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RN Circulator Surveys Reveal Gaps in RN Circulator Use

Publish Date: 10/12/2011

This September, AORN emailed 4,700 staff nurses, OR managers, nurse executives and other perioperative nursing professionals a survey on their facility's use of registered nurses as circulators.  AORN's goal was to learn more about the circulator position in hospitals and other facilities across the United States. We received over 1,000 responses, although not all respondents answered each question.

Most respondents work in a hospital inpatient facility (67%), an ambulatory surgery center (17%), or a hospital outpatient facility (10%), with only 1% of respondents indicating they are employed by a physician's office.  The remaining 5% of respondents are employed by another type of facility, primarily one that performs both inpatient and outpatient procedures.

Nearly all respondents (99%) reported that their facility consistently staffs a registered nurse as the circulator for the duration of each procedure. Overall, most facilities have a policy calling for a registered nurse to act as a circulator for the duration of each procedure (91%). If a RN is unable to circulate for a procedure, a significant majority of respondents (98%) reported that the procedure would be cancelled or rescheduled, while the remaining 2% indicated that the procedure would be performed with a non-RN acting as circulator. The types of non-RNs utilized as circulators included licensed practical/vocational nurses and certified and uncertified surgical technologists.

When asked about circulating for more than one operating room at the same time, 4% of respondents had been asked by their facility to circulate for multiple rooms concurrently. Of those respondents, 88% were responsible for two rooms, 7% were responsible for three rooms and 5% were responsible for four rooms simultaneously.  Not surprisingly, 99% of respondents believe that circulating for more than one OR at the same time compromises patient care.

OR Manager also recently completed a survey concerning OR staffing, published in their September 2011 edition. 4% of OR Manager's hospital employee respondents indicated that surgical technologists were circulating with a supervising RN in the room; however no surgical technologists were allowed to circulate unattended. 9% of OR Manager's respondents employed by ambulatory surgery centers stated that they allow surgical technologists to circulate, 7% of which have a RN in the room or immediately available. The other 2% circulate unattended.

AORN asked its survey respondents whether safety concerns related to the circulator role had been reported to their supervisor. 90% of AORN respondents indicated there had been no need to report safety concerns regarding the circulator role because they routinely have a RN as circulator, while 10% had reported safety concerns. Of those, 5% experienced positive changes implemented, 4% resulted in no change, and 1% had suffered retaliation. 9% of AORN respondents indicated they have left a job due to safety concerns related to the circulator role.

While AORN is pleased that a majority of healthcare facilities are consistently staffing a RN as the circulator, the AORN and OR Manager survey results confirm the need for continued advocacy at the state level on this important patient safety issue.

As healthcare reform efforts to reduce costs continue across the nation, AORN is concerned that 4% of its survey respondents have been asked to circulate for more than one room concurrently. Many of the AORN survey respondents who reported using a RN circulator 100% of the time cited state law as the reason. States without a RN circulator law remain vulnerable to continued cost savings measures such as use of a non-RN as circulator or requiring RNs to circulate for multiple rooms at the same time. ASCs appear particularly vulnerable to use of non-RN as circulator.

It is vitally important for perioperative nursing staff and OR managers with policies requiring a RN as circulator to ensure that these policies remain in place, particular in states without a RN circulator law. Every patient deserves the highest quality nursing care, and no other person is more knowledgeable or qualified to handle the multiple critical issues surrounding patient safety in the operating room than the RN who is specifically trained in perioperative nursing.

If you have any questions about AORN's survey, please contact AORN Government Affairs.

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