Should OR RN's be ACLS/PALS certified? - page 3

Ok, remembering that I work PACU my question occurs because out hospital has determined that it is unecessary for the OR nurses to take ACLS etc, except for BLS(basic life support) since there is an... Read More

  1. by   shodobe
    Well put, stevierae. I just have trouble putting into words on the computer what I think. I"ll be the first to admit I don't know everything about all drugs but know enough about the ones I might give in the OR to keep out of trouble. Luckily, the number of drugs we give in the OR is small and usually the same over and over. I still have to ask about some drugs that show up on patient's drug sheets. Some are completely over my head and I haven't a clue what they are. Doesn't make me a bad person. The worst thing about antibiotics being given before surgery is we get the patient from the floor and guess what- the little piggyback is sent with the patient and we end up giving it in the room. So the recommended one hour or so before surgery is null and void because the floor nurse forgot ot start it. We have been using alot of Cefotan and Rocephin(?) lately without any problem. If you had to try to remember everything that needed to be watched over then why would you need anesthesia or? If you have good, competent anesthesia then that is one less worry for you. I am still responsible for looking at all aspects of the patient's care but still rely on others to do certain things also. I don't think it is wise to worry about every detail. Leads to early retirement. Rambling, sorry got to go. Mike
  2. by   squeek
    ditto to shodobe and stevierae!

    I did not mean literally ... I realise all do not have ETT, this was a bloody unlucky situation.

    in Oz we do not start Abs prior to surgery {maybe we are a LITTLE behind}.!!! in litigation too happily.

    I can manage ANY airway>>> 10 yrs of recovery ensured that... I can place an LMA if required; obviously a guedels or nasopharyngeal; I have placed ETT under anaesthesia supervision, but would not do so without .. it is not in my scope of practice in Oz. I will not lose my licence for such a reason ... bag and mask til they wake will work for me.

    cheers Squeek
  3. by   stevierae
    Quote from squeek
    in Oz we do not start Abs prior to surgery {maybe we are a LITTLE behind}.!!! in litigation too happily.
    You know, that 30 minutes before incision rule is literally almost written in stone here--no more (unless, like Vanco, you need an hour) no less. In fact, I believe it is a CDC guideline; don't quote me, but the guidelines have been revised fairly recently because hospital aquired infections, (formerly called "nosocomial") especially post-op ones, have become so rampant.

    Now, those of us who are OR nurses prefer to blame the floor nurses for poor hand washing practices--and indeed that is usually the case with MRSA and VRE--but there are others that have been looked at by infection control and the OR criticized for not getting the antibiotic in within that golden half-hour before the incision is made. rarely is it ever found to be due to an unsterile insturment or a break in technique, even after scrupulosulay examining flash autoclave graphs and pulling entire loads of autoclaved instrumetns ot make sure the sterile indicators have "turned." It usually boils down to the wrong choice of antibiotic (although in ortho, good ol' Kefzol still is standard of care, and it's cheap, and it WORKS) or an antibiotic not given in a timely fashin, when it isn't a patient with risk factors for infection (obesity , diabetes, immunocompromised.)

    In fact, I am analyzing 2 med mal cases right now that are almost certainly because, in one, NO antibiotic was given pre-op (pretty much standard of care these days to give a pre-op antibiotic) and in the other because it was given well after the incision was made. There simply is no other logical explanation--these were ortho outpatients, so we can't blame the floor nurses, LOL!
  4. by   squeek
    hey I should have been a little more specific, we do give Abs before incision but not on ward pre-op. I wonder if else where in Oz they are following your trend [as we invariably will do, it is just a matter of time]

