REGISTERED NURSE AS CIRCULATOR FOR ASC Last updated 5/16/2012

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1 REGISTERED NURSE AS CIRCULATOR FOR ASC Last updated 5/16/2012 STATE CITATION STATUTORY / REGULATORY LANGUAGE Alabama ALABAMA ADMINISTRATIVE Administration (3) Personnel... (b) Director of Nursing Services. A registered ALABAMA STATE BOARD OF professional nurse shall be responsible for proper performance of HEALTH nursing services provided in the center. ALABAMA DEPARTMENT OF (e) Other required Nursing Service Personnel. PUBLIC HEALTH; DIVISION OF LICENSURE AND 1. Operating Room CERTIFICATION (i) Personnel in the operating room must include at least one (1) CHAPTER : registered professional nurse to serve as the circulating nurse in AMBULATORY SURGICAL each operating room. Additional personnel may include another TREATMENT FACILITIES RN, LPN or surgical technician to scrub. Alaska Arizona Arkansas California ALASKA ADMINISTRATIVE TITLE 7. HEALTH AND SOCIAL SERVICES PART 1. ADMINISTRATION CHAPTER 12. FACILITIES AND LOCAL UNITS ARTICLE 8. AMBULATORY SURGICAL FACILITIES ARIZONA ADMINISTRATIVE TITLE 9. HEALTH SERVICES CHAPTER 10. DEPARTMENT OF HEALTH SERVICES HEALTH CARE INSTITUTIONS: LICENSING: ARTICLE 17. OUTPATIENT SURGICAL CENTERS OF ARKANSAS RULES 016 DEPARTMENT OF HEALTH AND HUMAN SERVICES 24 BOARD OF HEALTH 007: HOSPITALS AND RELATED INSTITUTIONS 7 AAC Services required (a) An ambulatory surgical facility must provide surgical services and anesthesia services. These services must comply with the standards in 7 AAC * and 7 AAC for surgical and anesthesia services in general acute care hospitals. The medical staff shall comply with the requirements of 7 AAC (c). * 7 AAC SURGICAL SERVICE (g) A registered nurse must be present to circulate for each surgical procedure. R Definitions 2. "Circulating nurse" means a licensed nurse who is responsible for the functioning of the operating room during a surgical procedure and who does not directly assist the surgeon. R Nursing Services B. A licensed nurse shall function as a circulating nurse during each surgical procedure. A. General. Any facility in which surgical services, other than minor dental surgery, are offered which require the use of anesthesia, that renders the patient unable to be responsible for their actions, and where, in the opinion of the attending physician, hospitalization is unnecessary, shall be considered ambulatory surgery centers and shall conform with the following sections: 13. Section 26, Specialized Services: Surgical Services * * A. Organization and Supervision 3. A Surgical Services Registered Nurse supervisor shall be accountable and responsible for patient care. C. Staffing 3. Only qualified Registered Nurses may perform circulating duties in the operating room.

2 Colorado Connecticut Delaware Florida Georgia COLORADO OF REGULATIONS DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT HEALTH FACILITIES REGULATION DIVISION: Chapter XX Ambulatory Surgical Center GENERAL STATUTES OF CONNECTICUT TITLE 19A. PUBLIC HEALTH AND WELL BEING, CHAPTER 368ll, SECTION 19a-903a. Circulating Nurses in Hospitals and Outpatient Surgical Facilities. OF DELAWARE REGULATIONS AGENCY 16. DEPARTMENT OF HEALTH AND SOCIAL SERVICES SUB- AGENCY DIVISION OF PUBLIC HEALTH CHAPTER FREE STANDING SURGICAL CENTERS FLORIDA ADMINISTRATIVE TITLE 59 AGENCY FOR HEALTH CARE ADMINISTRATION 59A HEALTH FACILITY AND AGENCY LICENSING CHAPTER 59A-5 AMBULATORY SURGICAL CENTER LICENSURE XI NURSING SERVICES H. Circulating Nurse: A registered nurse, qualified by education and experience in operating room nursing, shall be present as a circulating nurse in each operating room during operative procedures. (1) "Circulating nurse" means a registered nurse licensed under chapter 378 who is educated, trained or experienced in perioperative nursing and who is responsible for coordinating the nursing care and safety needs of a patient in an operating room; (2) "Outpatient surgical facility" has the same meaning as provided in subsection (a) of section 19a-493b; and (3) "Perioperative nursing" means nursing services that are provided to patients during the preoperative, intraoperative and immediate postoperative periods of a surgical procedure. (b) Any hospital or outpatient surgical facility shall ensure that a circulating nurse is assigned to, and present for the duration of, each surgical procedure performed in an operating room of such hospital or outpatient surgical facility. While assigned to a surgical procedure, no hospital or outpatient surgical facility shall assign a circulating nurse to another procedure that is scheduled to occur concurrently or that may overlap in time with the originally assigned surgical procedure. A circulating nurse assigned to a surgical procedure shall be present for the duration of the procedure unless it becomes necessary for the nurse to leave the operating room as part of the procedure or the nurse is relieved by another circulating nurse FREE STANDING SURGICAL CENTERS 4405 Free Standing Surgical Centers 7.0 Nursing Services 7.8 Circulating Nurse: A registered nurse, qualified by education and experience in operating room nursing, shall be present as a circulating nurse in each operating room during operative procedures. 59A Departments and Services (d) A registered nurse shall serve as O.R. Circulating Nurse. (3) NURSING SERVICE. This service shall be organized under written policies and procedures relating to patient care, establishment of standards for nursing care and mechanisms for evaluating such care, and nursing services. (c) A registered professional nurse shall be the operating room circulating nurse.

