PACU Standards - 2 RNS

[Rinehajb]

I see this has been brought up a few times, and we are in a similar situation. I work a weekend shift and there are times when there is only one nurse staffed. We have 2 people on call, but are expected to use the OR RN as the second nurse. If I know enough ahead of time, I always call my call person in to be my second. But, there are times when something happens and for whatever reason I can't get my second PACU nurse there in time. The OR nurse stays for a bit and then leaves. In my opinion, I should never be alone with a patient because we all know things can change quickly. No one supports the 2 nurses at all times thing. I've looked at the ASPAN standards, you can use the OR as second, but they can't provide care because they aren't a PACU nurse/not ACLS trained. My question is, how did you convince management that two nurses should be followed? I can show them the standards, but it seems to be a bit of a gray area. What did you use to present a strong case for always having two pacu rns?? Thanks!

[Double-Helix, BSN, RN]

Where does the standard state 2 RNs? I thought the standard was that 2 staff members, 1 of whom must be an RN, be present in the immediate environment where the patient in receiving care. In this case, your facility still is not compliant because you can't manage an emergency while calling for help or running for supplies. The OR nurse wouldn't count either. But it might be easier for your facility to get on board with staffing a unit clerk or a tech overnight rather than another nurse.

[HeySis, BSN, RN]

ASPAN "retired" the position statement that said "It is, therefore, the position of ASPAN that two registered nurses, one competent in Phase I postanesthesia nursing, will be in the same unit where the patient is receiving Phase I level of care at all times " (ASPAN, Approval Statement 2, 1998 updated 2009, retired 2012) http://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/Retired/Min_Staffing_2012.pdf

The newest recommendation that was approved in 2016 states "Physical capacity of the unit to meet 1:1 admission criteria, preventOR delays and allow for additional resources to assist with adverse events (e g , delirium, agitation, respiratory events, cardiac events, hemodynamic instability, excessive pain, desaturation, hypoxia, hyperthermia)" (ASPAN Position Statement 14, 2016) http://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/Current/PS_14_Acuity_2017.pdf?ver=2017-01-13-101227-450

I'm not sure why ASPAN changed their position, in the statement it states that the old statement was interpreted differently all the time and the recommendations weren't followed due to budgets and difficulty predicting staffing needs. It also says that ASPAN receives a call at least weekly asking about these recommendations. So along with the above statement it gave 12 other consideration regarding staffing. You can find them in the above link. But the practice standard has remained the same.

Practice Statement 1 ( newest in 2015) states "Two Registered Nurses, one of whom is an RN competent in phase I postanesthesia nursing, are in the same room/unit where the patient is receiving phase I level of care.c These staffing recommendations should be maintained during on call” situations.”

1. 
   

http://www.aspan.org/Portals/6/docs/ClinicalPractice/PR1_2017_2018.pdf?ver=2017-02-09-145204-670

We too use the OR nurse as backup when on call. All most all will ask if they need to stay, sometimes they ask after they have already changed into street clothes, which send the obvious message they don't want to. They all do wait to come in and check and ask after they have finished in the OR. This means their paperwork is complete, and everything has been cleaned and the OR ready for the next patient. If we have multiple call cases back to back, I don't ever see the OR nurse and I'm hoping that I get my first patient recovered and to the floor before the next one rolls in. There have been times I worried about that and texted our team and asked if someone was available to come and help (my manager has never told us to stop doing that, and normally someone comes right in to help, but since they are not on call you are at the mercy of if and when they check their phones).

If I am super concerned about a patient I will ask the anesthesiologist to stay for a bit, if it's a teen/young adult male... I get the orderly or security to come and get my through the emergence delirium.

So I definitely hear those concerns and feel the same.

[Whitesranch, BSN, RN]

Hey sis is right. 2 RNs one of which must be proficient in Phase I recovery. It's a standard of care and if your policy states that you follow aspan guidelines then that's your ammo!!

[azhiker96, BSN, RN]

I did some PRN at a facility that expects the noc RN to cover by herself unless it was a particularly unstable pt. They told me that during the interview and said I might cover nights occasionally. I saw a copy of the ASPAN standards book in the room and mentioned that I was certified, was familiar with the standards, and would always practice at or above the minimum standard.

When I covered nights I did call in a backup RN and never heard boo from management. If they had tried to press their point my plan was to do a Midas about being told to work outside of published national standards. A Midas would have been reviewed by risk management and I'm pretty sure they wouldn't want to see something like that documented. It never came to that.

Granted, they could have let me go but they didn't. Also, I was a bit bolder because it was not my primary employment. My main job believes in and works within ASPAN standards. I made sure of that when I interviewed years ago.

Bottom line, if I worked without a backup and there was an incident ( emesis with aspiration, desaturation, code, etc ), the hospital and I could be seen as negligent. It would be a personal injury lawyer's dream. I will not risk my license, my assets, and my livelihood so a hospital can save a few dollars.