The surgical technologist

1Why it matters

Once anesthesiaanesthesiaan-us-THEE-zhuhLoss of feeling or sensation, often brought on by drugs so that surgery or a procedure can be done without pain.an- withoutesthesi/o feeling, sensation-ia conditionFull entry Close starts, the patient on the table cannot speak up for themselves. Everyone on the team acts as the patient's advocateadvocateAD-vuh-kayt (verb), AD-vuh-kit (noun)To speak up and act for a client's rights, safety and wishes; also, a person who does this.Full entry Close, doing what the patient would do if they were able. Your part is the sterile fieldsterile fieldSTAIR-ul feeldAn area set up with sterile drapes and supplies, kept free of all germs, for a sterile procedure.Full entry Close, the instruments and every step of the operation.

How you behave counts as much as what your hands can do. Employers, instructors, colleagues and patients notice your professionalism before they ever see your skill. In clinical training, the bigger problems are often not hands-on skills: they are a lack of professionalism, trouble with patients, poor communication and not fitting into the team. A person who never develops professional behavior often fails to get a job, or to keep one.

This chapter is about the profession you are joining. It covers what a surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close does, where the job came from, how you are educated and certified, what your clinical rotation must include, the organizations that shape your work, the careers open to you, how to get hired, and how to grow into a leader.

Other chapters hold the pieces around it: ethicsethicsETH-iksThe study of right and wrong, and the principles that guide good conduct and decisions.eth/o custom, character-ics the study ofFull entry Close, the law, your scope of practicescope of practiceSKOHP uv PRAK-tisThe actions and duties a licensed professional is legally allowed to perform.Full entry Close and AST's code of ethicscode of ethicsKOHD uv ETH-iksA written set of moral principles and duties that guides the conduct of members of a profession.Full entry Close in full in chapter 15; communication, teamwork and conflict in chapter 16; the members of the surgical team and how the surgery department is run in chapter 17; the surgical conscience at the sterile field in chapter 26; the scrub's duties before, during and after the case in chapters 28 to 30; and the assistant circulator in chapter 31.

2What a surgical technologist does

Surgical technology is one of the allied health professions, a large family of health workers that also takes in laboratory technologists, cardiac perfusionists, respiratory therapists, anesthesiaanesthesiaan-us-THEE-zhuhLoss of feeling or sensation, often brought on by drugs so that surgery or a procedure can be done without pain.an- withoutesthesi/o feeling, sensation-ia conditionFull entry Close technicians and many more.

A surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close works under the supervisionsuperviseSOO-per-vyzeTo guide, watch over and check the work of another staff member who is doing a task.Full entry Close of the surgeon. The job is to make sure the room is safe, the equipment works and the operation runs under conditions that protect the patient. Your special knowledge is sterile and aseptic technique, joined to anatomy, the steps of each operation and the instruments and technology it uses.

The exact job changes from one facility to the next and with your specialty, and AST posts a formal job description on its website. Whatever the setting, you never work alone. Your tasks fit into the work of many other professionals, the interprofessional team, so being a good team player is part of the job.

The scrub role

In the scrub role you are a sterile team member. You do a surgical hand antisepsis, put on a sterile gown and gloves, and stay at the sterile fieldsterile fieldSTAIR-ul feeldAn area set up with sterile drapes and supplies, kept free of all germs, for a sterile procedure.Full entry Close for the whole operation.

The sterile team, made up of the surgeon, any assistants and you, performs the operation, and your job is to support the surgeon's and the assistant's work. The word "scrub" is older than the title surgical technologist. Registered nurses and licensed practical or vocational nurses can also work in the scrub role. You may hear a surgical technologist in this role called the STSR (surgical technologist in the scrub role), the first scrub, or simply the scrub.

An operation can call for anything from a few basic instruments to hundreds of items: instrument sets, suturessutureSOO-cherA stitch, or the thread used to stitch, that holds the edges of a wound or incision together.Full entry Close, sponges, medications, solutions and electronic devices. Some instruments are put together on the field. Each item reaches the surgeon at the moment it is needed, which works only when you know every step of the operation and what the surgeon prefers.

You also protect the sterile field from contamination and keep your tables neat and in order. You speak up to prevent errors, such as handing the wrong instrument or handing it the wrong way round, and you ask the circulator for anything else the case needs. Chapters 28, 29 and 30 teach the scrub's work before, during and after the case.

Sterile and nonsterile team members

The surgical team works in two groups.

• Sterile team members have done a surgical hand and arm antisepsis and wear sterile gowns and gloves. They perform the operation or assist at the field: the surgeon, the surgical assistant and the scrub.
• Nonsterile team members touch only nonsterile instruments, supplies and equipment. The circulator is the main nonsterile team member, and the anesthesia provideranesthesia provideran-us-THEE-zhuh pruh-VY-derThe licensed professional who gives anesthesia and watches over the client's breathing and vital functions during a procedure.Full entry Close works on the nonsterile side too.

AORN calls for at least one registered nurse circulator dedicated to each patient for the whole operation, and federal hospital rules say the circulating nurse must be an RN; chapters 15 and 17 cover the law and the team.

The assistant circulator

A surgical technologist who works on the nonsterile side is the assistant circulator, also called the ST circulator or STCR (surgical technologist in the circulating role). A registered nurse must be immediately available and is the primary circulator.

The assistant circulator keeps watch over the conditions in the room that bear on patient care and safety, the records, the delivery of sterile supplies and the counts. Which duties you may take on depends on your state, your region and your facility. In NBSTSA's 2022 survey of CSTs, about a third said that part of their job is circulating. Chapter 31 teaches the role.

The second scrub

When a second surgical technologist scrubs in, they work in the second scrub role, also called the second assistant: they retract, sponge, suction and irrigateirrigationeer-ih-GAY-shunWashing out a wound, body cavity, tube or eye with a steady flow of liquid.Full entry Close, help with hemostasishemostasishee-moh-STAY-sisThe stopping of bleeding, either by the body's own clotting process or by medical or surgical methods.hem/o blood-stasis stopping, standing stillFull entry Close as the surgeon directs, hold the camera, cut suture, and at the close put together and attach the wound suction devices and apply dressings, but never cut into or remove tissue. Chapter 29 teaches the second scrub's duties.

The first assistant

The first assistant helps the surgeon with exposure, hemostasis and the other technical tasks that make a safe operation possible. This is the American College of Surgeons' definition, which AST uses. The tasks include retracting tissue, clamping and tying off bleeding vessels, using the electrosurgical unitelectrosurgeryee-LEK-troh-SUR-jer-eeUsing high-frequency electric current through a handheld tool to cut tissue or seal bleeding vessels during surgery.Full entry Close safely, suturing tissue layers or applying staples, and applying complex dressings.

