GI nurse seeking guidance on new job 🫣

[Arizoneicetea]

Hello all! I am hoping to have some input on my concerns with a new position.... I've been in endo for a few years and have recently picked up a contract in a new city on the east coast. This facility has nurse led conscious sedation which is new to me, I am worried because the standard here is one nurse working with one doc. No tech ever. Is this normal? I feel like it may be unsafe due to the nurse having to divide focus from monitoring vitals and helping with tools/polyp retrieval. Also they have one nurse doing both prep and recovery simultaneously I have never come across that even when working in a busy ASC, I also find it hard to focus on recovering patient while doing an intake at the same time. Am I just inexperienced and this is normal? Feeling overwhelmed and worried. 😟 
thanks in advance. 

[beachynurse, ASN, BSN]

I worked in a GI unit years ago, and there were 2 nurses in the room. One was assisting the MD, the other was administering the meds that the MD orders and documenting it so the MD could sign the orders after the procedure. 

[Arizoneicetea]

beachynurse said:

I worked in a GI unit years ago, and there were 2 nurses in the room. One was assisting the MD, the other was administering the meds that the MD orders and documenting it so the MD could sign the orders after the procedure. 

Thank you for the response, it seems much safer with another person in the room....

[beachynurse, ASN, BSN]

Thank you for the response, it seems much safer with another person in the room....

You are very welcome, and I agree that it is much safer with 2 people in the room..

[Atlantic143]

I suggest you ask to see the department's policy and procedure manual. There should be one in the dept. ...it is required in order for them to be accredited. Within the manual the issue you're asking about should be addressed...how many present for a procedure. There should also be a job description for each person working during the procedure, the credentials required, etc. Hopefully you'll find policy and procedure support for this issue and can take it to management...they are setting themselves up for failure ~ at the expense of the patient's safety .

[Nurse Beth, MSN]

The American Association of Moderate Sedation Nurses (AAMSN) says, 

"The registered nurse managing the care of the patient receiving moderate sedation shall have no other responsibilities that would leave the patient unattended or compromise continuous monitoring"

Also read the evidence-based  Guidelines for Safety in the Gastrointestinal Endoscopy Unit by the American Society for Gastrointestinal Endoscopy (ASGE) set forth precisely because of these kinds of concerns for safety as well as accreditation.

During the period in which the patient is sedated, the RN must monitor the patient for vital sign changes, hypoxemia, and comfort. The RN may assist with minor, interruptible tasks. In the event that more intense technical assistance is required, a second assistant (RN, LPN, or UAP) should be available to join the care team  for the technical aspects of the procedure.

Consider joining your professional organization, the Society of Gastroenterology Nurses and Associates (SGNA) which which also provides practice guidelines:

During moderate sedation, the registered nurse monitoring the patient may assist with minor, interruptible tasks once the patient's level of sedation/analgesia and vital signs have stabilized.

I hope this helps, and I hope you are able to help move the unit towards evidence-based practice. If they are accredited or seeking accreditation, you have more leverage. Best wishes!

[Mickeyii]

I didn't work in the GI Lab but I know there were always two nurses in each procedure, one assisting the doc and one monitoring the pt.  Anything less is crazy unsafe and putting your license in jeopardy, not to mention the life of the pt.