all PACU RNs Wrote up!

I'm not sure where you are or what your liscening board would say, but our facility has a policy that states that discharge can be done form Phase I pacu by the alderete scoring, and our anesthesia dept is on board with it. we switched anesthesia groups about 1 year ago and there have been some discussions on all of our policies, and Aspan's standards state that discharges need to be based on several data collections and assessments ( I think they list about 12 criteria) and the discharge criteria should be in consultation with anesthesia and medical staff. It sounds like you need to open up the communication with your new doc, bring in some literature, evidence based practice and work together. i do think a warning like that sounds a bit over the top

Just wait until the new policy causes some OR backup because anesthesia hasn't written the d/c orders yet and PACU is full - I'm sure they'll make that your fault, too somehow.

Can't you ask for standing orders?

We have preprinted order sheets with fill in the blanks for meds. Part of the standard preprinting says: "Discharge when PACU criteria met." All the doc or CRNA has to do is sign it & when they forget, we just write it as a verbal order.

This gives a lot of leeway to the nurses to use their judgement, but still technically be forllowing orders.

OP, Do you mean that in order to discharge a pt from PACU, to either a postop hospital bed,phase 2 recovery or to home,you are required now to have an MD personally write an order for discharge? I wonder what the reason is for what seems,on the surface,to be a power issue? Perhaps he has had some negative pt outcomes somewhere else, or is not cognizant of modern,accepted national standards of post anesthetic nursing care.

Here we must follow strict guidelines which have been developed,criteria which the pt must meet before we can discharge from PACU to anywhere. That being said, we are also treated as the professionals we are, and are credited for using common sense and sound judgement in assessing patients for suitability for discharge,and trusted to follow the procedures which have been established to maximize pt safety. Of course,there are always those cases that we consult with the anesthetist for if the case isn't clear cut - but those are the exception and not the rule.

I was very surprised that you all were approached by HR for practise-based criticism - this seems authoritarian and ill-informed ("working outside your scope of practise"?)....what has your Unit Manager's role been in all of this?! Usually she/he is the direct supervisor of nursing staff,is this not the case where you work?

You would have thought that the MD,as a professional,would have directly approached his fellow professionals - the bedside RNs and the unit manager - and arranged a meeting to explain his thoughts and concerns,and to be open at least to discussion. Sounds to me his thinking is antiquated and/or territorial...or,horrors, both!

I can appreciate that, there being such a small number of you,it might be easier for the MD and HR to intimidate you. Prior to requesting a meeting,it might be a good idea to have in hand the widely accepted ANSPAN Standards of Practise for discharge,as well as,if you can find them,statistics (or opinion articles) supporting the fact that these standards are well thought out and time tested.

Good luck with this and please let us know what develops!

jen

Where is your manager in all of this? How was this allowed to happen? How about having a meeting and making a new policy to start requiring DC orders, instead of sending you straight to HR and punishing you for something you were never told to do in the first place? Shame on whoever "reported" you, and shame on HR for allowing that to happen. That's totally unprofessional and I'd be weary of working for an organization that handles these issues so poorly. That's essentially harassment.

in our institution we have to inform the anesthesiologist that the patient is for discharge.. he/she would look into the discharge orders of the surgeon and assess if the patient is ready for discharge.. he/she then orders the discharge