AST separates the scrub and first assistant roles by education: a first assistant is educated to use instruments on tissue, while the scrub handles and passes them. A first assistant works at the table under the surgeon's direction at all times, and practice privileges should rest on verified credentials approved by the facility's credentialing committee. Registered nurses, physician assistants and nurse practitioners can also become first assistants.

AST's position is that the first scrub and the surgical assistant are separate roles. Chapter 29 explains why doing both at once, a dual role, can put the case at risk.

More than the operation

• Call. In a hospital or other facility that gives care around the clock, you will usually take call: you are available outside normal hours for emergency cases, on a rotating schedule. Most cases are done in the daytime and a 40-hour week is common, but you may also work evenings, nights, weekends and holidays.
• Instruments and equipment. You help prepare instruments and equipment: cleaning, disinfectiondisinfectiondis-in-FEK-shunCleaning a surface or object with chemicals or heat to kill most germs, though not always all bacterial spores.Full entry Close, sterilizationsterilizationstair-uh-luh-ZAY-shunA process that destroys all microorganisms, including spores, on an item; also a permanent birth control procedure.Full entry Close, assembly and storage, with extra training for robotic, fiber-optic and endoscopicendoscopicen-doh-SKOP-ikDone with an endoscope, a thin tube with a light and camera passed into the body.endo- within-scopic viewingFull entry Close equipment. Chapter 27 covers sterile processing.
• Direct patient care. AST has widened the role to include direct patient care, psychosocialpsychosocialsy-koh-SOH-shulRelating to a person's mind and emotions together with their relationships and place in society.psych/o mindsoci/o society, others-al relating toFull entry Close support included.
• Nonsterile duties. Even a first scrub does many nonsterile jobs, called assisting circulating duties, over the course of a workday.

What the job asks of you

The work is fast and exacting. You work quickly and accurately, put tasks in order of priority under pressure, and may be exposed to communicable diseasescommunicable diseasekuh-MYOO-nih-kuh-bul dih-ZEEZA disease that can spread from one person, or animal, to another.Full entry Close, unpleasant sights and smells, and hazardous materials. A steady temperament, patience and a strong sense of responsibility are as essential as good hands, good eyes and ears, and stamina.

AST describes what a surgical technologist must be able to do. Among other things, you must:

• stand, or sit, in one place for long periods with few or no breaks, and go up to 8 hours without eating or a restroom break
• lift at least 20 pounds, and help lift, move and position a patient who is unconscious
• see and feel well enough to load a fine 10-0 suture on a needle holder, through safety glasses
• hear muffled speech from up to 20 feet away without seeing the speaker's lips, and hear equipment alarms
• be immune or vaccinated against rubellarubellaroo-BEL-uhA contagious illness caused by the rubella virus; also called German measles.Full entry Close, rubeolameaslesMEE-zulzA very contagious illness caused by the measles virus; also called rubeola.Full entry Close, tuberculosistuberculosistoo-ber-kyoo-LOH-sisAn infection caused by the bacterium Mycobacterium tuberculosis, which most often attacks the lungs.tubercul/o small swelling-osis abnormal conditionFull entry Close and hepatitis Bhepatitis Bhep-uh-TY-tis BEEA liver infection caused by the hepatitis B virus.hepat/o liver-itis inflammationFull entry Close, or sign a waiver

The skills behind the work

The hand skills come first in the lab and are polished in clinical practice. Skills such as adaptability, decision making and communication, often called soft skills, take longer to build and are highly valued.

• Organization: setting up instruments and equipment in the order they will be used, keeping your tables clear of clutter, and asking the circulator for each extra item early enough, but not so early that it clutters the field. A disorganized table wastes time and makes it more likely that an item is miscounted or lost.
• Manual dexterity: precise, efficient hand work with good hand-eye coordination. Speed is not the most important skill: working too fast breaks down your organization, and instruments get dropped and people get hurt.
• Problem solving: looking at all the possibilities, putting the most important facts first and working out a plan. Like reading and math, it can be learned.
• Time management: balancing a busy workday, call and your private life. It is worth building before you graduate, when the pressure is lower.
• People skills: communicating, building relationships, handling conflict and getting along with others, so that patients and colleagues trust you.

3Aeger primo: the patient first

AST's motto is the Latin phrase aeger primo, "the patient first." The Core Curriculum lists it first among the professional behaviors of a surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close, as being patient centered. In every decision you make, the patient comes first.

Putting the patient first stays the top priority even when a rule, such as the federal patient privacy rules, costs money and staff training to follow. In every situation, a health care worker is the patient's advocateadvocateAD-vuh-kayt (verb), AD-vuh-kit (noun)To speak up and act for a client's rights, safety and wishes; also, a person who does this.Full entry Close. That is why you report a break in sterile techniquesurgical asepsisSUR-jih-kul ay-SEP-sisPractices that keep an area or object completely free of microorganisms; also called sterile technique.a- withoutsepsis decay, infectionFull entry Close that nobody else saw.

The same idea runs through the whole profession. AST's mission is "enhancing the profession to ensure quality patient care": a professional organization exists to improve its profession, but in health care, the point of that work is better care for the patient. Patient-centered carepatient-centered carePAY-shunt SEN-terd KAIRCare planned around the client's own needs, values and choices, with the client as a full partner in decisions.Full entry Close, in the Core Curriculum's words, is where professional behavior begins.

4Traits of a professional

What makes a professional

Being a professional means more than being good at your job. It means behaving in ways that others recognize and respect. Becoming a professional is a normal part of learning a career, and it grows fastest when colleagues, instructors and mentors give you feedbackfeedbackFEED-bakInformation about a result that is sent back to change what happens next, in the body or between people.Full entry Close on your behavior and attitude.

For a surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close, professionalism is a lifelong commitment. It means keeping your knowledge and skills competent and current, carrying out your duties for the patient, and holding the attitudes and values of the profession. Professionals also have a duty to support and develop their profession.

Personal and professional behaviors

These are the behaviors employers, teams and patients count on.

Critical thinking

Critical thinking means thinking with a purpose. You aim at a good result for the patient, use what you know and what you have seen, and keep checking your own conclusions as you go. Caring for patients professionally depends on it.

The Core Curriculum breaks it into five steps:

1. Identify the problem. This step includes looking ahead: anticipating what could go wrong and planning for it.
2. Define the problem: say exactly what is wrong.
3. Gather information about it.
4. Identify solutions and choose the best one. If time is short and the best answer is out of reach, choose another that still solves the problem, and bring others in when the problem is bigger than you.
5. Evaluate the outcome: check whether the solution worked, and work out your part in keeping the problem from happening again.

