For those of you that work PACU, perhaps you can be of assistance to me....I work at a small hospital in Florida in Labor and Delivery. We do our own C/Sections and recover patients in our own PACU. Here's my question: our nurse manager is well aware of the fact that: A. There is only ONE person in recovery (even though I truly belive there is a state law in Florida that TWO people must be present in recovery due to a case that took place about 7 years ago where a male nurse was molesting patients that were incoherent) and B. most of the nurses recovering these patients (myself included) do NOT have ACLS nor do we have even a basic EKG training under our belts...in other words, we were told (and I QUOTE) "just put "yes" in the box that asks for the cardiac monitor dx" (as in, yes, they're on a monitor, but I have no *******' idea what it says!) I am very nervous about this whole situation....and feel as though my manager is just trying to save a few bucks to make the budget look better (by not staffing the recovery room and not properly training the staff) when in the long run, I could be in jeapordy of losing my license, couldn't I??? I even asked my manager if she would "allow" me to take off a few Fridays so I could attend the one and only EKG course offered at my hospital and she told me no!! I sure don't want MY family having a baby where I work!!
Any help is appreciated. Thanks!
Last edit by southRNflchick on Mar 8, '04
Mar 8, '04
If you feel uneasy about a situation there's usually a good reason..it's your liscense..protect it.
Mar 8, '04
You should feel nervous about that, it is completely inappropriate. All it takes if for one patient to go bad....Yes, you could lose your license. I work in ICU and occassionally we do end up with some pretty unstable postpartum patients.....things happen..... Cover your behind and go with your gut feeling on this one.....
Mar 8, '04
Having someone on a cardiac monitor means that someone is present that can interpret the rhythm or else they are on remote tele where the monitor is read at another location in the hospital. This is incredibly dangerous for you and the patient.
Mar 8, '04
I would definitely look into this matter. I work in an outpatient surgery center and we are all required to have ACLS, just because they just had a baby doesn't mean they also just didn't have surgery and need appropriate monitoring in recovery. So protect your license and talk to some one.
Mar 8, '04
I think you are very wise to be concerned. Let me share a situation that occured just last week in our PACU.
We recover "non-complex" scheduled C-Sections in order to allow L/D to be freed for the emergency ones. Our pt was a 30 yr old repeat C-section who was given an Epidural prior to surgery that didn't "take", so the MDA used a General. After she arrived her BP was 59/34. They put her head down, feet up etc, and she then said she was numb from the waist down but more to the right side. We thought her block was causing the hypotension but after several doses of Ephedrine and many cc's of fluids she was still grey and showing very unstable B/P's. We all could read the monitors so we knew she was in normal SR(her pulse went up later to compensate). So we checked her H/H which was 6.5/19 down from preop of 11.5/30 !!!
We ran 5 units of blood and finally the OB orders a CT which shows 1 liter blood("fluid")in her abdomen. She was bleeding out slowly. To end this story it turns out her tube was not proplerly cauterized during the tubal ligation.
She is lucky to be alive. Now if her heart rythym went bad, all of us are ACLS and monitor trained to respond. This all happened on a "routine" healthy C-section patient. Scary!
I would resign or demand appropriate training so you protect both your RN and your patients lives. Isn't it amazing what the hospital does to save bucks? If something ever happened you can bet they would point their fingers right at you guys.
Mar 8, '04
I agree with everyone else. This is a bad situation. An accident waiting to happen. Pts deserve to be "recovered" after surgery with the same level and standard of care wherever they are recovered. Refer to ASPAN standards. Show the standards to your manager. You and your pts deserve better.
Mar 8, '04
Protect thy self! No one else will. Every recovery nurse I know has to have their ACLS and PALS. In your situation PALS is not necessary but definitley ACLS is. Your manager should know better. I would check with your state board for requirements and also check your hospital policy and procedure to see if a policy was ever written for this situation. Good luck, Mike
Mar 9, '04
I'm a surgical ICU nurse and I frequently float to PACU, been there done that. Any RN working in PACU needs to have ACLS (and PALS if you're recovering kids)and at least a basic EKG course. I think that you are jeopardizing your nursing license by working there without that essential knowledge. In my hospital, I frequently recover by myself, BUT we have a deal with the OR in that either the scrub or circulating RN stays until the patient is transferred to the floor. They usually have to set up their room for morning anyways. Help is just a holler away. Works well for us.
Mar 10, '04
I agree with everyone. You need to stand up to your manager and demand that this working condition changes. If you don't do something soon it could mean the life of your patient and your license.
Mar 10, '04
Quote from southRNflchick
most of the nurses recovering these patients (myself included) do NOT have ACLS nor do we have even a basic EKG training under our belts...in other words, we were told (and I QUOTE) "just put "yes" in the box that asks for the cardiac monitor dx" (as in, yes, they're on a monitor, but I have no *******' idea what it says!) I am very nervous about this whole situation....and feel as though my manager is just trying to save a few bucks to make the budget look better (by not staffing the recovery room and not properly training the staff) when in the long run, I could be in jeapordy of losing my license, couldn't I??? I even asked my manager if she would "allow" me to take off a few Fridays so I could attend the one and only EKG course offered at my hospital and she told me no!!
And when someone dies, and you go to court, someone will point at that box marked "yes" and ask why you filled it in. And do you think that your NM will say, "I told him/her to fill it in despite the fact s/he couldn't read it - place all the blame on me."
I think that you know the answer to that question.
Also, contacting the hospital's legal department may help push the issue.
Mar 16, '04
Having worked ICU and PACU, I say trust your gut.
My usual gauge is to picture myself on the witness stand with the deceased patient's family's lawyer asking me to defend my actions. Why did I accept that assignment? Did I feel properly trained and oriented to the post anesthesia care of these patients? Could I prove my qualifications?
If you accept an assignment that you are not trained for, YOU are responsible. That's the legal side. Here's the moral side, and my other "should I do this?" meter- if something went bad, could I sleep at night later knowing that I had accepted being responsible for this patient?
Check your professional organization's standards- in this case, both the L+D org and the peri-op nurses org. Check your hospital policy for staff requirements in post anesthesia care- you need to be trained to these standards if your job description includes immediate postop recovery of patients. Some things you won't care for- vascular and thoracic surgery, for example. But I absolutely promise you that PACU requires ACLS certification, which requires being able to interpret a monitor and familiarity with airway and BP management. A tele course is a good start- but not enough.
I'm not criticizing you here- you have skills I never will. But if you are going to act as the PACU, you need to be trained in and keep up to date in PACU skills. Your manager is way off base- refusing to provide safe staffing could be an issue for her personally as well.
I doubt it will be pleasant, but you need to document, insist on safe patient care, and be prepared for it to get ugly.
Mar 16, '04
1. You need to be ACLS trained to work in a PACU. No way to get around it.
2. Has your manager ever worked in your area directly?
3. Would she consider being a patient in there if she knew that the staff was not trained? Don't think so........
4. I would definitely get risk management involved. It is your license on the line. One problem in there with a patient, you would have no more license and someone else would own your hospital..........................
5. I am sure that your policy and procedure manual says something about "properly trained personnel".................but the strange thing is, what do your anesthesiologists say about this? And how about the OB/GYN docs? Do they realize that the person that they entrusted their patient to recover their patient has no training in this area?
Very, very scary!!!
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