On Call Coverage

[BarbRN62]

I need some input. I feel patient safety might be at risk.

I work in a mid sized level I trauma center PACU. Our regular weekday night nurse has moved on to another position. Weekends are covered by RN day staff with one RN on call. Weekend nights has two RNs on call. Management has decided to staff weekday nights with one call nurse with variable plans for backup. 1# if any ICU's have an empty bed use it and an ICU nurse can be your back up to recover a general floor patient or step-down patient. (random nurse not staying in room) 2# our emergency STAT nurse if available. (I can't get them to call me back when paged during a weekday...they are so busy) 3# OR supervisor or staff nurse (if available) We try to just run one room at night if possible. But poor judgment and alcohol happen. Sometimes two rooms run at night. If they go to the general floor or step-down, on call staff may have two patients.....phase one at the same time!

Patients going to or returning to an ICU are to go direct to ICU vented and non vented. This is a new thing and wonderful as long as an ICU bed/nurse is available. If not, it is a PACU patient (on call nurse coming in ) until a bed or nurse is available.

For years prior to recent staff changes, PACU had a nurse staffing at night. On call nurses were utilized still to be the second nurse. What has changed that makes it safe for just one PACU nurse at night ?

Have any other institutions gone this route with night time PACU staffing? Thanks for your input.

[tfesmire]

I don't know if this answers your question, but I work in a PACU at a level II trauma center at night, and I am a CNA. The whole reason that I was hired is because they were dinged with a violation for only having one provider in the PACU at night. They hired two CNA's full time to cover all of the nights with the nurse so they are not alone, and we still schedule an RN on call as backup (since CNAs are cheaper than RNs). I don't know if that's an option you might explore.

[TennBSN]

I am a RN at a large level 1 trauma center in the PACU. As far as I know, ASPAN standards recommend 2 RNs for any phase I patient. A phase I patient is anyone who has general anesthesia. Since it is a recommendation I guess your nursing leaders can ignore ASPAN.

[emain86]

Im a big fan of the whole recovering a patient in the ICU isntead of calling someone in. I work nights and really the standards say one PACU Phase 1 RN and a RN. ICU nurses are more than capable of helping with a PACU patient if things go south. Makes everyone happy and saves the hospital money.

What I'm not okay with is that as a nightshift PACU nurse every responsiblity is on me. I'd rather have the on call person come in because then I get a second set of hands; get the patient out early and can get back to my other duties ( mainly making sure things in same day are good and the unit is in good order for the next day.)