A count that comes up one sponge short runs through the same steps: the team is told at once, everyone searches and recounts, and once the sponge is found you work out your part in prevention, because a cluttered table makes it more likely that an item is miscounted or lost. Chapter 28 teaches the count and the search, and chapter 29 the closing counts.

Surgical conscience

Surgical conscience is being accountableaccountabilityuh-kown-tuh-BIL-ih-teeBeing answerable for your own decisions, actions and the results of the care you give or hand to others.Full entry Close for your actions and admitting your errors, including the ones nobody saw. Contaminating the sterile fieldsterile fieldSTAIR-ul feeldAn area set up with sterile drapes and supplies, kept free of all germs, for a sterile procedure.Full entry Close, preparing or giving the wrong drug, and forgetting a safety measure so that a patient is hurt are all examples. A mistake that is not reported at once can have devastating results for the patient, while a mistake you admit can be corrected. Chapter 26 shows surgical conscience at work at the sterile field.

Ethical behavior

EthicalethicalETH-ih-kulHaving to do with what is morally right, or acting in line with accepted moral principles.Full entry Close behavior is the last item on the Core Curriculum's list for professionalism, and AST's code of ethicscode of ethicsKOHD uv ETH-iksA written set of moral principles and duties that guides the conduct of members of a profession.Full entry Close, adopted in 1985, sets it out; chapter 15 teaches the code, ethicsethicsETH-iksThe study of right and wrong, and the principles that guide good conduct and decisions.eth/o custom, character-ics the study ofFull entry Close, the law and your scope of practicescope of practiceSKOHP uv PRAK-tisThe actions and duties a licensed professional is legally allowed to perform.Full entry Close.

5Where the profession came from

Surgeons have always needed skilled helpers who know the instruments. For a long time that helper was the surgical nurse. In the late 1800s nurses prepared the instruments for surgery, in the early 1900s they assisted at operations and gave ether, and from about the 1920s to the 1940s their duties looked like those of today's circulating nurse.

The job you are training for grew out of war. In World War II, antibiotics such as penicillinpenicillinspen-ih-SIL-inzA group of antibiotics, including penicillin and amoxicillin, that kill bacteria by stopping them from building their cell walls.Full entry Close and the sulfa drugs let surgeons save many more of the wounded, and there were not enough nurses for the field and base hospitals. The Army trained corpsmen to assist in surgery and called them operating room technicians (ORTs).

The Korean War kept nurses scarce, and operating room supervisors began hiring former corpsmen for civilian surgery. Registered nurses worked as the "instrument nurse" until about 1965, when they moved to the circulating role, and hospitals began training civilian ORTs.

One reference dates the AORT's formal organization to 1969, and the new name, AST, to 1978, the year the magazine became The Surgical Technologist.

When the profession chose certification over licensure, it did so in consultation with the American College of Surgeons and the American Medical Association, because certification sets one standard for the whole country. Ever since World War II the military has trained its own surgical technologists, and it still does. Its operating room specialist course parallels civilian programs, with added training in combat and war surgery.

6Becoming a surgical technologist

The program

Surgical technology programs range from certificates of 9 to 12 months to two-year associate degrees. AST treats the associate degree as the model for preparing graduates for entry-level work, and it worked with the ARC/STSA to make the associate degree the preferred way into the profession. A CAAHEP-accredited program must award at least an associate degree.

Every program combines three kinds of learning: classroom study, skills practice in a lab, and clinical training in a health facility. In clinical training you take part in real operations, supervisedsuperviseSOO-per-vyzeTo guide, watch over and check the work of another staff member who is doing a task.Full entry Close by a skilled mentor and a clinical instructor.

What accreditation means

Accreditation is how a program shows that it meets the profession's minimum standards of quality. Lists of accredited programs are published so that students, employers and the public can check them.

• CAAHEP, the Commission on Accreditation of Allied Health Education Programs, accredits surgical technology programs.
• ARC/STSA, the Accreditation Review Council (ARC) on Education in Surgical Technology and Surgical Assisting (STSA), is CAAHEP's only committee on accreditation for these programs, sponsored by the American College of Surgeons and AST. It reviews each program against CAAHEP's standards and the Core Curriculum, then recommends it to CAAHEP for accreditation.
• ABHES, the Accrediting Bureau of Health Education Schools, is another accrediting body. Its graduates can also sit for the CSTCSTsee-es-tee (said as letters)Certified Surgical Technologist, a credential for surgical technologists; in maternity care, contraction stress test.Full entry Close exam.

An accredited program makes its graduates eligible to sit for the national certificationcertificationser-tih-fih-KAY-shunA credential from a professional organization showing that a person has met the standards for a specialty.Full entry Close exams.

Accreditation also holds the program to account. Each year it reports its outcomes to the ARC/STSA: how graduates do on the national certification exam, how many students finish, how satisfied graduates and employers are, and how many graduates find jobs in the field or a related one. It must also post a summary of its graduates' results on its website.

That is one reason graduates of an accredited program are expected to sit for the certification exam.

Your clinical rotation

Your clinical rotation follows the Core Curriculum's case requirements. Every case you log counts in one of three roles.

• First scrub (FS). To log a case as first scrub, you do all of these with proficiency: check the supplies and equipment; set up the sterile fieldsterile fieldSTAIR-ul feeldAn area set up with sterile drapes and supplies, kept free of all germs, for a sterile procedure.Full entry Close with the instruments, medications and supplies; do the required counts by AST's guidelines and your facility's policy; pass instruments and supplies, anticipating what the surgeon needs; and keep sterile techniquesurgical asepsisSUR-jih-kul ay-SEP-sisPractices that keep an area or object completely free of microorganisms; also called sterile technique.a- withoutsepsis decay, infectionFull entry Close, recognizing and correcting any break and documenting it as needed.
• Second scrub (SS). You have not met every first scrub criterion, but you take an active part in the whole operation by doing any of these: assisting with a diagnostic endoscopyendoscopyen-DOS-kuh-peeA procedure that uses a thin, flexible tube with a light and camera to look inside the body.endo- within-scopy looking with an instrumentFull entry Close or a vaginal delivery, cutting suturesutureSOO-cherA stitch, or the thread used to stitch, that holds the edges of a wound or incision together.Full entry Close, holding the camera, retracting, sponging or suctioningsuctioningSUK-shun-ingRemoving mucus, saliva or other secretions from the mouth, nose or airway with a tube connected to a suction source.Full entry Close.
• Observation (O). Observation is for a case you cannot yet scrub in either role: you have not met the first or second scrub criteria, so you watch the case, in the sterile or the nonsterile role. Observation cases must be documented, but they never count toward the required 120.

