In the ongoing quest to save hospital money, our hospital administration has instituted a new practice. Has anyone else had this experience? As a bit of background:

We have one, 24 hour, in-house call CRNA every day. The PACU has two RNs on beeper call every night (11PM - 7 AM) and 24 hours on weekends. Both PACU RNs are called in to recover a patient during these hours. Hospital administration has mandated that rather than call in and pay overtime for the 2nd PACU RN, the 24 hour, in-house call CRNA will stay with their patient post-op to assist 1 PACU RN in recovering the patient. The rationale is, why pay a 2nd PACU RN overtime when the CRNA is already here and is getting paid to go upstairs and sleep at the end of the case? The majority of the CRNAs are unhappy at the prospect of working all day and into the night and then being expected to recover the patient as well, not to mention the possibility of other cases occuring during the rest of the night. Is this becoming a common expectation?

First of all, there should be no reason the hospital should be paying a 2nd RN to recover a patient in the PACU. We have one nurse who recovers the patients and that is all. If they get in trouble, then we help, but not for the entire recovery. If there were more than 3 patients or an ICU patient then the 2nd nurse gets called in. You, the CRNA, are on call for OR cases only. You are not a PACU nurse and should never be used as one. Also, are you responsible for any other duties when you are on call? ie..codes, ER intubations etc...? Then you'd be leaving your patient in PACU and having to do cases and emergencies also. This is unreasonable. Try to talk to administration about this again, b/c if you are unavailable patient safety is at risk and their risk of lawsuits goes up too.

In the ongoing quest to save hospital money, our hospital administration has instituted a new practice. Has anyone else had this experience? As a bit of background:

We have one, 24 hour, in-house call CRNA every day. The PACU has two RNs on beeper call every night (11PM - 7 AM) and 24 hours on weekends. Both PACU RNs are called in to recover a patient during these hours. Hospital administration has mandated that rather than call in and pay overtime for the 2nd PACU RN, the 24 hour, in-house call CRNA will stay with their patient post-op to assist 1 PACU RN in recovering the patient. The rationale is, why pay a 2nd PACU RN overtime when the CRNA is already here and is getting paid to go upstairs and sleep at the end of the case? The majority of the CRNAs are unhappy at the prospect of working all day and into the night and then being expected to recover the patient as well, not to mention the possibility of other cases occuring during the rest of the night. Is this becoming a common expectation?

After hours PACU nurses recover patients in one of the ICUs, second pair of hands readily available if needed. No second PACU RN. Our ICUs are pretty busy but very rarely have we had a problem with a 'full house' in all of the ICUs for 2h to recover a patient.

PG

Sounds pretty scetchy to me. The PACU I work in has two RN's on staff 24 hours a day, 7 days a week. Our hospital doesn't employ CRNA's though. So that would mean an MDA would be required to recover and I can't see that happening, ever. In the middle of the night most ICU patients go direct and bypass the PACU. But there are times that our 80 ICU beds are full and they end up in the PACU.

Legally the PACU must have two RN's even if there is just one patient. That became the standard of care in the last few years. Some places have one of the OR nurses stay in the PACU until the patient is transfered.

You are exactly correct about this jvrb! It is currently a standard of care in the PACU. The standard actually reads that there should be 2 nurses (not necessarily RNs) who are competent in STAGE 1 peri-anesthesia care at the bedside, until the patient is no longer a Stage 1 pt. There are actually three stages, the third ending with discharge from out-patient. As the patient progresses from stage 1 to stage 3, the nurse-to-patient ratios also change. There are specific time-limits & patient criteria for stage one...and all stages. I would think the hospital requiring the CRNA to stay in PACU is on the verge of violating this standard of care, if the CRNA must leave the bedside to do other things "house-wide" while the patient is still in Stage 1. I think these standards are posted on the ANA website? I know some OR nurses are cross-trained in the PACU, and this would be the only way they too would be qualified to stay with the first PACU nurse to recover the pt.

Legally the PACU must have two RN's even if there is just one patient. That became the standard of care in the last few years. Some places have one of the OR nurses stay in the PACU until the patient is transfered.

I'm curious. I am an anesthesiologist and at times I have sat with a pt in the PACU while waiting for the second on call RN to come in (I have also had the surgeon sit with the pt in the PACU while I have gone to the ER). Seriously is this a violation since I am not a PACU trained RN (nor was the surgeon). I am confident that pt care is not compromised but after reading the above I am curious if a violation has occurred.

Thanks everyone for your feedback. Most CRNA's we've contacted have never heard of this situation occuring. We've spoken with the AANA, our state association and our hospital risk management dept. Risk management and the AANA inform us that it is within our scope of practice to assist as a PACU RN, however we can't act in two roles at the same time. So if we're working in PACU and an emergency arises we have to prioritize and determine where we need to be.

The first two nights this policy went into effect, the CRNA on call was helping recover a patient in the PACU and three different emergencies requiring their assistance arose. Fortunately there were no disastrous outcomes. After reviewing this situation the Administration has decided to put the practice of CRNA as PACU RN on hold until further notice!

Two of our CRNAs have resigned. Rather than saving overtime pay for a 2nd PACU RN, the hospital is now going to pay a lot more for locum tenens CRNA.