3 Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana OF HAWAII RULES TITLE 11. DEPARTMENT OF HEALTH CHAPTER 95. FREESTANDING SURGICAL OUTPATIENT FACILITIES ILLINOIS COMPILED STATUTES CHAPTER 210. HEALTH FACILITIES 5. AMBULATORY SURGICAL TREATMENT CENTER ACT INDIANA ADMINISTRATIVE TITLE 410. INDIANA STATE DEPARTMENT OF HEALTH ARTICLE 15. HOSPITAL LICENSURE RULES RULE 2.5. REQUIRED AMBULATORY OUTPATIENT SURGICAL CENTER SERVICES KENTUCKY ADMINISTRATIVE REGULATIONS TITLE 902. CABINET FOR HEALTH SERVICES DEPARTMENT FOR PUBLIC HEALTH CHAPTER 20. HEALTH SERVICES AND FACILITIES Nursing service. (a) Each facility shall have a nursing staff which shall be directed by the director of nursing. The director of nursing shall be a qualified registered professional nurse who shall be appointed by the administrator with the approval of the governing body. The director of nursing shall develop such nursing service policies and procedures, recruit such nursing personnel, and provide such supervision as is necessary to achieve the objectives of the facility. (e) Working personnel in each operating room must include at least one registered professional nurse who shall serve as the circulating nurse. (210 ILCS 5/6.5) (2.5) A registered nurse licensed under the Nursing and Advanced Practice Nursing Act and qualified by training and experience in operating room nursing shall be present in the operating room and function as the circulating nurse during all invasive or operative procedures. For purposes of this paragraph (2.5), "circulating nurse" means a registered nurse who is responsible for coordinating all nursing care, patient safety needs, and the needs of the surgical team in the operating room during an invasive or operative procedure. Sec. 5. (a) All patient care services must meet the needs of the patient, within the scope of the service offered, in accordance with acceptable standards of practice. Patient care services must be under the direction of a qualified person or persons. Patient care services must require the following: (B) Circulating duties in the operating room shall be performed by a qualified registered nurse. Licensed practical nurses and surgical technologists may assist in circulating duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies, in accordance with applicable state law and approved medical staff policies and procedures. 902 KAR 20:106. Operation and services; ambulatory surgical center Section 4. Surgical Services. (4) A registered nurse shall be available to circulate at all times. The operating rooms shall be supervised by a registered nurse.

4 Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE LETTER DATED 2/23/06 OF MASSACHUSETTS REGULATIONS TITLE 105: DEPARTMENT OF PUBLIC HEALTH CHAPTER : LICENSURE OF CLINICS SUBPART F SURGICAL SERVICES NEBRASKA STATE RULES & REGULATIONS DEPARTMENT OF HEALTH AND HUMAN SERVICES SYSTEM TITLE 175. HEALTH AND HUMAN SERVICES SYSTEM; DEPARTMENT OF REGULATION AND LICENSURE NEVADA ADMINISTRATIVE CHAPTER 449. MEDICAL AND OTHER RELATED FACILITIES SURGICAL CENTERS FOR AMBULATORY PATIENTS Medical Records, Services and Facilities NEW JERSEY ADMINISTRATIVE TITLE 8. DEPARTMENT OF HEALTH AND SENIOR SERVICES CHAPTER Consistent with this unambiguous opinion of the Maryland Board of Nursing as well as various principles related to patient safety, it is the position of the Office of Health Care Quality that circulating duties which occur in Maryland hospitals and ambulatory surgical facilities must be performed by a registered nurse : Adequate Assistance (B) Only registered nurses shall function as circulating nurses. CHAPTER 7. HEALTH CLINICS These regulations apply to any health care facility where advice, counseling, diagnosis, treatment, surgery, care, or services relating to the preservation or maintenance of health are provided on an outpatient basis for a period of less than 24 consecutive hours to persons not residing or confined at such facility. Health clinic includes, but is not limited to: 1. An ambulatory surgical center; STANDARDS OF OPERATION, CARE AND TREATMENT: B Each ambulatory surgical center must maintain a chronological permanent admission and discharge record that, at a minimum, includes: 7. Name of nursing personnel (scrubbing and circulating); Operating and recovery rooms; endoscopy suite. (NRS ) 4. A registered nurse experienced in surgical procedures shall supervise the operating room. 5. Only a registered nurse may function as the circulating nurse in the operating room. 8:43A-12.6 Surgical policies and procedures (a) The facility shall develop and implement written bylaws, rules, regulations, policies, and procedures for surgical and anesthesia services, in accordance with the governing authority