You must complete at least 120 cases, divided this way:

The specialties are every surgical specialty except general surgery: cardiothoracic, genitourinarygenitourinaryjen-ih-toh-YOOR-ih-nair-eeRelating to the genital (reproductive) organs and the urinary organs together.genit/o reproductive organsurin/o urine-ary relating toFull entry Close, neurologic, obstetric and gynecologicgynecologygy-nuh-KOL-uh-jeeThe branch of medicine that cares for the female reproductive organs and breasts.gynec/o woman-logy study ofFull entry Close, orthopedicorthopedicor-thuh-PEE-dikHaving to do with the bones, joints, muscles, ligaments and tendons, and the branch of medicine that treats them.orth/o straightped/o child (the field began with straightening children's bones)-ic relating toFull entry Close, otorhinolaryngologic (ear, nose and throat), ophthalmologic, oral and maxillofacial, peripheral vascular, plastic and reconstructive, and procurement and transplant.

Cases are counted by these rules:

• One pathologypathologypuh-THOL-uh-jeeThe study of disease and its causes and effects, or the disease changes found in a person or tissue.path/o disease-logy study ofFull entry Close is one case. A breast biopsy followed by a mastectomymastectomyma-STEK-tuh-meeSurgery to remove all or part of a breast.mast/o breast-ectomy surgical removalFull entry Close for breast cancer is one general surgery case.
• Different specialties on one patient count separately. A trauma patient's splenectomy (general surgery) and repair of a LeFort I fracture (oral and maxillofacial) are two cases, and so are a mastectomy and an immediate breast reconstruction, which need different setups.
• Diagnostic or operative endoscopy. An endoscopy classed as a semicritical procedure is diagnostic, and one classed as critical is operative; chapter 27 explains the classes. A cystoscopy is diagnostic, but a cystoscopy with a ureteralureterYOOR-uh-terOne of the two tubes that carry urine from the kidneys down to the bladder.Full entry Close stentstentstentA small tube, often of metal mesh, placed inside a vessel or duct to hold it open.Full entry Close placed is operative. Diagnostic cases count in the second scrub role, up to 10 of the 120.
• Vaginal deliveries count in the second scrub role in obstetrics and gynecology, up to 5 of the 120.

Each case is documented with the case, your role, your performance evaluations and verification by the program director. Your program must also show that you moved on to more complex procedures as you worked toward entry-level competencycompetencyKOM-puh-tun-seeA specific skill or ability that a person has been shown to perform to an expected standard.Full entry Close. Programs can ask their accrediting agency to clarify how a case counts, so follow your program's rules for the case log.

7Certification

Certification and licensure

Certificationcertificationser-tih-fih-KAY-shunA credential from a professional organization showing that a person has met the standards for a specialty.Full entry Close is recognition by a private agency that a person has reached a stated level of knowledge and skill. It usually rests on graduating from an accredited program and passing a written exam.

LicensurelicensureLY-sun-sherThe granting of a license by a government body that gives a person legal permission to practice a profession.Full entry Close is a different credential. It is a legal requirement for certain professions, issued by the state where the professional works. Surgical technologistssurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close chose certification instead, in consultation with the American College of Surgeons and the American Medical Association, because it sets one national standard. Certification may or may not be required by law, depending on the state, and chapter 15 covers those laws.

Employers often require certification anyway. In NBSTSA's 2022 survey, about two out of three CSTs said their employer required the CSTCSTsee-es-tee (said as letters)Certified Surgical Technologist, a credential for surgical technologists; in maternity care, contraction stress test.Full entry Close as a condition of employment, and about the same share said their credential was checked at their annual review.

The NBSTSA and the CST

The National Board of Surgical Technology and Surgical Assisting, or NBSTSA, makes every decision about the CST and CSFA credentials: who is eligible, and whether a credential is granted, renewed or denied. It began in 1974 as the LCC-ST.

Its board has ten members: seven CSTs and CSFAs, one member of the public, a surgeon appointed by the American College of Surgeons, and a surgical technology educator. The National Commission for Certifying Agencies (NCCA) accredits the NBSTSA to run both exams.

A CST, a certified surgical technologist, is a surgical technologist who has passed the certification exam. Passing it shows that you meet the national standard for the knowledge that underlies surgical technology practice. You may use the initials CST only as long as your certification is current.

Keep the NBSTSA and AST apart in your mind. AST is your professional association, which you choose to join. The NBSTSA is the board that certifies you.

Who may sit for the CST exam

The NBSTSA gives three ways to be eligible:

1. You graduated from a surgical technology program accredited by CAAHEP or ABHES.
2. You graduated from a military surgical technology training program.
3. You are a CST now, or were one in the past.

You send in an application with proof of graduation and the fee. Once you are approved, the NBSTSA sends an Authorization to Test (ATT) email, and you use it to book your exam with the testing company, PSI. Book soon: the exam must be taken within your six-month eligibility period, or the fee is lost.

The CST exam

The exam has 175 multiple-choice questions. Of these, 150 are scored. The other 25 are unscored pretest questions, mixed in at random so the NBSTSA can study how they perform.

You have four hours, and breaks do not stop the clock. The passing score is a set number of correct answers, and nbstsa.org posts the current number.

The questions follow the content outline. The outline comes from a national job analysis: the NBSTSA surveys working CSTs about which tasks they do and how often and how much each matters, and committees of subject matter experts write and review the questions.

The candidate handbook at nbstsa.org gives the rest: the current fees, the identification to bring, arrival and rescheduling rules, what you may take into the room, and how to ask for accommodations for a documented disability.

Results. If you test at a testing center after you graduate, and you sent in your own transcript, you may get your score report on test day. If your class tests on campus, your score is released once you graduate and your school releases it, and the NBSTSA must receive your proof of graduation within 60 days of the exam, or the result is canceled and the fees are lost.

Retakes. If you do not pass, you may apply to test again right away, with no waiting period, up to three times in a calendar year. Each attempt needs a new application and the full fee.

The questions are the NBSTSA's copyrighted property, and you may never discuss them or take exam materials out. Cheating, or using a false certificate, can lead to denialdenialdih-NY-ulRefusing to accept or believe a painful fact or situation, often without being aware of doing so.Full entry Close or revocation of your certification.

