What's it like to be an ambulatory care nurse? - page 2

What are some of the things you like best or that you hate the most about ambulatory care nursing? What's the biggest stressors, and what are the doctors like to work with, compared to acute care... Read More

  1. by   Goofball
    He got a million-dollar workup in a hurry - cath lab, TEE, intubated/ventilator, spiral CT, propofol, dopamine drips; luckily no permanent cardiac damage - it was a coronary art. vasospasm
    (due to lack of blood pressure! his coronary vessels were found to be clean and clear). I used to think maybe ambulatory or outpt. nurses had it
    easy, but I can see they probably have even more responsibility, at least much more risk and less support in the way of extra staff to help out.
  2. by   Becka
    Where I work, surgery is done with one Doc and one nurse only. Pt has a hep lock and is on monitor (BP, O2, pulse, resp) Doc gives the med orders but she is usually given 150mcg Fentanyl, flush with NS, 2 mg Versed, final saline flush. Sometimes he will order an additional 1 mg of Versed. Procedures usually take from 10 minutes to 25 minutes. We have been told to get baseline VS pre-op, then again post-op, again when we have them sitting up (for W/C transfer to RR) at which point the monitor is turned off. VS are taken once again about 15 min later in RR then again at 30 minutes if they are still there. O2 is available in each OR, a crash cart of meds is available in the RR. None of the nurses are required to have ACLS cert, and if an entubation were needed, the Doc would have to do it. Our Doc just started offering it about a year ago. The only "qualification" he had was that an RN do the procedures with him. At this point, I (an LPN) am also doing them as one of our RN's left and hasn't been replaced. On my own, I had taken a 30 CEU offering on Conscious Sedation for $50. When the RN left, our Doc asked to review the course materials and my cert of course completion, then said I could assist with CS procedures.


    Originally posted by BRobison
    HI group.
    I've just read through the posts on amb care nursing, and I'm glad to see the subject of concsious sedation come up.
    I'd appreciate an of you discussing what, primarily, makes up "conscious" sedation in your facility.
    What kinds of classes did you take to "qualify" for doing this?
    Did your facility qualify you, or your state board of nursing?
    Do the physicians actually tell you how much and what and when to give, or do you independently make those decisions?
    Or do you just have standing orders....?
    Do you use propofol?
  3. by   Goofball
    It was just a 4-hour lecture by one of the heart cath lab RNs, along with a short post-test and a 6-page typed handout of info. There is no annual check; and people who haven't been to the 'class' (lecture) still participate anyway. BRN had nothing to do with it, just our hospital. The MD always tells you how much to give for each increment. The nurse must question the patient/check LOC every few min., do q 5-minute BP's, HR, Resp., watch the 02 sats, and record all this plus the doses and times meds given; Every 5 min., the pt. is given a 'score' based on the key
    printed on the form. Resp Therapist must be alerted before procedure starts, but doesn't have to be physically in the room. No standing orders.
    Almost always use Propofol. Sometimes use Fentanyl and Versed.
  4. by   BRobison
    Originally posted by Goofball
    [Almost always use Propofol. Sometimes use Fentanyl and Versed. [/B]
    How much propofol?
    Are you using drips, or giving it push? ANy other sedation with the "milk of amnesia?"
  5. by   Goofball
    Never drips, always IVpush. Bag of NS with tubing already set up in case of need for rapid fluid bolus. No set dosage, MD tells you how much
    (example, "Give 10mg prop." or "give another 20mg
    prop." or "Give 50 mcg Fent" and continues to give various orders based on effects/level of sedation/BP's, resp., sats.
  6. by   MrsK1223
    HI Guys...I posted this on the General Nursing Discussion but thought I would come here and see if any of you have any advice on an interview with the AC coordinator tomorrow. They have a day shift opening and she worked me in for an interview. I'm really nervous now as I didnt expect this to happen so fast. I psych/infirmary exp and dermatology with outpatient surgery exp but thats it.....new nurse. And its gastro ambulatory. Any advice?
  7. by   MrsK1223
    I think I did well at my interview....wish me luck!
  8. by   hogan4736
    in az, an RN CANNOT give propofol or versed (legally)...