    squeek
  5. by   squeek
    ps. not a standard of care here yet, many procedures are done without antibugs!
    squeek
  6. by   lifeisbeautiful
    Quote from shodobe
    I do agree the more you know the more your going to be responsible for.
    Isn't that the truth! My employer will 'push' extra classes and certifications onto people. Though it is wonderful to obtain the education, I often question the real motive behind it. Like you said, the more you know can often used as a way for the hospital to assign 'just one more assignment now that you know about----(fill in the blank)'
    Quote from shodobe
    This is why I let my ACLS expire. Mike
    Unfortunately, if I did that, I wouldn't be allowed to work in the PACU. ACLS/PALS is a requirement where I work for PACU nurses. Plus, if PACU Nurses weren't certified, who would help the Anesthesiologist and the Surgeon with the patients during a Code?
  7. by   shodobe
    Going way back to mt original post, I let my cert expire because we don't require it. If it was a required like alot of ORs do, I would certainly get it. Unlike the main OR, PACU is left alone with many problem patients and do not always have the luxury of anesthesia being there, so of course they are required to have ACLS/PALS. If you go through the older threads you will fine a few about CS and such and about if it iss a good idea to have all of these responsibilities in the OR, not PACU. There are many opinions on wether to have or not to have certs a requirement to work certain places. I am not by any means a drug wiz, but I know enough about them to get by and stay out of trouble. Mike
  8. by   emcrn
    Our hospital does not require ACLS/PALS for OR nurses. However, if you want to be able to administer conscious sedation then you must have ACLS. Personally I consider it a professional responsibility to keep up my certifications, even if the chances of my having to use any of my knowledge are (thank God) slim to none, because of the presence of MDAs and CRNAs in the rooms. Just because you "don't have to" do something doesn't mean you shouldn't do it anyway.

    Ellen
  9. by   nurselily3
    I think it would be a good idea. Having information to better care for your patient is never a bad thing. As an ACLS/PALS cert nurse (used to be in the ICU and now in the OR) I think it helps me keep up with what's going on. In fact, I think all acute care nurses should be ACLS certified.
  10. by   stbernardclub
    Oh my God....O.R. nurses that do not need A.C.L.S????????????????? NUTS!!! TOTALLY NUTS!!!!!!
    Quote from sharann
    Ok, remembering that I work PACU my question occurs because out hospital has determined that it is unecessary for the OR nurses to take ACLS etc, except for BLS(basic life support) since there is an anesthesiologist in the room. This is purely a cost cutting matter we believe. Whats up in your neck of the woods? We are a 290 bed acute care facility averaging 15 cases(give or take) a day.
    Thanks,
  11. by   jwk
    Quote from stbernardclub
    Oh my God....O.R. nurses that do not need A.C.L.S????????????????? NUTS!!! TOTALLY NUTS!!!!!!
    Why is it nuts? There are plenty of hospitals where it is NOT required for OR nurses.
  12. by   R.T.
    We have 26 OR rooms, and nurses are not required to be ACLS or PALS certified in the OR. The hospital pays .10 an hour for each certification, and we do about 3 IV conscious sedation cases a year. The nurses who are ACLS or PALS certified do not feel comfortable in that role because of the lack of use. We have CRNA'a and Anesthesiologists present on typically 99.9% of cases. I am now the Clinical Manager for the OR and when I was ACLS certified, always felt uncomfortable when assigned to give IV conscious sedation. I usually did 1 case a year and did not have time to sit with the CRNA or MD and watch and learn to be confortable in that role. I do not require my nurses to put their licenses on the line when we have staff (CRNA's) who are trained and use that skill everyday.
  13. by   cwazycwissyRN
    Quote from emcrn
    Our hospital does not require ACLS/PALS for OR nurses. However, if you want to be able to administer conscious sedation then you must have ACLS. Personally I consider it a professional responsibility to keep up my certifications, even if the chances of my having to use any of my knowledge are (thank God) slim to none, because of the presence of MDAs and CRNAs in the rooms. Just because you "don't have to" do something doesn't mean you shouldn't do it anyway.

    Ellen
    To the original question. Yes.

    Do I agree with the above post? Yes,

    Been a nurse for 14 years, worked ER,OR, SCU and MS...were there drugs and treatments on this years ACLS that I had changed and or that I had not heard of......................YES
    Times change, advances are made........to be aware or not to be...that is the question

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