I work in the Endoscopy unit of a hospital. Although I am ACLS certified, most of the other RNs I work with (and who also give Conscious Sedation (CS)) are not.
However, our hospital does require that we study for, and pass, a CS certification exam. This includes ALL meds used during CS, i.e. Versed, Fentanyl, Dem, etc., the titration for each, total amounts a nurse is legally allowed to give in my state, along with the reversal drugs and their titration amounts, times, etc. We are annually "checked off" on CS competency.
Due to the nature of our unit, we have a crash cart available and ready at all times, and everyone on the unit is well versed in its contents and their use.
Due to the diligent monitoring of our patients during their procedures (cardiac monitor, B/P, and O2 Sats), any deviation from their baseline VS are addressed, and immediately remedied. In the entire time I have worked in Endo we have only had to "crack a cart" once, and that was erring on the side of caution for a post bronch patient.
Have a good one!