To prepare, use the NBSTSA's online practice exams, its study app and its study evaluation, which shows which outline areas need your attention, and the list of references its question writers use, from the textbooks to AST's Guidelines for Best Practices and the American Heart AssociationAmerican Heart Associationuh-MAIR-ih-kun HART uh-soh-see-AY-shunA US nonprofit group that funds heart and stroke research and publishes guidelines, including for CPR.Full entry Close's CPR guidelines.

The NCCT and the TS-C

There are two certifying agencies for surgical technologists: the NBSTSA and the National Center for CompetencycompetencyKOM-puh-tun-seeA specific skill or ability that a person has been shown to perform to an expected standard.Full entry Close Testing (NCCT). A surgical technologist in the scrub role may be certified as either a CST or a TS-C.

TS-C stands for Tech in Surgery-Certified, and the NCCT awards it. It shows that you have the skills and knowledge to keep asepsisasepsisay-SEP-sisThe state of being free of germs that cause disease, and the practices used to keep things that way.a- withoutsep- decay or infection-sis conditionFull entry Close during surgery, anticipate the surgeon's needs and stay alert to every part of the operation, so the patient is safe. Like the CST, it is accredited by the NCCA.

The NCCT offers six pathways to its exam. Every pathway except the high school one needs a high school diploma or an equivalent such as the GED, and any required work experience must be in the United States or its territories.

• Current student: you are enrolled in an NCCT-authorized postsecondary surgical technology program, U.S. Department of Labor Registered Apprenticeship programs included.
• Graduate: you finished such a program within the past 5 years.
• High school: you are a student in, or graduated within the past 5 years from, the surgical technology program of an NCCT-authorized high school.
• Military: you completed a surgical technology program or its equivalent in U.S. military service within the past 5 years.
• Experience: you worked 3 years full time (6,240 hours) as a surgical technologist within the past 5 years, under the direct supervisionsuperviseSOO-per-vyzeTo guide, watch over and check the work of another staff member who is doing a task.Full entry Close of a licensed physician, a surgeon or a registered nurse.
• Instructor: you taught surgical technology for 3 years at an NCCT-authorized organization within the last 5 years, and you have 3 years of experience as a surgical technologist.

On the student, graduate, high school and military pathways you also send in a Critical Skills Competency form and proof that you finished your program, such as a diploma, a certificate of completion or a signed transcript, or for the military pathway a DD214 or SMART transcript. A student may test before graduating, but the certification is not released until the proof arrives.

The TS-C exam has 150 scored items and 25 unscored pretest items, and you have four hours. About 92% are standard four-option multiple-choice items; the other 8% are alternative items, such as drag and drop, multi-select and hotspot, so practice those formats too. The test plan comes from a national job analysis and has four areas: perioperative care and preparation (41 scored items), preoperative care and preparation (48), intraoperative care and preparation (37), and end-of-procedure tasks and postoperative care (24). In 2026 the exam fee was $199.

The TS-C is renewed every year. Each year you complete 14 contact hours of CE (one contact hour is 60 minutes of learning), apply and pay the recertification fee ($89 in 2026 for one credential), and you keep to the NCCT's code of ethicscode of ethicsKOHD uv ETH-iksA written set of moral principles and duties that guides the conduct of members of a profession.Full entry Close. The NCCT's own online CE library is free, and approved outside courses count too.

A TS-C that is not renewed on time becomes inactive, and an employer may keep you from working in the certified role until you complete the missed years, one year at a time. After five years in a row without recertifying, the credential is invalid: you must meet the eligibility rules and pass the exam again.

The CSFA

The NBSTSA also certifies surgical first assistants, with the Certified Surgical First Assistant (CSFA) credential. A CST who completes an educational program in surgical assisting can go on to become a CSFA, and the NBSTSA sets the requirements. For Medicare payment, a CSFA counts as a nonphysician surgical assistant. In NBSTSA's 2022 survey, about 5 percent of CSTs also held the CSFA.

Keeping your certification

Certification is not a one-time event. Every CST must keep up with changes in the field, by earning continuing education credits or by passing the exam again.

The CST runs on a 2-year cycle. To renew by credits, you need 30 continuing education (CE) credits in each cycle, and at least 4 of them must be live credits, from events such as a conference, a workshop, a webinar, an in-service or a state assembly meeting.

• Renew by credits. Earn every credit within your current cycle, before your expiration date. Credits from before or after the cycle do not count, and extra credits do not carry over to the next one. You can renew up to 6 months before you expire.
• Renew by exam. You can choose instead to show your competencecompetenceKOM-puh-tunsHaving the knowledge, skill and judgment to do something well; in law, a person's ability to make their own decisions.Full entry Close by passing the CST exam again.
• Renew late. From 1 to 90 days after your certification expires, you can still renew by credits, with a late fee, but only if you earned every credit while you were certified. Credits cannot be earned after you expire; if you are short, you renew by taking the exam.

From January 5, 2027, you enter your CE credits, upload their records and renew in your own NBSTSA account at nbstsa.org. AST's national and state assembly offerings still count. Until that date, you send your credits to AST for approval first.

The 2026 fees: $40 to renew by credits, plus a $100 late fee in the 90-day late window ($140 in all), or $540 to renew by exam.

Continuing education, more formally called professional development, is the education you keep taking after you become a professional. You earn credits by going to lectures and in-service presentations, or by studying and passing a test, and usually only peer-reviewed professional writing counts. AST offers CE through its journal, its conferences and other programs.

CE also matters for its own sake. AST's code of ethics asks you to keep up a high level of efficiency through continuing education, and AST's guidelines call for CE to keep you current on topics such as emergency procedures in the OR. They also have CSTs renew their CPR and basic life support (BLS) certification as their employer requires.

8The Association of Surgical Technologists

AST is the professional organization for surgical technologistssurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close. Its main purpose is to make sure surgical technologists have the knowledge and skills to give patients care of the highest quality. It is the only national organization representing surgical technologists, more than 80,000 of them.

How AST is organized

• A board of directors governs AST: 11 members in all.
• Standing committees at the national level cover bylaws and parliamentary procedure, education and professional standards, and state assembly leadership.
• State assemblies are AST's local chapters, about 50 of them. They link members to the national association and give them a place to learn, discuss issues and advocateadvocateAD-vuh-kayt (verb), AD-vuh-kit (noun)To speak up and act for a client's rights, safety and wishes; also, a person who does this.Full entry Close.
• Members include working surgical technologists and students, who can join as student members.

