I'm going to keep this as brief as possible but I was hoping I could get some advice/feedback. I am an ER nurse that has cross trained to work in the pre-op/PACU in our little rural hospital. Tomorrow I am scheduled to be the first nurse (i.e. get there early and set up for the day and get the first pt ready for surgery) however the first surgery of the day is one that I am incredibly concerned about from a safety level. I verbalized my concerns to my manager several times about how this was a procedure should not be doing in our facility and that we do not have the training/staff to handle the pt afterwards and was told that "everyone is on board with this" and that it will be fine. I completely disagree and want my name and license no where near that chart, especially since I've already verbalized to both the manager and the CNO (and the head of anesthesia) my concerns for this pt's safety.
At this point though I'm not sure how to handle tomorrow morning. Like I said, I'm expected to be the first nurse in and should be the one to get him ready for surgery. I've never refused an assignment before and I feel like that's essentially what I'm doing, but I'm not sure really how to handle that since the assignment has not technically been made. I do not want to be a part of this whole ordeal because I truly feel like we are placing this pt in harms way, but I'm not sure what I should say/do in the morning to ensure that I haven't "accepted care" of the pt.
Any tips or advice would be greatly appreciated. TIA!
Mar 28, '12
Tough one. Is the doctor performing this procedure board certified? Has he performed this procedure before? Is your facility certified/approved to perform this surgery? Like not every facility is approved to perform open heart.....so just because a MD WANTS to and the administration says it's OK.....it isn't.
If you make waves and "everyone is on board' be prepared to lose your job. You can file a complaint with The Joint Commission about quality of care. You are within your right to refuse to care for a patient you do not feel safe about but there are no laws protecting you from retaliation from your employer for not being a "team player".
In an emergent situation I could see crossing the usual and customary lines....scheduled? Not so much. You are in a catch 22 situation. This may be one time I'd become suddenly very ill and somehow an anonymous complaint would get filed from someone
Chicken, I agree....but in this current employment market the path of being righteous is a lonely and probably unemployed one.
Mar 28, '12
Are you a member of a Nurse's union? If so seek their help! Where I come from it is permisable to distanced yourself from a situation that threaten's your registration. We as Nurse's are the patient's advocate and must fight for their safety!
Mar 29, '12
Op, it's already the 29th where I live, so any further discussion is probably moot at this point. You don't say what kind of surgery is planned. As the pre-op nurse, you don't have much say as to whether the surgery is performed or not, other than fulfilling your pre-operative duty and ensuring the patient signs informed consent.
You can inform the theater UM that you will be doing this, so as to ensure that the PATIENT is on board with the "plan", and that the Dr, Hospital Manager and NSM have all done their duty and informed the patient of the potential safety hazards,!20which are ultimately their responsibility. If the hospital is indeed performing a procedure on a patient for which it is not equipped, both doctor and patient need to sign documents indemnifying the hospital if things go South.
Mar 30, '12
I just wanted to follow up and thank you for all of your responses. Unfortunately the surgery went as scheduled, and instead of being able to distance myself from the situation I was in fact the primary nurse for both before and after surgery (until I handed off to the ICU nurse) because I was the only one in the recovery area competent/capable/comfortable with the invasive monitoring that the pt came out of the OR with. The next day I told the manager that I would no longer be working in that unit because of the safety problems that I had identified and then witnessed and experienced (including being left completely alone with the pt in the PACU). No more PACU for me. Thank you all for the advice though-it was very appreciated!
Mar 31, '12
I'm glad it all ended up being OK. Talk about a great ethical dilemma paper subject.
Mar 31, '12
Being left ALONE in PACU unfortunately is very common.... We have the surgery nurse to call if we need help (yeah right).. If though I do think ASPAN standards do state 2 licensed nurses in unit at all times, again HA.... If they bring me a patient and I'm not comfortable with their status, neither that circulator nor the anesthesia provider get to leave... I ususally prefer the CRNA to stay over circulator, most of the time they aren't comfortable either... When we are on call, its just one of us.. The ciruculator always tries to leave and go home when they are done, and so does anesthesia... But sorry I'm not being left in a locked down unit alone
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