California Board of Medicine Rules on Assisting-At-Surgery
Unlicensed assistive personnel, including surgical assistants and technician, may not clamp, cut, or suture tissue per a ruling by the Medical Board in California. These activities may only be performed by physicians, physicians' assistants (PAs), or registered nurses; even licensed practical/vocational nurses may not perform them, as they are considered outside for their scope of practice. In its ruling, the Medical Board cited clamping, cutting and suturing tissue as medical acts which may not be delegated to or performed by unlicensed persons. The Board noted that nurse practitioners or RN first assistants, with demonstrated competency, may act as first assistants-at-surgery; California requires standardized procedures for specific delegated acts by RNFAs. PAs function under their standards for physician delegation and supervision. The ruling applies to all surgical settings, including ambulatory surgical center and physician offices.
Surgical Technologists (UAPs)
Surgical Techs also known as UAPs (Unlicensed Assistive Personnel)must not be allowed to circulate or first assist according to AORNsstandards. It is our job as the professional and patient advocatewho delegate tasks to the STs to enforce this standard.In New York, the Department of Education made a decision that only licensed personnel can first assist, UAPs can hold retractors. See the government affairs/legislation page for AORNs position statement regarding STs.
Surgical Technologists (Unlicensed Assistive
Personnel - UAPs)The Association of Operating Room Nurses (AORN) position statement on
UAPs states: "Perioperative registered nurses are accountable for patient
outcomes resulting from the nursing care provided during the perioperative
(before, during, and after surgery) experience. A perioperative registered
nurse must plan and direct the care of every patient undergoing operative
and other invasive procedures. A 1:1 perioperative RN to patient ratio
is required for each patient during operative and other invasive procedures.
To ensure that patients receive the highest quality and standard of
care, the circulating nurse must always be a registered professional
nurse."The statement goes on to identify the core activities of perioperative
nursing as assessment, diagnosis, outcome identification, planning,
implementation, and evaluation. The perioperative RN may not delegate
assessment, diagnosis, outcome identification, planning, and evaluation;
however, depending on the patient's potential for adverse outcomes and need
for complex interventions and teaching, the perioperative nurse may delegate
appropriate patient care activities. The perioperative nurse uses judgment
to decide to whom and under what circumstances to delegate these activities.
Factors that must occur before UAP assume responsibilities for patient
care activities are as follows: 1. Nursing Practice Factors
The patient's risk for adverse outcome must be determined.
The patient's need for complex technology and complex intervention must be determined.
The patient's need for teaching must be determined.
2. Training and Education Factors
RNs must receive education and demonstrated knowledge and skills of delegation .
The level of preparation and education of UAP required to perform the delegated task must be determined.
UAP must receive appropriate didactic and psychomotor training.
UAP must demonstrate compentency for each patient care activity that will be delegated.
3. Management Factors
UAP position descriptions and job duties must delineate which patient care activities can be performed.
Perioperative nurses must participate in defining UAP position descriptions.
Perioperative nurses must assist in validating UAP competencies.
An appropriate number of perioperative nurses must be provided to perform core patient care activities that may not be delegated.
An appropriate number of perioperative nurses must be provided to supervise and coordinate the performance of patient care activities that may be delegated to UAP.
Regulation of Surgical Technologists
(UAPs)The Association of Operating Room Nurses (AORN) is opposed to state licensure
or registration of STs. STs are not independent practitioners. STs
always work under the direct supervision of a physician or registered
nurse. Delegation of designated tasks to unlicensed care providers,
with the accompanying responsibility for the public's safety related to care,
is a part of the scopes of practice of physicians and nurses. Public
safety will not be enhanced with the regulation of an additional class of
provider that remains accountable to another professional provider. The
educational preparation of certified surgical technologists (CSTs) does
not include the nursing process and judgment about patient care needs
and the evaluation of patient care processes and outcomes. AORN supports
the delegation of nursing tasks as provided for in law and as implemented
through guidelines developed by the nursing profession.