What AST does

• keeps the profession's standards of practice, code of ethicscode of ethicsKOHD uv ETH-iksA written set of moral principles and duties that guides the conduct of members of a profession.Full entry Close and code of conduct, and publishes evidence-based Guidelines for Best Practices
• publishes a professional journal, The Surgical Technologist, with news, legislative updates and articles for professional development
• holds an annual national conference and an annual educators' conference, along with workshops and forums
• offers continuing education and keeps a membership registry
• offers its members professional liability insurance, a kind of insurance that pays for harm caused by a professional's acts or omissions; chapter 15 explains liability
• speaks for patient care standards to state and federal lawmakers and the public, including laws that require graduation from an accredited program and the CSTCSTsee-es-tee (said as letters)Certified Surgical Technologist, a credential for surgical technologists; in maternity care, contraction stress test.Full entry Close as a condition of employment
• works with the ARC/STSA on education standards, and with the NBSTSA on the CST and CSFA credentials
• gives scholarships through its Foundation for Surgical Technology
• celebrates the profession every year in National Surgical Technologist Week, which began with a board resolution in 1984

Students are encouraged to join AST and take an active part. Conferences and seminars show you new ideas and technology and introduce you to others in the profession, and AST members pay a lower CST exam fee.

9Other organizations that shape your work

The Core Curriculum lists the related professional organizations a surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close should know. They work in two different ways.

Some are government agencies that write and enforce rules. OSHAOccupational Safety and Health AdministrationOH-shuh (said as a word)The US federal agency, part of the Department of Labor, that sets and enforces rules to keep workplaces safe.Full entry Close protects workers, the FDA regulates drugs and medical devices, and the EPAEPAee-pee-ay (said as letters)Environmental Protection Agency: the US agency that registers disinfectants; also eicosapentaenoic acid, an omega-3 fat.Full entry Close regulates disinfectantsdisinfectantdis-in-FEK-tuntA chemical used on objects and surfaces to kill most germs.Full entry Close. Others publish voluntary standards and guidelines, which are not laws, though facilities build their policies on them and other agencies rely on them.

The Core Curriculum and one textbook give ESAR-VHP's name as the Emergency Services Advanced Registry for Volunteer Health Professionals.

Volunteering in a disaster

Disasters are one place to give community service: you can volunteer with the Medical Reserve Corps, register in your state's ESAR-VHP system, serve on a Disaster Medical Assistance Team (DMAT), or help through a private agency such as the American Red Cross, which registers disaster volunteers through the state emergency management agency. Chapter 17 covers disaster response.

10Supporting your profession

The Core Curriculum expects a professional surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close to support the profession as well as practice it.

• Join and take part: membership in AST, and work on its committees or in your state assembly.
• Keep your certificationcertificationser-tih-fih-KAY-shunA credential from a professional organization showing that a person has met the standards for a specialty.Full entry Close and keep learning: earn national certification, keep it current, and take part in continuing education.
• Develop yourself: personal development is anything you do to build your talents, become more employable and improve your life. Professional development is a commitment to keep learning and to take charge of your own growth.
• Educate others about the profession. AST's position is that surgical technologists are subject matter experts in asepsisasepsisay-SEP-sisThe state of being free of germs that cause disease, and the practices used to keep things that way.a- withoutsep- decay or infection-sis conditionFull entry Close and sterile techniquesurgical asepsisSUR-jih-kul ay-SEP-sisPractices that keep an area or object completely free of microorganisms; also called sterile technique.a- withoutsepsis decay, infectionFull entry Close, who can advise staff in other departments that do invasive procedures, such as the cardiac catheterizationcardiac catheterizationKAR-dee-ak kath-uh-ter-ih-ZAY-shunA procedure in which a thin tube is threaded through a blood vessel into the heart to take pictures, measure pressures or open blocked arteries.Full entry Close lab, imaging, the emergency department and endoscopyendoscopyen-DOS-kuh-peeA procedure that uses a thin, flexible tube with a light and camera to look inside the body.endo- within-scopy looking with an instrumentFull entry Close.
• Serve others and your community: as a volunteer, a mentor and a role model.
• Behave ethicallyethicalETH-ih-kulHaving to do with what is morally right, or acting in line with accepted moral principles.Full entry Close, at all times.

Precepting, mentoring and helping other rooms

The CSTCSTsee-es-tee (said as letters)Certified Surgical Technologist, a credential for surgical technologists; in maternity care, contraction stress test.Full entry Close exam outline expects you to serve as a preceptor to staff and students, to help other operating rooms as needed, and to mentor new or traveling staff.

Preceptor. A preceptor is an experienced professional who coaches and supervisessuperviseSOO-per-vyzeTo guide, watch over and check the work of another staff member who is doing a task.Full entry Close a student or a new employee in the clinical setting. The preceptor teaches by doing, gives feedbackfeedbackFEED-bakInformation about a result that is sent back to change what happens next, in the body or between people.Full entry Close on the spot and evaluates the learner's work.

You may be asked to precept students or new graduates in both the sterile and the nonsterile role. It takes patience and a willingness to share what you know; some people love it, and others would rather stay in their usual role. AORN recommends that new staff be oriented through a preceptor system, with an experienced RN or surgical technologist always at hand. An orientee is not counted in staffing until they are judged competent to work on their own.

A good preceptor:

• agrees on a plan with the learner first, such as who opens the case and when the learner takes over
• never does the same task at the same moment as the learner; if the learner is passing instruments, you point quietly to the right one instead of reaching for it
• coaches quietly when the learner struggles, asks before taking over, and introduces the learner to the team before the case
• encourages instead of criticizing, never makes the learner feel foolish, and backs the learner up if the surgeon grows impatient, bringing them back in once a critical moment has passed

Mentor. A mentor gives long-term guidance on a colleague's career and growth, as a role model, adviser and advocateadvocateAD-vuh-kayt (verb), AD-vuh-kit (noun)To speak up and act for a client's rights, safety and wishes; also, a person who does this.Full entry Close. Mentors share their skills and practical tips, help a newer colleague build critical thinking, set career goals and cope with stress, and they grow from the work too.

New graduates need mentors, and so do travelers. Travelers are surgical technologists who work for an agency on short-term contracts, in one hospital after another.

Helping other rooms. You may also be asked to help another room when it needs a hand. Through the day, even a first scrub takes on many nonsterile duties, and the whole department works as one team.

11Careers and workplaces

Where surgical technologists work

Most graduates work in hospitals and ambulatoryambulateAM-byuh-laytTo walk, or to help a client walk.Full entry Close surgery centers (ASCs), which is the work entry-level programs prepare you for. Surgery is also done in community healthcommunity healthkuh-MYOO-nih-tee helthThe health of the people who live in a certain area or share something in common, and the work done to improve it.Full entry Close centers and freestanding clinics. An ASC does surgery that needs no hospital stay afterward, and the standard of carestandard of careSTAN-derd uv kairThe level of care that a reasonably careful nurse with the same training would give in the same situation.Full entry Close, the safety guidelines and the procedures there are the same as in a hospital.

