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This is a discussion on Not following ASPAN guidelines in PACU Nursing, part of Nursing Specialties ... Just reading about standards due to problems i've been having after back injury (see my other post)...by deehaverrn Jan 13, '07Just reading about standards due to problems i've been having after back injury (see my other post) which my hospital is exceeding my limitations. Anyway with reading the guidelines it seems that ASPAN calls for 2 RNs in a PACU for recovery in Phase I of care. To me this means that after a cesarian with general or epidural or spinal...we should have 2 nurses in the room..we only ever have one...anyone else have similar situations? I think its the whole double standard thing once again, with women who have just had major surgery being downplayed because its just childbirth afterall. We need to stand up for our patients too.
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- Jan 20, '07 by KrustyTheNurseASPAN postion statement is a guideline - guidelines are suggested modes of practice. This guideline states "requires two licensed nurses, one of whom is a Registered Nurse competent in postanesthesia nursing, be present in the Phase I PACU whenever a patient is recovering from anesthesia." The other licensed nurse can be an LPN. Anesthesia means general, spinal por epidural anesthesia. Please visit the ASPAN website for more info www.aspan.org.
Is there a staffing committee at the hospital you are referring to that could be of assistance? Are there state mandated nurse/patient ratios that need to be addressed? Do you know the name of the nurse manager of this department where you could discuss this with? Are you familiar with nursing administration at this hospital where you could voice your concerns?
- Jan 21, '07 by deehaverrnThanks for replying. There are no mandated ratios where I live, otherwise my job would be sooo much better, we run postpartum with 2 nurses to 18 pts, antepartum with a 1:5 or more, which are all against any recommended ratios by AWHONN which establishes those guidelines. We don't have any staffing committee, our nurse manager pretty much decides, although she will of course claim that we are well staffed and that it isn't her fault if people "call out", but just for example, I have been on limited duty working only part of the day for over a year now, and she had never covered the remainder of my shift. I think that she must like that people have become resentful of me for this, since people from the next shift have told me that they would be willing to cover it, if she scheduled them that way. Also, this way I am forced to try to complete a whole shifts work in less time. The real problem with her not following this guideline is that I have actual physical disabilities (such as not being able to lift more than 20 lbs) which I think should preclude me from being alone in PACU with a fresh postop. For pete's sake, if they've had General- I can't even raise the head of their stretcher, and if spinal or epidural, I can neither turn them nor lift their legs to check for vaginal bleeding. It seems completely unsafe to me, but no one seems to want to support me. Recently a coworker hurt herself and can't lift and she has a cast shoe on one foot--but she frequently is assigned to PACU also. The nurse manager says there's no reason we can't "sit there and take vitals". That's why I have been trying to get documentation to take to her bosses. I have been reluctant to just go right over everyones head to public health or JCAHO, despite supposed protection for whistle blowers.
- Jan 21, '07 by KrustyTheNurseThat's a very sad story. I think, from a patient safety perspective, you are going to have to make some decisions as to whether you should be working in this environment due to your limited physical abilities, and if you should even continue working in this organization. Patient safety should be the most important piece and if there are clear violations of accepted guidelines from AWHONN and ASPAN that are clearly being breached you need to think twice about devoting anymore time, energy or emotion into this job. I'm sure there is a policy from HR that indicates what type of work you would be allowed to do taking into consideration the limitations you list. Have you been cleared by Employee Health to return to 100% function? It doesn't sound like you meet the physical requirements of the RN job description. If your injuries were related to work then it falls into the Workman's Comp arena and it's the obligation of the hospital to give you work that you could due with your specific limitations. Your manager, her administrative supervisor and the hospital are leaving your case wide open for any liability related to limitations you have where you are being required to function as if you were free of any injury.
This is purely a patient safety issue and that is where I'd start with your documentation. You might have to decide this situation is too dangerous for patients and yourself and that you need to get out of there. Policies are also a wonderful thing if you can correlate how your situation is in violation of any organizational employee health and work injury policies.
