Required nurse minimum in night shift PACU Help!!!

Nurses Safety

Published

I work in a very busy Level I Trauma Center. I have worked all the units, but took a job as night shift PACU nurse two years ago for a little break. Compared to working the units, this is generally a sweet job. The problem is, they only staff one nurse on nightshift weekends after 9 pm. When I first took the job, I was always alone, even during the week, but we are so busy now, doing scheduled surgeries through midnight, that they added a second nurse Mon-Fri. Problem is, I'm getting my butt kicked on the weekends. Thank God I have unit experience, because I am now bedding unit patients (we are constantly on divert with overflow unit patients) as well as recovering emergency surgeries. I have reported these safety issues to my manager and she has told her manager, but they say they have no FTE's to apply to nights. It's getting real dangerous, not only do I not have another RN to back me up or help, but I don't even have a secretary to put orders in or answer the phone. So far I've been holding it together, but I had a real bad incident with an overflow trauma last week that was still bleeding with an H and H of 4 and 11, and I was calling for emergency release blood and pushing LR and starting pressors, etc. and I had another patient in there recovering from a general surgery who got totally ignored. Administration didn't even care about that, and I'm lucky I didn't lose that patient. Many other instances are occuring to varying degrees of danger, they are even sending me rapid responses and codes from the floor. Other PACU's in the area that don't operate all night and call in their nurses for cases, call in TWO nurses just to recover their one surgery patient. I am managing unit patients and surgery patients alone. I've been told that is a standard to have two nurses in a PACU at all times if we have a patient. Whose standard? Who do I contact or which agency's name do I use to my manager to get her attention? Is it a standard to have two nurses in a PACU at all times? My administration says that we are not required to have two nurses in there. I don't know what to do, but it is getting worse. I appreciate any help.Thanks.

Up Vote Up Vote ×
Specializes in Fall prevention.

First of all if you are not being staff sufficiently to provide safe pt care I would consider looking for a different position. You worked to hard to get your license. If your management is not listening to you I would see if contacting Joint commission would be appropriate. If a pt is harmed I am afraid they would hang you out to dry. I just changed jobs my self because they were expecting the nurses to care for too many multi-acuity pts. Good luck hope things get better

Up Vote Up Vote ×
Specializes in ICU/Critical Care.

I would tell them that if they do not give you another nurse to work with on weekends then you will be resigning. I agree with the poster above me. Contact risk management or JCAHO or CMS. Management will change their tune quickly.

Up Vote Up Vote ×
Specializes in here and there.

According to what you have narrated, you are working in a very safe environment., and the powers that be do not care. I will personally evaluate the situation. Do i care more about unsafe job or my nursing license. My license is more important. I would start looking for another job as soon as possible.With all the experiences you have developed at this hospital, and the fact that you have been able to handle difficult situations while working independently, your new safer job will definately appreciate you there.:twocents:

there is no perfect job out there , but there are some worse than others. Protect your license. :wink2:

Up Vote Up Vote ×

I think I would like to contact Joint Commission. Is there a hotline, or does anyone know if there is a place I can actually look up Joint Commission standards for staffing a PACU? Also anyone else out there work in a PACU? What are your night shift standards? You're right, I will get blamed if something goes wrong. I love this job Mon-Fri and I dont want to quit if I can fix this weekend issue, but I don't want to lose my license :(

Up Vote Up Vote ×
According to what you have narrated, you are working in a very safe environment., and the powers that be do not care. I will personally evaluate the situation. Do i care more about unsafe job or my nursing license. My license is more important. I would start looking for another job as soon as possible.With all the experiences you have developed at this hospital, and the fact that you have been able to handle difficult situations while working independently, your new safer job will definately appreciate you there.:twocents:

there is no perfect job out there , but there are some worse than others. Protect your license. :wink2:

After I secured a position at another hospital, as I have recommended before, make an appointment with the senior partner of the law firm that defends the hospital. Take someone with you as a witness. Explain the goings on in the hospital, and that you have contacted regulatory agencies concerning this situation, and your next stop in the local paper, and the six o'clock news. And make sure that they understand that you have copies of all of the incident reports etc (don't listen when they tell you that they will not defend you if someone sues), staffing schedules, assignments, and you are keeping them as evidence if and when someone sues. That should get someones attention. JMHO and my NY $0.02.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Up Vote Up Vote ×
Specializes in ICU/Critical Care.
I think I would like to contact Joint Commission. Is there a hotline, or does anyone know if there is a place I can actually look up Joint Commission standards for staffing a PACU? Also anyone else out there work in a PACU? What are your night shift standards? You're right, I will get blamed if something goes wrong. I love this job Mon-Fri and I dont want to quit if I can fix this weekend issue, but I don't want to lose my license :(

I don't think there would be standards for staffing. I really think its up to the hospital's administration. Make sure you bring your concerns to risk management.