  9. by   MrsK1223
    Ambulatory care for the most part is a great thing. I am having a horrible experience with a specific facility. It has a great potential to be a great place to work but it doesn't. We have no support from management and not enough nurses to run the unit. The nurses we do have suck...plain and simple. No one works as a team, it's each for their own. Another new nurse and I work really well and end up taking a big part of the load on ourselves since our other "supposed team members" won't do anything to help and they are the senior nurses. Our techs have the worst attitudes I've ever seen. I went to ambulatory care because it was a Mon-Fri 6:45 to 3:30PM job. It allowed me to do nursing and be a mom that was there for her family. Not so. I end up working 10 and 12 hours, backbreaking non-stop running and standing all day, catering to a dozen docs that treat us like crap, our patients don't get the personal attention they need cause we are spread so thin. Management just shrugs their shoulders when we beg for help. People have been quitting left and right and there are NO plans to replace them. So, needless to say, I'm looking elsewhere too.

    I'm sure this is mostly an isolated incident.
  10. by   crazedredhead
    My experience in Ohio is this: We refer to it as moderate sedation, as most patients aren't conscious. We took courses and annual refreshers, but nothing from the state board.

    Drugs of choice include demerol and versed. Unless you are a nurse practitioner/anethestist, versed is a no-no.

    Generally docs will dictate how much they want given.

    When doing moderate sedation, the nurse should not be expected to do anything but monitor the patient and administer the drug.

    In GE lab, the usual starting doses were 50mg of demerol and 2-3mg of versed.

    Hint: While the patient was conscious, I put the nasal cannula on, because we nearly always used it!
  11. by   MrsK1223
    Where I work, the nurses give the sedation, but only afer the doc tells us what drug and how much. After a while, we know what drugs each doc prefers and have them ready, but its often based on the procedure and condition of the patient. Most often used drugs are versed and ketamine, demerol and phenegran are used as preops, some like versed and fentanyl. My facility didn't give us any training on conscious sedation which I thought was absurd but according to the hospitals policies and state laws per management, they don't have to provide such training. As far as monitoring the patient and doing nothing else, not so until just the last week. There would be one circ nurse for 3 rooms...imagine bouncing from room to room and trying to keep both eyes on all three patients. Not safe. Now we stay we only one patient. Never the less, I'm out of there in 2 weeks.
  12. by   Brownms46
    Originally posted by crazedredhead
    AMEN! If it weren't for ambulatory surgery, I would be asking people if they would like fries with that...I.
  13. by   Brownms46
    Originally posted by maia1212
    HI Guys...I posted this on the General Nursing Discussion but thought I would come here and see if any of you have any advice on an interview with the AC coordinator tomorrow. They have a day shift opening and she worked me in for an interview. I'm really nervous now as I didnt expect this to happen so fast. I psych/infirmary exp and dermatology with outpatient surgery exp but thats it.....new nurse. And its gastro ambulatory. Any advice?
    I work per diem in a GI amb center, and we do conscious sedation. And most of our pts are conscious, and talk to us thoughtout the whole procedure. I have worked in two GI centers, and the first used Versed and Fentanyl depending on pt. The new place uses Versed and Demerol, or at least the older docs do, and the younger ones use Fentanyl and Versed.

    I find that when pts are given Demerol, they're more times likely to be nauseated, then the ones who get Fentanyl. They're also more sleepy.

    Both units are very fast paced, the first one more than the last. But I find it a bit boring after awhile, as you keep saying the same things over and over again. Guess that is why I stayed per diem. I dislike routines! My best advice is learn to be quick and good with the IVs, and to explain to pts. throughlly about the procedure. People come in sometimes scared witless! But we have received almost constant positive feedback from pts. on our ability to provide reassurance and comfort to those we serve.

    Several pts stated, we're a "class act", and we're sooo efficient". Really makes you smile! Good luck in your new position
    Last edit by Brownms46 on Sep 11, '03