As a nurse manager I'm constantly making sure I apply established policies fairly to all employees and patient situations. I don't know what type of hospital you work in or what her budgeted P/I (productivity index) has been established. It's sometimes feels like you're being squeezed in this role - from my supervisor at the top and from staff and patient issues from the bottom. Staff sometimes don't have that bigger picture that the manager has. I usually tell my staff that I'm the Reality Officer for the department. I have to define reality daily to them and perhaps this is how your manager is defining reality for you in your department.
Take care and good luck!
- Apr 27, '07 by Ortho_RNActually they are "Standards" not guidelines...
- Apr 27, '07 by yankeecamperAlso, you should consider that if (God forbid) there was ever a negative outcome for a patient that went to a lawsuit, you would be judged against the standard of care for your particular practice.
- Apr 27, '07 by sharannQuote from yankeecamperExactly correct. The first thing the prosecuting lawyer will look for is standards of practice for a specialty. In my state(CA) I believe the PACU is considered a critical care unit and we are required by law to have 2 licenced nurses at all times when a patient is present. It is also not safe for the patient or nurse to be alone in a unit(any unit) with a patient. If you look at the hospital policy(the ones they claim to follow when the accredidation committee is there) you will find this is your policy.Also, you should consider that if (God forbid) there was ever a negative outcome for a patient that went to a lawsuit, you would be judged against the standard of care for your particular practice.
- Apr 27, '07 by deehaverrnI don't know quite how they get away with having only one nurse in the PACU area, which on our unit is just a room (it is a solarium that was retrofitted to be a recovery room). I think they claim that there is always an Rn at the Nurse's station which is across the hallway..which is untrue.
Unfortunately, I can't quit my job as I need the money. I am on worker's compensation but in our state that doesn't carry much weight. They constantly force me to exceed my limitatations but even though I have protested it doesn't improve. I have even testified in court that this is so during a compensation hearing..which I won the judgement in btw. We also have an obstetrical triage area which I am usually assigned to now. I have discussed with my boss that this is beyond my limitations. In one room we have an exam table. I can't raise the hob, or assist the pt into the stirrups. Pts arrive from the ECU via wheelchair, not having been seen by a doc yet. I can't even push the w/c or assist them from it. I have narrowly avoided several disasters with true emergent situations such as a pt who was hypotensive from placental abruption and fetal heart tones were decelerating--people ignored the emergency call light that I had pulled since the assumption is that whoever is in triage will answer it..I was screaming for help and luckily someone heard finally,(triage is an area at the rear of our unit with a desk surrounded by four rooms so its isolated), also a pt who I begged the charge nurse to move to a room who had an eclamptic seizure 10 minutes later. My nurse manager as well as ALL the dayshift charge nurses maintain that "all you have to do is call for help when you need it" to justify assigning me there. Its ridiculous but I'm pretty much stuck...I can't see getting a job elsewhere with my present limitations.
- Aug 5, '07 by TXguyRNWe had a similar issue at my hospital, management had been putting unlicensed staff as our 2nd person, we got together & told management that if there was an untoward outcome, that as professionals we would be obligated to testify that we'd brought our concerns to managament and were ignored.
We were immediately staffed with 2 RN's (our hospital doesn't employ LVN's)
There was a bit of drama, but ASPAN's standards were written by a group of nurses with hundreds of years of cumulative experience...
- Sep 22, '07 by steven44121http://www.aspan.org/PosStmts3.htm
As pointed out they are standards not guidelines and if you read the position paper it is clear. "two registered nurses one competant in post anesthetic nursing will be in the room where the patient is receiving Phase 1 level of care"
Nowhere does it say -- another nurse is within shouting range, or just down the hall.
I live in Ontario , the hospital I work at follows the ASPAN and OPANA (Ontario Post Anesthetic..) standards.
I worked at a smaller community hospital for a short while where on nights they expected you to do solo nursing . "Just call into the O.R. if you need help".
I felt that was unsafe and tried to advocate for change from both a nurse and patient safety perspective. However, I no longer work there and choose to work at a facility that is willing to follow standards set forth.