Alone in the PACU

[Statdotcom]

Hi Everyone.

Do any other PACU nurses work alone on call?  I work at a very small hospital and when the OR staff leaves after a surgery, in the evening or middle of the night, the on call PACU nurse is by herself.  The PACU is isolated and no one could hear you if you shouted. I've never heard of this at any other hospital I've worked at.  When I was a circulator at a larger hospital I was required to stay with the PACU nurse (if she was alone) until she could transfer the patient.  This smaller hospital says the recovery nurse could call the house supervisor if necessary.  That wouldn't make me feel better if my patient was in trouble. I wondered if this is common in other places?

[JadedCPN, BSN, RN]

I don’t work PACU and never have worked in a very small hospital. However as float I often have to open up or small overflow “unit” which is tucked away in a hidden corner of the hospitals and consists just of one RN, me. BUT, we always have to have two trained BLS staff on the unit at all times which means me and a PCA.

I would definitely not like the idea of being the only one in PACU.

[Rose_Queen, BSN, MSN, RN]

This is what is in the 2017-2018 standards (my current year book is.. at work):

Quote

Phase I Level of Careb

The perianesthesia registered nursing roles during this phase focus on providing postanesthesia nursing care to the patient in the immediate postanesthesia period and transitioning them to Phase II level of care, the inpatient setting, or to an intensive care setting for continued care .

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.

Wow. That copied weird. But standards say 2 RNs, one of them Phase I recovery competent. Either the OR nurse needs to stay or another nurse needs to be in PACU. I would address this with management.

[Statdotcom]

"I would address this with management."

It has been addressed. They always give us some version of It's Always Been Done Like This.  Very frustrating.  

[Rose_Queen, BSN, MSN, RN]

6 minutes ago, Statdotcom said:

"I would address this with management."

It has been addressed. They always give us some version of It's Always Been Done Like This.  Very frustrating.  

Pull out the standards to back you up. If they still won’t make a change, then they’ve shown their “dedication” to safety and it may be time to move on. 

[Statdotcom]

I appreciate your advice. Thank you!

[gizmopacurn]

You always have to have 2 RN's in a pacu unit, 1 can be a PACU RN and the other an RN. Our hospital would never leave a nurse by herself recovering a fresh post op patient, so many safety reasons. 

 

[kp2016]

Sadly it's very common. ASPAN has a very clear policy statements that it is dangerous and not acceptable but I've noticed a lot of smaller hospitals do it anyway. I normally put my concerns in writing with a copy of the published ASPAN standards. 

[TriciaJ, RN]

On 4/17/2021 at 3:51 PM, Statdotcom said:

"I would address this with management."

It has been addressed. They always give us some version of It's Always Been Done Like This.  Very frustrating.  

Of course.  It's always "Always been done like this" until they have to settle a lawsuit.  Then they magically see the light.

[CABGpatch_RN, BSN]

How on earth do you waste meds or give high alert meds or meds that require a second eye and documentation (like insulin)?  Is there at least a code button you can readily push if needed?  Are you supposed to give only bystander CPR until the code team can arrive?  Or are you expected to do both chest compressions and bag?  I mean it can be done, but c'mon!  It just sounds so unsafe.  I'd be high-tailing it outta there pdq.

[kp2016]

6 hours ago, CABGpatch_RN said:

How on earth do you waste meds or give high alert meds or meds that require a second eye and documentation (like insulin)?  Is there at least a code button you can readily push if needed?  Are you supposed to give only bystander CPR until the code team can arrive?  Or are you expected to do both chest compressions and bag?  I mean it can be done, but c'mon!  It just sounds so unsafe.  I'd be high-tailing it outta there pdq.

According to the managers I've asked;

- Give any /all medications yourself and then take them with you when you discharge the patient to a unit so the receiving RN can waste with you.

- Press the code bell on the wall in PACU, it only rings inside the OR because we don't need additional staff for a code...during the day when fully staff... so I never got an answer on, what the heck will happen alone in the middle of the night, other than "it's really very unlikely to happen".

- Problems, concerns, safety issues, urgently need help or medications from pharmacy, call the Hospital Charge Nurse and ask them to come help you.... What if they are busy in the ER, ICU, L&D??? This was always the point where I was told to stop being deliberately difficult, so I don't have the answer to that one.

In real life I quit this job and took a pay cut to work somewhere with much lower acuity patients and no on-call. Problem solved, for me anyway. At the point where your job feels more like an abusive relationship with the threat being to your license and having to live with knowing your patients are receiving care that is defined as unsafe by nationally recognized professional associations (ASPAN) it is time to find something else.

Less money and "losing your skills" are not a reasons to put up with situations this dangerous. The sooner more nurses start making this clear to hospitals the sooner they will stop demanding we do it.

[TriciaJ, RN]

4 minutes ago, kp2016 said:

According to the managers I asked;

- Press the code bell on the wall in PACU, it only rings inside the OR because we don't need additional staff for a code...during the day when fully staff... so I never got an answer on, what the heck will happen alone in the middle of the night, other than "it's really very unlikely to happen".

 

That's their answer?  "It's really very unlikely to happen"?  Do these people even carry fire insurance on their own homes?

I wonder how many patients would sign consent forms if they had any idea what they were consenting to.