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"The robot should be able to do everything a nurse can," Dr. Treat said.

Penelope and Michael Treat photoJanuary 18, 2005-- Today The New York Times ran Marc Santora's piece "For Surgery, an Automated Helping Hand," which describes the work of surgeon Dr. Michael Treat and his team, who are developing a robot called Penelope that Treat said will some day replace scrub nurses in operating rooms. This robot may well prove to be a helpful surgical tool, and we salute Dr. Treat and his team for their promising work. Unfortunately, the Times piece reflects Treat's own apparent undervaluation of what scrub nurses actually do, giving readers a misimpression of these critical OR professionals and a dangerously flawed vision of OR care. The article appears to reflect no input from the nurses whose work it ostensibly concerns. Since the article ran, both Marc Santora and Michael Treat have, commendably, told the Center that they regret the effect this article will likely have on public understanding of nursing, and they have vowed to publicly repair the damage done.

Dr. Treat reportedly created Penelope in response to "the ever-widening shortage of nurses in the country," and what the piece calls "a problem that has frustrated him as a working surgeon." (It's not totally clear if Treat's frustration is with the shortage, or something else.) Relying primarily on grants from the National Science Foundation, Treat's team of engineers and programmers is developing Penelope in a Bronx lab, and looking forward to a test that New York-Presbyterian Hospital has agreed to allow as part of an operation on a benign cyst. Of course, Treat is hoping that some day the robot will be working on more difficult operations in every hospital. The robot is named for the formidable Ithacan queen who waited 20 years for her husband to return from Troy in Homer's Odyssey. The piece compares Treat--who seems geeky, yet rides a motorcyle--to Leonardo da Vinci, Thomas Jefferson, and Bill Gates. This uncritical approach was also reflected in a prior Times piece on replacing nurses with technology, in which Penelope played a prominent role.

In the current piece, Treat is quoted as saying: "The robot should be able to do everything a nurse can." The piece also states, no doubt relying on Treat, that "the scrub nurse does not move from the doctor's shoulder. She is there to do one thing: get the doctor's tools." The piece notes that Treat says the robot, with its computer, "can do some things even better" than a scrub nurse, as it can "keep track of tools as they come and go." Treat notes that "[l]eaving instruments in patients still happens." As the piece explains, operating rooms now typically include a circulating nurse, who "can move about the room." It notes that "[i]f Penelope replaced the scrub nurse, the circulating nurse would have to be trained to set her up and use her." How is the work going? Currently, Penelope has voice recognition software, and she can recognize 12 surgical tools. The reporter observes the robot, on voice command, place a tool on a table, then remove it.

Bravo! Nursing problem solved. Well...not quite. In fact, scrub nurses do manage the access of surgeons and other OR professionals to the tools needed for successful surgery. It's certainly possible that a robot like Penelope could assist a nurse or surgeon with some of the more mechanical tasks that occur in operating rooms, including counting tools. This kind of technology could provide real benefits by preventing items from being left behind in patients, thereby saving lives and money.

But scrub nurses in fact perform a variety of other critical functions. First, though the piece doesn't quite make this clear, scrub nurses do monitor whether surgeons have left any materials in patients. The piece discusses this problem as if the nurses were causing it, or as if it simply "happens" without any error by the surgeon. But this is just a small way in which scrub nurses monitor surgical practice, in order to protect patients. Scrub nurses monitor sterile technique, ensure that the sterile field is preserved, make sure all needed materials are available, ensure that the surgeon is doing the right procedure in the right place in the right way, ensure that patients get the proper medications and solutions at the surgical site, intervene when the surgeon is not up to the task for any reason (common ones include incompetence and intoxication), provide emergency nursing care if the patient crashes (e.g. cardiac arrest), assess the patient generally, intervene or recommend intervention for problems identified, and advocate for the patient generally. The circulating nurse, who--as the name implies--circulates in the room and oversees the nursing process, is not in a position to do much of this, as only the scrub nurse remains right at the patient's side. (Yes, the scrub nurse remains beside the patient, not at "the doctor's shoulder," since the nurse's work is primarily to help the patient, not the surgeon, which may not always be the same thing.)

Critical thinking is what underlies many of these nursing tasks, and it is not clear to us that Penelope is equipped to do that. Nor does it appear that Treat's highly skilled team is making any effort to enable the robot to talk. But OR nurses' skilled monitoring and patient advocacy saves countless patients' lives. More information about the important work of OR nurses is available from the Association of periOperative Registered Nurses.

Clearly, this article's vision of what a scrub nurse does ignores critical elements that involve protecting patients from the surgeon, monitoring the surgeon's performance and speaking up when it falls short. Some surgeons may wish that scrub nurses did no more than handle and count tools. And no doubt the health care decision-makers who have cut nursing positions in order to save money (replacing many with minimally skilled, unlicensed caregivers) would be enthusiastic about Treat's work. (Of course, research has shown that nurse short-staffing increases patient mortality and drives nurses from the workforce.)

Homer's Penelope was, as Treat notes, "faithful, resourceful and clever," especially in fending off the aggressive suitors who appeared in Odysseus' long absence. But the vision of the robot presented in this article seems to reflect the Homeric character's classic "female" qualities: relative passivity, obedience, and assistance to the active, adventurous, husband. And she's also--as Treat is quoted as saying--"one hot little number." Male OR nurses are unlikely to be impressed with the gender stereotyping that appears to surround Penelope's development. And even Homer might not be amused: Penelope was not a mute, obedient fembot created by men to do their bidding. And neither are nurses.

We have established a constructive dialogue with both Michael Treat and Marc Santora, who deserve a great deal of credit for being receptive to our input. Please follow our news alerts for more information on this issue.

See Marc Santora's article "For Surgery, an Automated Helping Hand" in the January 18, 2005 edition of the New York Times.

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