I am working as a traveler in a SFBA CA hospital in L&D; after I got here I learned that the RNs are responsible for managing epidurals: priming the tubing for the infusion bag, loading and setting the pump, and connecting it to the patient. They do require the RN to follow the written order of the MD/CRNA for drip rates, and another RN must be present to double check and sign off on everything, but .... The RN is also responsible for hourly assessment of dermatome levels, and for giving a bolus if the patient wants it. This bolus dose is in the orders. The anesthetist does not see the patient again unless the RN calls them ...
I have worked in many hospitals from coast to coast and this is a new one for me. I know this is a hot legal topic everyplace else. I am very concerned that I am practicing outside my scope of practice. I fear my malpractice insurance
won't cover me if god forbid there is a problem with the patient and the lawyer discovers the epidural is RN managed .... I couldn't find this situation addressed on the CA BON website and am thinking of calling them. To say that I am uncomfortable about this is an understatement. I am not a CRNA by training, licensure, or pay. I feel like I am doing their job. I expressed misgivings to the charge nurse and she indicated I should talk to the manager about my patient care assignment. I want to quit before they decide to nullify my contract over this issue.
Have any of you encountered this before? Any comments, suggestions, words of advice? Thanks.
Mar 3, '08
Our L&D nurses attach the epidural pumps to the catheter, program and start the pumps per anesthesia orders, and call if there's a problem. It's just not that big a deal. These are low concentration fentanyl/ropivicaine infusions. If the patient ends up with a C/S, they get a different type of pump in the PACU, also programmed and hooked up by the nurses. IV PCA pumps are far more dangerous overall with a much higher rate of complications and adverse events than epidural pumps.
Last edit by jwk on Mar 3, '08