conscious sedation

1. 1 I was currently hire at an Endoscopy clinic to recover pt from conscious sedation. My first day there I was given a fifteen minute orientation by the office manager, who is also an RN, then thrown into a situation I was not prepare for. The nurse hired the previous week quit. I am the third nurse in two weeks. After fifteen minute of orientation I was told that I would have to do all the conscious sedation. There's an LPN in the recovery room, however she is training to do the medical assistant job, but can recover the patients. She is not ACLS or even BLS certified. I've never had a conscious sedation class. I feel unprepared for this job. Everyday I'm learning that the position I was originally hired for come with many extra task. I'm asked to signed off on all the pre-op, in-op and post-op paperwork. The only time I see the patient is when I'm placing the IV and giving them sedation. I feel that I'm placing my license on the line by signing for pre-op and post-op teaching that I haven't conducted. Also, sign that I've asset the pt during post-op. Today two new young ladies quit. I feel that because I haven't been given a proper orientation, the position was not fully explained to me and the request asked of me I should quit before my license become jeopardize. Please advised. Only been out of nursing school a year.

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2. 12 Comments

   Topic Closed
3. 
   #1 2

   Jan 24, '08 by MichaelFloridaRN

   I would follow those who came before you. Run, don't walk away from this. Never sign off on anything that you have no control over and are not even informed of. While I do not live in constant fear of loosing my license, this sounds like one place that has "license revoked" written all over it.
4. 
   #2 1

   Jan 24, '08 by kmoonshine

   You are responsible for the nursing care that you provide as well as for med administration. These meds can kill people. You must have training on the meds you're giving, reversal agents, etc. The patient must have a dedicated RN with them throughout the whole procedure, as well as afterwards - monitoring heart rhythm, BP, HR, Pulse Ox, etc. Very scary. You need to leave NOW. I would report this to the state board. I don't know if this applies everywhere, but the docs I work with have to be certified to give consious sedation - don't you think RN's should have to also?
   
   Everyone that lays the hand on the patient needs to be ACLS certified and know how to manage a patient's airway, code cart in room, etc. Please seek advise from the state board. And NEVER give propofol!!!!
5. 
   #3 1

   Jan 24, '08 by wtbcrna, MSN, DNP, CRNA Guide

   Here is the American Assoc of Nurse Anesthetists website information on conscious sedation. When and if something happens to one of your patients that you are taking care of these are the guidelines the lawyers will be looking at. http://www.aana.com/resources.aspx?u...enuID=6&id=706
   
   A. Qualifications
   1. The registered nurse is allowed by state law and institutional policy to administer sedation and analgesia.
   
   2. The health care facility shall have in place an educational/credentialing mechanism which includes a process for evaluating and documenting the individual’s competency relating to the management of patients receiving sedation and analgesia. Evaluation and documentation occur on a periodic basis.
   
   3. The registered nurse managing and monitoring the care of patients receiving sedation and analgesia is able to:
   
   Demonstrate the acquired knowledge of anatomy, physiology, pharmacology, cardiac arrhythmia recognition and complications related to sedation and analgesia sedation and medications.
   Assess the total patient care requirements before and during the administration of sedation and analgesia, including the recovery phase.
   Understand the principles of oxygen delivery, transport and uptake, respiratory physiology, as well as understand and use oxygen delivery devices.
   Recognize potential complications of sedation and analgesia sedation for each type of agent being administered.
   Posses the competency to assess, diagnose, and intervene in the event of complications and institute appropriate interventions in compliance with orders or institutional protocols.
   Demonstrate competency, through ACLS or PCLS, in airway management and resuscitation appropriate to the age of the patient.
   The registered nurse administering sedation and analgesia understands the legal ramifications of providing this care and maintains appropriate liability insurance.
   
   
   I would show the AANA website link to the nurse manager, especially #2 . There are also similar JC/JACHO guidelines on conscious sedation.
   
