported "REGISTRATION" for Surgical Techs as long as they were under the State Board of Nursing! I still concur!

FINALLY: A an old synopsis BUT relevant and wise note from a TECH:

("It's nice to see that "there's nothing new under the sun." This quote from a person called Solomon means that we will observe the same problems resurface every generation or decade. I returned from my two tours in Vietnam and left the US Army in 1968. I received great experience while spending my last year in a MASH unit. OR Techs, trained by Nurses, were utilized to perform many procedures at that time due to the need for the Doc's to operate upon the more severe patients. I returned home to the US to take part in the first OR Tech meeting and to help form as a charter member, the AST. I started as a Tech in my first hospital and was extremely proficient in my craft thanks to the Nurses who trained me well and the first OR Supervisor who literally kicked me so hard in the butt that I almost fell into the scrub sink. Those were the days when a good OR supervisor had that kind of power. I was on a Thoracic case with a Surgeon who asked me to close the wound after the lobe was removed. I was thrilled as I had done this many times before in the military but my Head Nurse was less than thrilled to walk in 10 minutes later to see the surgeon gone and this 20 year old merrily closing a chest. The Anesthesiologist backed me as he wanted the patient off the table but I had one pissed off nurse who had a few words with the Surgeon later that day. It is now 33 years later, I am a Senior PA, and a national leader in my profession with much more experience and savvy. I am respected by all the members of the surgical team and I tend to be a peacemaker and moderator of some of these discussions among the staff at the hospitals. The biggest problem that I saw in this post was the fact that the Surgeon left the OR Suite.

Questions:
What if the patient sustained a Cardiac arrest, where's the Doc?
What if the patient on emergence from anesthesia developed a laryngospasm that was unable to be broke by the anesthesiologist and could not be reintubated, where's the Doc?
What if that patient needed an emergency Tracheotomy and the Anesthesiologist was not proficient in Criccothyrotomy, where's the Doc?

A surgeon has no business leaving an OR suite (not the room) until his/her patient has been successfully extubated and arrived in the recovery Room. We never leave until we see the whites of their eyes in recovery. That is the only time I can call a family member and let them know that their loved one did fine and is in the RR awakening. Talk about egg on ones face, if they made that statement prior to the patient leaving the OR and if that patient were to have a life threatening problem. I would be working to have this problem taken care of in an OR Committee meeting with protocols put in place and approved by the Medical board as well as the Chief of Surgery. That's my two cents.")

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* There was a quote in one of the Virginia BOH minutes recently quoting a Tech who said that in the military he had the "ability to remove the skull, put my fingers or a suction tip in a brain" and etc., to this person I say, "What you do in the military while under combat conditions is up to you and the military! However, this arrogance can be deadly to a patient. If I were a patient I want the surgeon taking off my skull. You, sir might be very intelligent, BUT you sir are not neither a doctor nor a surgeon! AND you sir do not represent the wonderful Surgical Techs whom I had worked with for many years, we all had our "roles" and for our patients' safety, we worked together keeping in mind our legal and ethical responsibilities.

On this day of Senator Kennedy's death, and since I worked in a Teaching Level 1 hospital for almost 20 years out of my 33 years in the OR, and since I am very familiar with Gamma Frame Placements for cranial tumors as well as cranial surgery, I can bet my life that Senator Kennedy's surgeon was the only one who put a suction tip in his brain when the Senator's tumor was debulked. Reading about Senator Kennedy's concern for "patients" leads me to think that he believed that "every patient" should have their surgery performed by a surgeon.

Respectfully,
My opinions as a private citizen of the State of Virginia,
Helen French RN, BSN (once a CNOR )

www.operatingroomrnwatchingoveryou.com


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Dear Anonymous Professional:

It was very nice meeting you at the last BOH Professions meeting. Maybe the next time you will not be so busy and then perhaps we can talk some about the issues at hand. As you can probably ascertain, I will share with you my expert opinions based on my knowledge, education, and experiences. As far as my experiences, I have many on the topic of the operating room arena, 35 years of documentation. I have realistic and honest solutions to critical operating room issues because I am not part of any advocacy group or organization. I only speak for patients because they cannot speak for themselves!

Prevention is the only real answer! It is only when solutions are not netted out at the genesis of issues, do issues get complicated. I am glad to see that Virginia is looking at the issue of UAPs, as one TECH stated at the last meeting. People would be outraged if they knew what is going on in operating rooms.

As, I mentioned at the meeting, I am for "registration" of all UAPs especially SAs and Surgical Technologists.



Respectfully,
Helen French RN,BSN

www.operatingroomrnwatchingoveryou.com