In NBSTSA's 2022 survey, about 68% of CSTs worked mainly in a hospital or other health care institution, about 12% in an ambulatory care center, about 8% in an academic institution and about 4% for a traveling staffing agency.

In a hospital or an ASC, surgical technologistssurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close have traditionally been part of the nursing department. A private or traveling surgical technologist may be employed by a surgeon, a group of physicians or an agency instead, and some facilities then require permission to work there through their medical credentials committee.

Many surgical technologists build expertise in one or more specialties, such as orthopedicsorthopedicor-thuh-PEE-dikHaving to do with the bones, joints, muscles, ligaments and tendons, and the branch of medicine that treats them.orth/o straightped/o child (the field began with straightening children's bones)-ic relating toFull entry Close, neurosurgery, cardiac, obstetric, plastic, eye or ear, nose and throat surgery, and experienced specialists are in high demand. In the 2022 survey, more than half of CSTs said they worked in each of these specialties: general surgery, orthopedics, obstetrics and gynecologygynecologygy-nuh-KOL-uh-jeeThe branch of medicine that cares for the female reproductive organs and breasts.gynec/o woman-logy study ofFull entry Close, ear, nose and throat surgery, plastic surgery and podiatry.

Career paths

With experience, and for some jobs more education or certificationcertificationser-tih-fih-KAY-shunA credential from a professional organization showing that a person has met the standards for a specialty.Full entry Close, a surgical technologist can move into many other roles.

Other paths include endoscopyendoscopyen-DOS-kuh-peeA procedure that uses a thin, flexible tube with a light and camera to look inside the body.endo- within-scopy looking with an instrumentFull entry Close technician, veterinary assistant, traveling surgical technologist, military service, technical writing and illustration, and private consulting.

The clinical ladder

Some employers offer a clinical ladder, a program that lets you move up to positions with more responsibility. AST has published one with three levels:

• Level I, entry-level practitioner: a graduate of an accredited program in their first year on the job, who scrubs basic procedures on their own and becomes certified within a year of graduating.
• Level II, proficient practitioner: a CSTCSTsee-es-tee (said as letters)Certified Surgical Technologist, a credential for surgical technologists; in maternity care, contraction stress test.Full entry Close with a year or more on the job, who scrubs most procedures with advanced skill, handles emergencies and helps with circulating.
• Level III, expert practitioner: a CST who thinks beyond the department: precepting students, mentoring, serving on a committee, and helping choose equipment and plan the budget.

For an employer, a clinical ladder is a long-term way to keep staff and good morale. For you, it is a reason to keep improving your knowledge and skills.

12Getting hired

From student to employee

Think of yourself as a professional from your first day of school. Learn everything you can, even in the subjects that interest you least. Work on your time management, watch how good team players work, and talk with people who already have the job you want.

Picture the career you want and make a detailed plan to get there; if you cannot map the way, you are unlikely to arrive. Your program will ask you to write that plan as an employment plan.

Your first job starts with orientation: AORN recommends a structured orientation with measurable competencycompetencyKOM-puh-tun-seeA specific skill or ability that a person has been shown to perform to an expected standard.Full entry Close checks, which may last up to 6 months for a new graduate and at least 3 months for an experienced surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close new to the facility.

The first months are often hard. A theory from nursing called reality shockshockshokA life-threatening state in which blood flow is too low to bring enough oxygen to the body's tissues.Full entry Close describes a new nurse's first year: excitement at first, then a low point on first working without a preceptor, when the job feels harder than expected, then recovery, as the role becomes clear, and by about the end of the year, a sense of how your work fits the profession, with its demands easily met. Knowing the pattern, and leaning on a preceptor and a mentor, helps you through it.

Read your job description. AST writes role descriptions for the profession, but your employer writes your job description, and you should know it well. It names the job title, the requirements (such as graduation from an accredited program and national certificationcertificationser-tih-fih-KAY-shunA credential from a professional organization showing that a person has met the standards for a specialty.Full entry Close), the nature of the position, your duties, whom you answer to and your immediate supervisor. Every new employee must be given one, because most confusion over who does what comes from poor communication and a job description that was never defined.

Employability skills

Employers hire for knowledge and skill, but professional or soft skills can tip the choice toward another candidate. The Core Curriculum groups the skills that get you hired, and keep you employed, into four sets.

Another way to list the employability skills: a work ethic built on honesty, communication, dedication, adaptability, the ability to resolve conflict, a professional appearance, accountabilityaccountabilityuh-kown-tuh-BIL-ih-teeBeing answerable for your own decisions, actions and the results of the care you give or hand to others.Full entry Close for your own actions, and a commitment to continuing education.

Your resume

A resume is a summary of your experience, education, skills and accomplishments. It is the first thing an employer sees of your abilities and your professionalism, so start building it while you are a student.

A resume usually includes:

• your contact information
• a career objective or professional goal
• your education and your certifications
• your work experience
• your skills, awards and accomplishments
• your professional memberships, such as AST, and your community service
• at least two references, people who can vouch for your skills and abilities

Make it count:

• Tell the truth, always.
• Fit it to the job: research the duties, then show the experience and skills that set you apart.
• Organize it logically, and keep it clear and short.
• Check it for spelling and typing errors before you send it.

Letters

A job search uses five kinds of letters:

• Cover letter: goes with your resume and introduces it.
• Thank-you letter: after the interview, thanks the interviewer for the chance to meet and talk about the job.
• Acceptance letter: thanks the employer and accepts the job and the terms offered.
• Letter of refusal: thanks the employer for the interview and declines the job.
• Professional reference letter: a letter of recommendation from a professional who knows you and your work, skills and abilities.

The application

Employers take applications on paper or online. Fill the application out completely, honestly and neatly, before the interview. Practice on sample applications so you know what to write and how to word it, and find out from the facility's human resources department what qualifications it requires, so you are ready when you apply.

The interview

Prepare:

• Learn about the organization, including its mission and vision and anything in the news about it.
• Review the qualifications for the job, and know your own resume well.
• Expect two kinds of questions: open-ended ones that you answer in your own way ("Give an example of a time when..."), and closed-ended ones that need a short answer. Many interviews use both.
• Plan answers to the common questions: tell me about yourself, why you chose this career, your strengths and weaknesses, your goals, and a time you were a good team player.
• A good answer answers the question and backs it up with an example. Think through what you want to say instead of memorizing a speech.
• Practice with mock interviews, ideally with someone who works in the profession.