5 New Mexico New York North Carolina North Dakota Ohio Oklahoma 43A. MANUAL OF STANDARDS FOR LICENSING OF AMBULATORY CARE FACILITIES SUBCHAPTER 12. SURGICAL AND ANESTHESIA SERVICES NEW YORK S, RULES AND REGULATIONS TITLE 10. DEPARTMENT OF HEALTH CHAPTER V. MEDICAL FACILITIES SUBCHAPTER C. STATE HOSPITAL ARTICLE 6. TREATMENT CENTER AND DIAGNOSTIC CENTER OPERATION PART 755. FREESTANDING AMBULATORY SURGERY SERVICES OKLAHOMA ADMINISTRATIVE TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 615. AMBULATORY SURGICAL CENTER REGULATIONS SUBCHAPTER 1. GENERAL PROVISIONS and medical staff bylaws. The policies and procedures shall be reviewed at least every three years and revised as needed, and shall include at least the following: 6. A registered professional nurse shall be assigned to circulating nurse duties in each room where surgery is being performed; Section Nursing services The operator shall ensure that: (e) only registered professional nurses function as circulating nurses in the operating room. 310: Purpose The purpose of this Chapter is to insure the quality of medical care in ambulatory surgical centers is the same as that required in hospitals licensed by the State of Oklahoma. OKLAHOMA ADMINISTRATIVE TITLE 310. OKLAHOMA STATE DEPARTMENT OF HEALTH CHAPTER 667. HOSPITAL STANDARDS SUBCHAPTER 25. SURGICAL SERVICES 310: Department of surgery The department of surgery shall have effective policies and procedures regarding surgical privileges, maintenance of the operating rooms, and evaluation of the surgical patient. (4) The operating room log shall be complete and up to date and include the following information: (F) Circulating nurse. (11) Surgical technicians and licensed practical nurses may be permitted to serve as "scrub nurses" under the direct supervision of a registered nurse; they shall not be permitted to function as circulating nurses in the operating room. Oregon OREGON REVISED STATUTES TITLE 52. OCCUPATIONS AND PROFESSIONS CHAPTER 678. NURSES; NURSING HOME ADMINISTRATORS As amended by HB 2800 (2005): As used in this section: (a) Circulating nurse means a registered nurse who is responsible for coordinating the nursing care and safety needs of the patient in the operating room and who also meets the needs of

6 Pennsylvania Rhode Island South Carolina PROFESSIONAL NURSES GENERALLY Definitions for ORS to and Authority of nursing assistants to administer Noninjectable medication; authority of nurse to report questions about continuation of medication. PURDON S PENNSYLVANIA STATUTES AND CONSOLIDATED STATUTES TITLE 35 P.S. HEALTH AND SAFETY PA ST 35 P.S SOUTH CAROLINA STATUTES TITLE 44. HEALTH ARTICLE 7. HOSPITALS, TUBERCULOSIS CAMPS, AND operating room team members during surgery. (b) Type I ambulatory surgical center means a licensed health care facility for the performance of outpatient surgical procedures including, but not limited to, cholesytectomies, tonsillectomies or urological procedures, involving general anesthesia or a relative high infection control consideration. 2(a) The duties of a circulating nurse performed in an operating room of a Type I ambulatory surgical center or a hospital shall be performed by a registered nurse licensed under ORS to (b) In any case requiring anesthesia or conscious sedation, a circulating nurse shall be assigned to, and present in, an operating room for the duration of the surgical procedure unless it becomes necessary for the circulating nurse to leave the operating room as part of the surgical procedure. While assigned to a surgical procedure, a circulating nurse may not be assigned to any other patient procedure. (c) Nothing in this section precludes a circulating nurse from being relieved during a surgical procedure by another circulating nurse assigned to continue the surgical procedure. (3) At the request of a Type I ambulatory surgical center or a hospital, the Oregon Health Authority may grant a variance from the requirements of this section based on patient care needs or the nursing practices of the surgical center or hospital. The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows: Section 1. Short title. This act shall be known and may be cited as the Circulating Nurse Act. Section 2. Purpose. The purpose of this legislation is to require a registered nurse to be the circulating nurse in an operating room for the safety of the patient. Section 3. Definitions. The following words and phrases when used in this act shall have the meanings given to them in this section unless the context clearly indicates otherwise: "Health care facility." Any hospital or class C ambulatory surgical facility as defined by 28 Pa. Code Pt. IV (relating to health facilities). "Operating room of the facility." The phrase shall only include the number of operating rooms covered by a health care facility's license issued by the Department of Health. "Registered nurse." An individual licensed under the laws of this Commonwealth to practice professional nursing. Section 4. Operating room staff. Only a registered nurse, licensed in this Commonwealth, qualified by training and experience in operating room nursing shall function as a circulating nurse during all surgical procedures performed in an operating room of a Health Care Facility. Section (A) As used in this section, an 'operating room circulator' means a registered nurse trained, educated, or experienced in perioperative nursing who is responsible for

