Only PACU nurse at ASC

[jcsa719]

This has been bothering me for awhile so I wanted to put this out there to get everyone's opinion. I've been a recovery nurse at an Outpatient Eye ASC for the last three years and I no longer feel comfortable working there due to patient safety issues. For the most part, we do conscious sedation cases but usually one day a month we do general anesthesia cases for both adult and pediatric patients until just recently. Now, we do generals randomly and without warning.

I am one of two nurses that are qualified to recover these general anesthesia cases (previous ASC experience) and the other six nurses refuse to learn because they don't want the responsibility that is involved. I don't feel that this is a safe environment for patients and I've been told that I will be doing all the generals when the other nurse retires next year and my manager is okay with this. I have raised concerns about certain patients being done in an outpatient facility because they are very sick and we aren't set up to handle these cases. Management's response is "it will be fine, just do it" or I'm made to feel that I'm causing unnecessary problems. We don't even have a code team because the other nurses don't know what to do even though they are all ACLS and I have to direct them on every little thing.

Has anyone else heard of ASC's having only one or two nurses recovering generals? Every other place I've worked, the nurses all have to have the same skills and be able to take care of any surgical patient. I'm afraid for my license and am already looking for another job.

[brownbook]

Your post is crazy in so many ways. That management would not address, respect, your concerns with anything more than "it will be fine, just do it", is inappropriate...even if they are right, their dismissal of your concerns is not appropriate.

That your co-workers "don't know what to do even thought they have ACLS and I have to direct them on every little thing", shows a real lack of management or supervision. Every nurse hired in PACU should be equally qualified and take all cases.

Are you recovering pediatric patients and no one has PALS? I tried to find rules and regulations regarding peds and ASC, but I would imagine (hope) for an ASC to take peds, the staff would have to have PALS?

If what you say is accurate I would leave.

However if you like other aspects of the job, and don't want to start over, perhaps you could tell your head of anesthesia your concerns. They would be, should be, very concerned about the outcome of their patient care and be the go to people about what is going on in PACU. They may be held as accountable as the nurses if their patient had a poor outcome in recovery.

I keep visualizing your co-workers all hiding in the linen closet when a "general" patient comes out???? (There are a lot of nurses looking for work, management should fire your "lame" co-workers and hire and train staff to recover all cases.)

Also, playing devil's advocate, the term "general anesthesia" is very misleading. Many "general" surgeries are done with not even an LMA, simply some propofol, versed, and fentany,. these patients do still need close monitoring.

And "very sick'? I can't imagine an anesthesiologist being willing to give general anesthesia to a "very sick" patient in your facility. All the anesthesiologists I work with would refuse and have the patient taken to an acute care hospital!

[brownbook]

PS. Anesthesiologists would refuse a "very sick" patient in any ASC, not just yours.

[TheCommuter, BSN, RN]

Welcome to Allnurses.com!

We have moved your thread to our PACU Nursing forum with the goal of stimulating interest and more responses. Good luck to you!

[jcsa719]

In answer to your question, I have PALS and so does my retiring partner. No one else does except for Anesthesia. The other nurses that are preop giving oral Versed and in the OR with the Peds patients are not and they have no plans to do it. When I talk about general anesthesia patients they are patients with LMA's or ET tubes like other general anesthesia patients. The other nurses may not hide in the linen closet but it is pretty close. They close the doors to the recovery area and disappear until that patient has been discharged.

Most Anesthesiologists that I have worked with over the years would have cancelled most of these cases because they don't fit the criteria for ASC patients. We rarely took care of CP patients, stroke patients, and developmentally delayed patients at my last job because of the possible care that could be involved. My current job just seems to do whatever comes in the door and I dread coming into work on these days.

We are going up for Accreditation soon and I don't believe we will pass. Our facility isn't up to life code and you know about the rest of the staff. I convinced them two years ago to do ACLS together because they were working without it.

I'm going off to back surgery next month and I won't be returning. I don't think I can physically do it anymore and I worry about my license.

Thanks for listening.

[brownbook]

Yikes, that is horribler (I know, not a real word) than your original post. I hope they don't pass accreditation!

[azhiker96, BSN, RN]

It sounds like you have a plan. I hope your surgery/recovery goes well.

Here is a suggestion for anyone you like who may still be working at that clinic. They could talk with either the PACU manager or head of anesthesia. They should mention there is an organization for PACU, ASPAN. That organization has a published book of standards of care. It would be wise for patient safety and accreditation if they were running their PACU in accordance with published standards of care.