Up Vote Up Vote ×
Specializes in Telemetry, ICU, Resource Pool, Dialysis.

The reason hospitals continue to staff like this is because nurses continue to put up with it. Why are you still there????????????????????? Why, WHY, WHY?????

You have experience on multiple units, which makes you a prime candidate for any job you want! Get out NOW. Don't dither around complaining to anybody, or writing to any organization, give your two weeks NOW. You're absolutely nuts not to.

Up Vote Up Vote ×
Specializes in PeriAnesthesia.

You are looking for the ASPAN (American Society of PeriAnesthesia Nurses) Standards and Practice Guidelines. Please visit their website at www.aspan.org. You can find some of the information you need at the following link http://www.aspan.org/PDFfiles/Resource%203%202006-08%20Standards.pdf. Phase I PACU should have 2 RNs in the room whenever there are patients present. The standards will elaborate more directly as to staffing based on patient acuity.

From what you describe, you definitely aren't meeting the standards.

Susan

Up Vote Up Vote ×

ASPAN (Association of Perianesthesia Nurses) does have standards for PACU...do a web serach for ASPAN and you will find their recommendations. From the sound of your situation you NEED at least 2 nurses! I have worked in PACU and we always had 2 nurses come in for ANY case and it wasn't even a trauma hospital.

In addition, for your own protection I would put your concerns in writing to your manager and cc your director voicing your safety concerns and referencing ASPAN standards, maybe even provide a copy with your letter. In the letter you may want to share an example such as the one you posted here. Administration will not appreciate you documenting your concerns but it will make them pay attention to you! By documenting your concerns you now put the responsibility on ADMINISTRATION/MANAGEMENT exactly where it belongs. It must be in writing however, any verbal communication you have will definitely be forgotten if there is ever a issue. Plus if you ever run into legal and/or licensure issues, the documentation will show you knew of the safety issues and lack of care and you took steps to correct it by notifying the approriate responsible parties in your hospital.

If you do not get results, you may then consider writing a second letter to the risk management department (they will probably already be made aware of your first letter but it sure would not hurt to yank their chain a bit more!).

Also, have you spoken about your concerns with anyone in the anesthesia department? I have often found it beneficial to talk with anesthesia because they often times have power to get things done quickly.

You may also consider voicing your complaints to Joint Commission however the response time will probably be relatively slow.

Good luck and thanks for being a patient advocate!

Up Vote Up Vote ×

aspan's recommendations are just that. recommendations. and that's how hospital's get away with it. they recommend that two licensed staff be available, so many pacu's have one nurse and then use the OR staff is available if needed excuse.

what you're doing sounds really scary and dangerous.

Up Vote Up Vote ×
I would tell them that if they do not give you another nurse to work with on weekends then you will be resigning. I agree with the poster above me. Contact risk management or JCAHO or CMS. Management will change their tune quickly.

Why not also report them to the Board of Nursing and/or the ANA? I was waiting for that one next.

I don't wish to be unkind, but if a call to these organizations did any good, do you really think we'd still be having these staffing disasters throughout the United States?

These organizations are useless!!!! In fact they are WORSE than useless because most mandate more paperwork for an already swamped bedside nurse force. Others actively oppose meaningful safe staffing standards. Still others punish the individual nurse when serious errors are made, yet historically disregard the supervisors (licensed by the same board) who continually make blatently unsafe assignments.

Think I'm being too harsh? Show me some cases where JCAHO came in after an employee complaint and the facility beefed up their staffing. The ONLY time JACHO comes in (other than to collect tens of thousands of dollars every 3 years) is AFTER the inevitable disaster has struck---repeatedly,,,AND the news media has determined that there is sufficient shock value. Only then will those useless dregs reappear (Oft times ignoring the fact that their crack survey teams may have given the facility in question a clean bill of health just weeks or months before).

The ONLY answer to unsafe staffing is minimum nurse-patient ratio legislation. And the ONLY way for such laws to pass is for bedside nurses to organize.

Up Vote Up Vote ×
+ Add a Comment