7 HEALTH SERVICES DISTRICTS ARTICLE 3. STATE CERTIFICATION OF NEED AND HEALTH FACILITY LICENSURE ACT coordinating the nursing care and safety needs of a patient in the operating room and who also meets the needs of the operating room team members during surgery. (B) An operating room circulator in a health care facility must be a licensed registered nurse educated, trained, and experienced in perioperative nursing. (C) A surgical technologist may not serve as the circulator in the operating room of a health care facility; however, a person who is employed to practice surgical technology in a health care facility may assist in the performance of circulating duties: (1) consistent with the person's education, training, and experience; and (2) as assigned and supervised by a registered nurse circulator who must be present in the operating room for the duration of the surgical procedure. South Dakota Tennessee Texas RULES AND REGULATIONS OF THE STATE OF TENNESSEE TENNESSEE DEPARTMENT OF ENVIRONMENT AND CONSERVATION BUREAU OF MANPOWER AND FACILITIES; DIVISION OF HEALTH CARE FACILITIES CHAPTER STANDARDS FOR AMBULATORY SURGICAL TREATMENT CENTERS TEXAS ADMINISTRATIVE TITLE 25. HEALTH SERVICES PART 1. DEPARTMENT OF STATE HEALTH SERVICES CHAPTER 135. AMBULATORY SURGICAL CENTERS SUBCHAPTER A. OPERATING REQUIREMENTS FOR AMBULATORY SURGICAL CENTERS BASIC SERVICES (1) Surgical Services. (e) The operating rooms must be supervised by an experienced registered nurse or a doctor of medicine or osteopathy. (f) An ASTC may use scrub nurses in its operating rooms. For the purposes of this rule, a scrub nurse is defined as a registered nurse or either a licensed practical nurse (L.P.N.) or a surgical technologist (operating room technician) supervised by a registered nurse who works directly with a surgeon within the sterile field, passing instruments, sponges, and other items needed during the procedure and who scrubs his or her hands and arms with a special disinfecting soap and wears surgical gowns, caps, eyewear, and gloves, when appropriate (g) Qualified registered nurses may perform circulating duties in the operating room. In accordance with applicable State laws and approved medical staff policies and procedures, LPNs and surgical technologists may assist in circulatory duties under the supervision of a qualified registered nurse who is immediately available to respond to emergencies (a) Nursing Services (1) There shall be an organized nursing service under the direction of a qualified registered nurse (RN) and staffed to assure that the nursing needs of all patients are met. (2) There shall be a written plan of administrative authority for all nursing services with responsibilities and duties of each category of nursing personnel delineated and a written job description for each category. The scope of nursing service shall include, but is not limited to, nursing care rendered to patients preoperatively, intraoperatively, and postoperatively. (C) Surgical technicians and licensed vocational nurses may be permitted to serve as the scrub nurse under the direct supervision of an RN; they shall not be permitted

8 to function as circulating nurses in the operating rooms, except in ASCs where no general anesthesia is administered and when there is an adequate number of RNs immediately available for an emergency situation. Licensed vocational nurses and surgical technicians may assist in circulatory duties under the supervision of a qualified RN during general anesthesia cases. Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming WASHINGTON ADMINISTRATIVE TITLE 246. HEALTH, DEPARTMENT OF CHAPTER AMBULATORY SURGICAL FACILITIES PART I OPERATIONAL RULES WEST VIRGINIA CHAPTER 30. PROFESSIONS AND OCCUPATIONS ARTICLE 7. REGISTERED PROFESSIONAL NURSE Surgical services An ambulatory surgical facility must: (6) Assure a registered nurse qualified by training and experience functions as the circulating nurse in every operating room whenever deep sedation or general anesthesia are used during surgical procedures Circulating registered nurses. A registered nurse as defined in this article, qualified by education, licensed, and experienced in operating room nursing, shall be present as a circulating nurse in each operating room in a hospital, or ambulatory surgical center as defined by section one, article five-b, chapter sixteen of this code, during operative procedures