Originally Posted by 2rntish I just don't understand why you'd take on the extra headaches and liability--with NO extra compensation. And, believe me, there is HUGE potential liability for you.
I am an operating room nurse and a legal nurse consultant. I, too, have very strong feelings on the issue of nurse administered propofol, and they are, in part, THAT PROPOFOL SHOULD NOT BE GIVEN, BY A NURSE, TO A NON-INTUBATED PATIENT!!!!!!!! EVER!!!!
There are nurses perfectly cabable of administering Propofol, yes. They are called CRNAs.
I LIVE in Oregon. I will be WAITING for the day when I see the Medford facility called on the carpet for unsafe patient care practices, and I will be VOLUNTEERING my services as a behind the scenes consultant--or as an OR nurse expert--OR assisting with expert location--to any attorney who wants to put a stop to this dangerous practice and shut your facility down.
In fact, maybe I can be the one to make a few calls and speed up the process.
I am really tired of "gonzo" nurses who don't know what they don't know, and think it makes them look important to do an anesthesia provider's job. If you are not capable of delivering one level higher than deep sedation--that is, general anesthesia; skilled intubation and all--then you should not be delivering deep sedation. I don't even think you should be delivering MODERATE sedation. That's an anesthesia provider's job.
I get tired, also, of hearing about your capability to "rescue." Yeah, yeah, we're all (operating room nurses)ACLS certified; nothing special about that. But you guys in endo labs seem to think that as long as you can deliver--or THINK you can deliver; based on what you learned in classes-- ACLS, it almost makes it OK to take unnecessary risks.
Why GET a patient to a point where he needs to be "RESCUED?" The fact that he ends up there in the FIRST place shows that YOU HAD NO BUSINESS DOING WHAT YOU DID THAT GOT HIM THERE!!!!!!!
Ususally "rescue" means that you have to call on someone--i.e., an ER doc, who has to drop what he is doing and come to YOUR "rescue" by intubating the patient for you and dealing with all the unnecessary problems that have been created--i.e., a period of anoxia or hypotension or both.
You've had no adverse effects to date? Famous last words....many a nurse who gave Propofol in a plastic surgery clinic has used that phrase--and maybe she DIDN'T have any "adverse effects," by sheer luck or the grace of God--until the day she DID, and her facelift patient died...
Do you think the GONZO nurses are the ones ordering these meds? What I am sick and tired of are nurse consultants who think they know everything about MEDICINE when you are JUST A NURSE. Why not let the CRNAs take care of Propofol issues in court. Why are qualified as an expert when you just stated NO NURSE SHOULD HAVE ANYTHING TO DO WITH IT?
Try tackling the Drs who order these things be given. And don't start with"the nurse always has the right to tefuse to carry out an order" crap. I understand that.
Our Endo lab has NO GONZO NURSES and NO NURSE CONSULTANTS that think they hung the moon. I monitor all Conscious sedation cases and have seen fewer rescue case in that dept that radiology that only uses Versed, OP surgery that will use Versed...
Get off your high horse, look at the numbers. Is the drug really safe but you have a few idiots out there that don't know how to use it???
Inapsine also caused quite a stir years ago. Adjunct to general anesthesia...whoa...maybe CRNAs should give that.
I DO NOT like your threat to make a few calls to speed the process along. If you want to respond privately to my e-mail I will be happy to give you our info. Welcome the challenge. Our chief of staff had the board of nursing change their stance on CS several years ago to include LPNs. Bring it on.
GONZO.[/quote]
Ummmm....I am an operating room nurse... with over 25 years of experience. I do travel assignments in operating rooms all over the West Coast, in major teaching hospitals and trauma centers, and I scrub and circulate all specialties. I have a fair grasp of the way things are done elsewhere. You?
What you are doing is NOT conscious sedation--it is moderate or DEEP sedation--something only an anesthesia provider should be doing. I would only testify to NURSING SOC--that is, to what a reasonable and prudent NURSE is allowed to do--and that DOES NOT include moderate or deep sedation.
And, oh, trust me--ANY CRNA or anesthesiologist would be more than willing to testify that what you are doing does NOT constitute safe patient care--that only an anesthesia provider should be administering Propofol.
And, I know more than one gastroenterologist expert who does NOT feel that Propofol is even the appropriate sedation of choice for colonoscopy. Most people go with Fentanyl and Versed, and truly CONSCIOUS sedation. They want their patient to be alert enough to let them know if--and where--and the nature of--any pain or discomfort, so that they can intervene accordingly. In other words, they want the patient to be an active participant in the procedure.
This is what I feel perfectly comfortable testifying to in court--the fact that you are overstepping your bounds. You are stepping outside the parameters of what is permitted of a Registered Nurse. If you are from the Southern Oregon facility, read the Oregon Nurse Practice Act!!! if you are from somewhere else, read your OWN state's Nurse Practice Act!
Does the joint statement put out by the American Association of Nurse Anesthetists and the American Society of Anesthesiologists denouncing your practice mean NOTHING to you? What about the one put out by AAAAFS? How do YOU think a jury would react to both those statements, blown up about 500X?
Argue about semantics and terminology to call it whatever you want, but the bottom line is, no RN should be administering propofol to a non-intubated patient. EVER.
In fact, I won't even give conscious sedation---not even "just Fentanyl and Versed." They don't pay me enough to do an anesthesia provider's job, and, truthfully, I think every patient deserves an anesthesia provider gving his anesthesia. I KNOW my limits--I am only an operating room nurse. I KNOW WHAT I DON'T KNOW.
You have LPNs giving conscious sedation? LPNs are not even allowed to carry out patient assessment!! How can they give conscious sedation, if they cannot continually assess the patient?
You still have not told me why you choose to do an anesthesia provider's job for a nurse's salary. Is it the "prestige" you enjoy, that makes it all worthwhile?
Oh, and Inapsine? Most reasonable and prudent practitioners across the country have all but abandoned its use. Zofran and even Decadron are being utilized to combat post-op nausea--and in some places Compazine is making a comeback. There are those diehards who insist on using IV Phenergan, but more and more reasonable and prudent nurses are reluctant to give that particular drug IV, due to the effect of its pH on peripheral veins, and just saying "No" to giving it via peripheral IV. I absolutely will not give Phenergan through anything but a PICC, EJ, or IJ--regardless of who says it's "OK" or who orders it.
There are many of us out there that don't do things simply because a doctor or a nurse supervisor tells us to. We think for ourselves, and we function, always, in our primary role--that of patient advocate.
You don't know what you don't know
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