On the day:

• Dress professionally, whether the interview is in person or by video, and arrive early, about ten minutes before the time.
• Bring copies of your resume, silence your phone, and do not chew gum.
• Make eye contact, speak with confidence, and answer honestly and fully, with examples.
• For a video or phone interview, find a quiet place with no distractions.
• Ask your own questions. They show your interest and help you decide whether the job fits you: how long orientation lasts and how long you will have a mentor, the weekend and holiday rotation, how long the shifts are, tuition reimbursement, and how the facility handles error reporting.
• Close by thanking the interviewer and asking when you can expect to hear back. Afterward, send a thank-you letter.

Leaving a job well

The most important rule when you resign is to leave on good terms with your employer. Give notice, spoken or written. Most jobs are "at will," but giving two weeks' notice is still the courteous thing to do. Some employers hold an exit interview, in which someone from human resources asks you questions, has you fill out a questionnaire, or both.

Never walk out in the middle of a case. Suddenly refusing to scrub a case, or leaving partway through one, can be treated as abandoning the patient, a subject of chapter 15.

13Leading and managing

Leadership and management overlap, but they are not the same. Leadership sets a direction and influences and motivates people to reach it. Management takes care of the tasks: planning and organizing, setting priorities, budgeting and staffing, coordinating and reporting. Management brings order and consistency; leadership brings change.

Not everyone becomes a manager, but anyone can lead, from any role, by helping others reach their goals.

What makes a good leader

The Core Curriculum names seven characteristics.

• Time management: setting timelines, meeting deadlines and keeping several projects moving at once.
• Emotional intelligence: the ability to control and express your emotions. It takes in self-awareness, self-management, social awareness and managing relationships, and people who have it handle their relationships with empathy. For a leader that means an open mind, a grip on your own emotions, positive relationships, and calm in stressful situations.
• Accountabilityaccountabilityuh-kown-tuh-BIL-ih-teeBeing answerable for your own decisions, actions and the results of the care you give or hand to others.Full entry Close: taking responsibility for your actions and their results, keeping your commitments, following through and staying focused on results. Once you accept a task, you do not give it up; if you cannot finish it, you report back to the person who gave it to you.
• Financial knowledge: managing a budget and knowing the resources the department has. A budget estimates income and costs over a set period, usually a year. Every CSTCSTsee-es-tee (said as letters)Certified Surgical Technologist, a credential for surgical technologists; in maternity care, contraction stress test.Full entry Close is expected to follow cost containment processes, and every member of the team needs both cost awareness and a quality conscience.
• Effective communication, which chapter 16 teaches.
• Decision making: solving problems, with the five steps of critical thinking, and delegatingdelegateDEL-uh-gaytTo hand a specific nursing task to another trained person while the nurse stays responsible for the client.Full entry Close. When you delegate, you hand a task to a competent person, but you stay accountable for it. The five rights of delegationrights of delegationRYTS uv del-uh-GAY-shunFive checks a nurse uses before handing a task to someone else: right task, circumstance, person, directions and communication, and supervision.Full entry Close check the right task, the right circumstances, the right person, the right directions and communication, and the right supervisionsuperviseSOO-per-vyzeTo guide, watch over and check the work of another staff member who is doing a task.Full entry Close. Which tasks may be delegated to a surgical technologistsurgical technologistSUR-jih-kul tek-NOL-uh-jistA member of the operating room team who prepares the sterile field and instruments and hands them to the surgeon.Full entry Close, and by whom, is a legal question for chapter 15.
• Creativity: bringing good ideas and inspiring the team, by creating a shared vision, encouraging creative thinking and empowering people to grow.

What a leader does

• Sets goals that fit the facility's values. Good goals are measurable; one way to write them is SMART: specific, measurable, attainable, realistic and timed. The leader explains the goals to staff and ties each one to the tasks that will meet it, then watches whether they work or need to change.
• Recruits and hires. The leader finds candidates through the technology at hand, such as online applications, and through referrals, then judges them against the job description and the qualifications it requires. A job may go to someone from outside or to a current employee who is promoted. Good staffing means the right number of people with the right skills: recruiting, hiring, scheduling, developing and keeping them.
• Coaches staff. Coaching starts with orientation, a clear statement of each person's duties, progress that can be measured, and training. A coach helps someone improve specific skills by asking questions that make them reflect and solve problems; a supervisor oversees the day-to-day work and enforces policy.
• Helps people grow. The leader gives constructive feedbackfeedbackFEED-bakInformation about a result that is sent back to change what happens next, in the body or between people.Full entry Close, which is about the behavior or the performance and never an attack on the person: given in private, specific, prompt, and with suggestions for improving. Growth also takes continual assessment, attention to employee satisfaction, and a positive work environment. When corrective action is needed, chapter 16 covers it with conflict resolution.
• Keeps good staff. Turnover is costly, and empty positions add to the workload of the people who stay. Satisfied staff stay, so leaders offer professional development, fair staffing and support for balancing work and life; a clinical ladder is one long-term way to keep staff.
• Ends a job when it must. A manager may have to let go an employee who does not meet performance standards, after the performance concerns are assessed and documented, and following the facility's policy.
• Builds the budget: from the facility's resources and the funding allocated, the department's performance goals and the facility's objectives, with room to adapt to future needs. Managers use resources well and make the case for more staff or resources when they are needed.

A path to leadership

Big goals are reached through smaller ones. To become a department leader, for example, you may first need more education and other leadership jobs along the way. The Core Curriculum's path to leadership:

1. Get involved. Serve on committees inside your facility and outside it, and join professional organizations. Serving on a committee or holding office builds the management and decision-making skills a leader needs.
2. Meet or exceed expectations, putting extra effort into your own duties.
3. Meet the job posting's criteria. Find out what the job you want requires, then gain the knowledge or credentials it asks for, through certificationcertificationser-tih-fih-KAY-shunA credential from a professional organization showing that a person has met the standards for a specialty.Full entry Close, conferences, professional groups and leadership training on the job. A new job or a promotion can be decided by a small margin: experience teaching in-services, for example, can give you the edge for an educator's job.
4. Build a network and find a mentor. Professional groups put you in touch with peers and mentors who share ideas and experience, inside your specialty and beyond it.
5. Plan for success. Name your goal, list what it requires, take stock of your strengths and what you need to improve, and write an action plan with a timeline. Then stick with it.

Check yourself5 quick questions

Free for everyone. Pick an answer for each, then check them all at once.

In the ORWhere you'll use this