   It is just not worth the risk, if something goes wrong you are the one going to be liable. As far as a nurse in recovery that isn't even BLS certified......You have got to be kidding!
   
   This place is just waiting for a lawsuit/pt to die!
6. 
   #4 1

   Jan 24, '08 by chris_at_lucas_RN

   Quote from MichaelFloridaRN

   I would follow those who came before you. Run, don't walk away from this. Never sign off on anything that you have no control over and are not even informed of. While I do not live in constant fear of loosing my license, this sounds like one place that has "license revoked" written all over it.

   I don't think this advice could be improved upon.
   
   Can't imagine why those other nurses quit!
   
   One of the hardest things to do as a new nurse is turn away from a bad situation. We think maybe it is us, we don't know enough.
   
   You did the right thing, OP, by posting here. More seasoned nurses have good insights. You will do yourself a good deed by following their advice.
   
   You might want to report your concerns to the Board of Nursing for your state as well, as that facility is dangerous for patients.
7. 
   #5 1

   Jan 24, '08 by jmgrn65

   I agree with all other posters run, and don't look back. Also report them to board of nursing and if they are accreditated by anyone I would inform them as well.
8. 
   #6 1

   Jan 24, '08 by bill4745

   Quit. Now.
9. 
   #7 2

   Jan 24, '08 by RN1989

   Quit. Do not wait to give notice. You are well within your introductory period and there is no need to put this job down when looking for a new one.
   
   You need to report this before someone dies. Contact:
   
   state nursing board - tell them that your story, that the nurse in charge is requiring you to do all the tasks listed and any other, include the names of the other staff who have left as well as why if you know and how long they were there if possible
   
   state medical board - any doctor that is allowing untrained staff to give moderate sedation is dangerous
   
   state licensing board (usually under dept of health, go on your state's official "state" website to find it
   
   If they are accredited by JCAHO, file a complaint with them.
   
   Contact CMS (Centers for Medicaid/medicare) - they don't like authorizing and paying for unsafe procedures
   
   local newspaper/tv news investigative reporter - they will be able to investigate and shut that place down faster than the board will and may save a life
   
   Hang tough. I know it is such a scary thing when you are first confronted with such blatant lack of regard for the rules. Usually employers are a little more insidious in having you do things but obviously this place has huge problems. You cannot continue to work there. Every day that you show up to work you are placing yourself in the line of fire not only for a lawsuit but to lose your nursing license. If you need help with letter writing, pm me and I will be happy to give you pointers.
10. 
    #8 1

    Jan 24, '08 by CrunchRN

    This is the one time i would say quit without giving notice - you are at great risk of losing everything!
11. 
    #9 2

    Jan 24, '08 by ddoosier

    

    Quote from CrunchRN

    This is the one time i would say quit without giving notice - you are at great risk of losing everything!

    I agree. Wow. You are assuming a huge responsibiltiy with minimal experience. It sounds very unsafe.
12. 
    #10 1

    Jan 24, '08 by nursedede

    Thank you all for the good advice. I've decided to take the advice. When I go in tomorrow morning I will notified them that I quit. I will not assist with any procedures. Since I only worked there one week I will not use them as a reference. I will contact the state board of nursing for further assistant.

    Last edit by nursedede on Jan 24, '08 : Reason: wrong spelled word
13. 
    #11 1

    Jan 25, '08 by CrunchRN

    I think you have made a very wise decision. Let us know how it goes.
    
    I once had to quit a radiation oncology job I loved because the position needed skills I just didn't have, and although they loved me, and wanted me to stay, they couldn't offer me the proper formal education needed to safely provide the services so I left.
14. 
    #12 0

    Apr 20, '11 by vagirn

    I am a GI endoscopy RN encountering the same situation in IL I work in the VA. I am told by nurse manager and charge nurse to delegate post conscious sedations recovery to and LPN to monitor the recovery, document and discharge the patient with me co signing the recovery process and discharge documentation what does the Illinois law say about this practice. I feel it is dangerous and compromising to my patient recovery and safety.

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