From OR nursing to GI Lab

Editorial Team / Admin · Feb 21, 2017

Depending on the unit, you may be pre, post, and procedural or only one of those areas. Procedural is going to be a heck of a lot like the OR only sterility is not enforced because the GI and respiratory tracts aren't sterile and there are no counts. Specimens? You're probably going to see a lot more specimens in GI- polyps, biopsies, brushings, etc. I've watched some of our endo staff set up 12+ specimen containers before a case even starts. As for tension between staff, that's going to vary based on the environment fostered by staff and management, not the type of unit.

brownbook · Feb 21, 2017

If you are hired to work in the GI lab you will not have much patient care with an awake patient. Once in the lab the patient is quickly sedated, similar to OR.

I have always gotten along with GI techs. I know their on the job training makes them my equal, if not above me, in some technical aspects of working in the GI lab. I try to learn about the scopes and numerous wires, guides, clamps, clips, etc. so I can help them. I ask them for help and advice.

If you will float between admit, the lab, and discharge, then you will have the opportunity for patient care with an awake patient.

A lot of specimen labeling and sending out. There are tips and short cuts, hopefully whomever orients you will teach you well.

BklynHeightsRN · Feb 22, 2017

I never worked in the OR but it seems like the same type of set up only not sterile, and no scrubbing or counting so that sounds like it's a plus for you. TONS of specimens, depending on the patient and procedure. There are a lot of technical skills to learn with obtaining specimens and doing injections, tattooing and placing clips, but I find it super interesting and not necessarily hard, just requires some practice. Depending on the patients you get it could be straight forward stuff or a little more complicated (endoscopic ultrasound, fine needle aspirations, ERCP, etc.) In my experience, the endo techs are amazing and have very specialized skills. They will most likely be training you in the procedure room, in fact. You should respect the sh!t out of them because they're in charge. It depends on the facility, but like the others have mentioned, you might be rotating between pre procedure, procedure and recovery. I find that procedure is the most interesting of course, though the recovery room is also interesting and likely includes a lot of opportunity for patient teaching, which I love. Endoscopy is very very fast paced and most of the procedures are relatively short so maintaining the flow is a huge priority.

schmoodle · Feb 25, 2017

Thank you for the responses, everyone. I really appreciate it. I have a few more questions.

Is there an anesthesiologist in the room? Do nurses administer conscious sedation (under the doctor's supervision?) A lot of places ask for a background in ICU/Emergency with ACLS certification (the latter of which I have). Are you watching vitals during the procedure?

I truly respect my scrub techs in the OR and would respect my endo techs as well of course (just as I would respect any member of the staff). I just wondered about working relations between nurses and scrubs being a bit on the hostile side as universal thing in general or facility specific.

brownbook · Feb 25, 2017

I don't know what the nation wide standard for GI sedationi is?

When I first worked GI in an acute care hospital nurses did GI sedation. The GI lab was part of an ambulatory and in patient surgery clinic within an acute care hospital.

I moved to an independent, free standing, ambulatory clinic that added on GI a few years later, nurses were still doing GI sedation.

About 8 - 10 years ago suddenly anesthesiologist were doing all the GI sedation. The theory/rumor was anesthesia could give propofol. The patients would be "out" quicker and stay "out". When nurses did sedation with fentanty and versed it took longer for the patient to be sedated, they woke up more during the procedure, making it take longer. More patient complaints about it was uncomfortable. The bottom line was money, GI docs made money doing a lot of cases and they could do more cases quicker when anesthesia gave sedation.

Both "roles" are easy. GIving the sedation, or assisting the anesthesiologist, (along with assisting the tech and gastroenterologist). I could write a lot more about the different "roles". If you're curious let me know how it will be done where you might get a job.

LollygaggerRN · Feb 28, 2017

Re: administering sedation

I work in an outpt facility which utilizes anesthesiologists only one or two days per week. The other days of the week the RNs administer fent/versed for one set of providers, and do NAPS for the other. When doing the fent/versed the RN will also assist with bx, etc. as much as they are able. A GI tech is always available if necessary- if there are too many specimens to collect or the pt requires constant hands on attention. When administering Propofol that is all the RN does. No specimen collection. We are always right by the pts head monitoring airway at all times.

I really enjoy both types of sedation. Though my RN job is easier when the anesthesiologist is present, it is also less interesting.

Lucky724 · Mar 5, 2017

I work in an outpatient GI clinic (MD owned)..narcs are counted before the first procedure and after the last one. Fent & Versed are used, sometimes Demerol &/or Phenergan. It's conscious sedation done by an RN - no Nurse Anesthetist . Yes, biopsies or polyps are taken & sent to a lab however there is a printer that makes the lab labels based off what is documented so it's not a huge deal. In the Endo room there is the MD, RN & Tech. In pre/post op there is an RN & Tech who take vital signs & start the IV. There isn't a lot of documentation & it's all electronic.

The job itself is not difficult but it's very repetitive & honestly boring most of the time as it's EGD's & colonoscopies only & most of those are for GERD or routine cancer screen so if you like doing/seeing something different you may want to reconsider or at least choose a hospital based GI lab so there would be variety. Where I am there is no chance for picking up extra time if wanted & where I am there are no benefits other than expensive health insurance for employee only - no family coverage. The hours are basically 6:30-3 4 days a week. Low stress though obviously something could go wrong & you have to be ready to act of course but overall..it's just very routine. The stress comes mostly from not knowing how the MD is going to be - he can be very friendly one day, not friendly the next then not speak at all some days - in a small room that can make things uncomfortable but I've gotten use to it.

ILoveGI · Mar 25, 2017

I work in a hospital based endo unit and for the most part we have a great dynamic with our techs. They are rock stars and usually have a good relationship with the MD's. Their relationship is like a dance and anticipating each others needs is key.

We usually sedate our patients, but we have two days a week scheduled with anesthesia for patients that have complicated health histories or are substance abusers. We also can refuse to sedate a patient if we think they're an ASA IV or we have strong belief they are too high risk for nurse sedation. Critical thinking is key in the hospital setting as you are likely doing elective procedures on higher risk patients.

Pre-procedure teaching is crucial for better outcomes with patients because not all patients are "out" during procedure and not all patients forget the exam...

twinsmom788 · Aug 7, 2017

I work in a hospital based endo unit and for the most part we have a great dynamic with our techs. They are rock stars and usually have a good relationship with the MD's. Their relationship is like a dance and anticipating each others needs is key.
We usually sedate our patients, but we have two days a week scheduled with anesthesia for patients that have complicated health histories or are substance abusers. We also can refuse to sedate a patient if we think they're an ASA IV or we have strong belief they are too high risk for nurse sedation. Critical thinking is key in the hospital setting as you are likely doing elective procedures on higher risk patients.
Pre-procedure teaching is crucial for better outcomes with patients because not all patients are "out" during procedure and not all patients forget the exam...

Not certain what is meant by the comment that" all patients are not out and all patients forget the exam"? I was warding this off, when I asked for an Anesthesiologist and asked the team to make certain I did not awake in the midst of the procedure. I will say that I was truly out of it when they came to wake me up and told me to get up and I couldn't. I was then told by a tech to get up or else because my stretcher was needed. I then sank into the dressing room and my husband was called to haul me out of there. Not fun, but at least the end result was not cancer.