New grad working in Endo outpatient center has some questions

[knursing54]

Hi, I just recently start working at an outpatient endoscopy center as my first nursing job. I will eventually be the only RN working at a time and feel somewhat nervous especially if an emergency were to occur. I plan to become ACLS certified as soon as possible, but the MD I work for did not seemed to be too concerned about it and said as long as I get it within the next month or so it is fine. Most of patients we do see are stable, but you never know what could happen which scares me especially because the MD no longer gets ACLS certified and when I ask about the anesthesiologist being certified people just says well yeah he is "supposed to be." So basically is this normal, or something I should definitely be worried about?

Also, as the RN I will be responsible for getting the informed consent for the procedure and anesthesia signed. I know this is outside my scope of practice if it is not just witnessing the signature, but how do I make sure that this is all it is other than asking the patient is they understand the procedure and if the MD has already explained everything to them? Everything is computerized and I cannot write anywhere that I am just a witness to them signing.

For the most part I feel comfortable with the job, but I guess since I did not get any formal training from the previous RN I just want to be clear what is typical of a RN outpatient endo nurse doing admits and post procedure duties.

I appreciate any advice and tips!

[RNsRWe, ASN, RN]

Hi, I just recently start working at an outpatient endoscopy center as my first nursing job. I will eventually be the only RN working at a time and feel somewhat nervous especially if an emergency were to occur. I plan to become ACLS certified as soon as possible, but the MD I work for did not seemed to be too concerned about it and said as long as I get it within the next month or so it is fine. Most of patients we do see are stable, but you never know what could happen which scares me especially because the MD no longer gets ACLS certified and when I ask about the anesthesiologist being certified people just says well yeah he is "supposed to be." So basically is this normal, or something I should definitely be worried about?

This is not normal. What accreditation agency does this facility have? I don't know of a one that would allow the practicing GI MD to not be ACLS, along with the anesthesiologist. I would never allow a "they're supposed to be" to stand as is (I'm the nurse manager of an endoscopy ASC). Who is responsible for maintaining the credentials for the staff? I cannot have an RN who is not ACLS certified; any time there is a patient in the facility there must always be TWO ACLS certified people on hand: RN and MD or two RNs (with an MD within grabbable distance).

Also, as the RN I will be responsible for getting the informed consent for the procedure and anesthesia signed. I know this is outside my scope of practice if it is not just witnessing the signature, but how do I make sure that this is all it is other than asking the patient is they understand the procedure and if the MD has already explained everything to them? Everything is computerized and I cannot write anywhere that I am just a witness to them signing.

While I don't know how your consent form is worded, in general they say "the doctor has explained everything to me, I know the risks, I know the possibilities for the procedure, blah blah blah". They sign it and a witness TO THE SIGNATURE is made in the form of your signature. You are not witnessing their discussion with anyone. You are witnessing the fact that they signed that document....and that IS normal and usual. If the patient hesitates, is not sure of something, questions something or you in general feel that they don't know what they are getting into, by all means have a chat with the MD and have him/her go to the patient and go over it again. At that point, patient will sign and you will sign as witness.

I appreciate any advice and tips!

You're welcome :)

[RNsRWe, ASN, RN]

So......what happened?

[knursing54]

Thank you for replying RNsRWe! I found out the anesthesiologist is in fact ACLS certified and they need me to be as well. I also found out I am in fact just being the witness to the patient's signature for the consents. So far everything has been going well and I really like the job, but it is just PRN and something for experience until I find a F/T job!

[RNsRWe, ASN, RN]

Sounds good. They need to have a minimum of two ACLS persons on hand, like I said....less than that is asking for trouble. Our accreditation requirements are pretty clear on that, actually, as should the agency that your facility uses....every RN as well as every MD MUST be ACLS.

Anyway, good luck to you :)

[knursing54]

Thanks!:)

[TrissRN726]

I currently work in a gastroenterology office and I work very closely with the MD who performs the procedures, does the consults with the pts, etc. I myself get consent for the procedure, I explain the preparation to them as well, even though the physician has done so already it is good that the patient hears the same info more than once so they understand it.