OR Nurses Giving Conscious Sedation--WHY SHOULD WE?

[stevierae]

Frankly, I have never understood why some operating room nurses feel honored to be able to sit up at the head of the bed and administer conscious sedation, especially during elective cosmetic surgery procedures (in which the patient could afford the services of a CRNA or anesthesiologist.)

I think it is a power trip for them--makes them feel oh-so-important.

OK, here come the flames from those who consider it "an expansion of their role as a perioperative nurse" and apparently aren't concerned about not being trained--or compensated--in the same way a CRNA or anesthesiologist would be for doing the same thing.

I truly believe that this is a classic example of the saying, "A little knowledge can be dangerous."

Yes, I am ACLS certified--I am good at starting IVs--I know the conscious sedation drugs and the drugs to reverse them---and hey, I have even had to do a stab trach or two with a jelco to ensure an adequate airway and prevent imminent death----but that was as a Vietnam era corpsman, when there was no other option.

There was no MD or CRNA to call on--as an independent duy corpsman, I was it. Oh, and the situation was trauma--NOT elective cosmetic surgery.

Today, there are plenty of other options--those include staff CRNAs and anesthesiologists who are PAID for their skills at airway management and conscious sedation (as well as far more complicated anesthesia situations.)

Yes, times have indeed changed. Personally, I do not feel they pay me enough to take on this role and the extra responsibility it entails--especially when CRNAs or anesthesiologists are sitting around with nothing to do--simply because hospital management, or cosmetic surgery patients who are paying out of pocket, do not want to reimburse those people (or bill the insurance) accordingly.

This often happens in elective cosmetic surgery cases where insurance ISN'T picking up the tab. Rather than pay the person who is trained--and welll compensated--to do this job--we are supposed to do it.

Why are we allowing ourselves to be exploited as a source of cheap labor?

I actually worked registry a few times at a hospital where, in my opinion, the "queen bee" RNs who fought for the chance to give conscious sedation were waayyyyyyyy over their heads--they were allowed by certain plastic surgeons to simply give drugs in the increments they (the nurses) saw fit--usually Fentanyl and Versed--and more than once they got into trouble and had to slip in an oral airway, bag the patient, and reverse the Versed with Romazicon or the Fentanyl with Narcan to end up with (eventually!) a spontaneously breathing patient.

Forget about having anesthesia nearby to come bail them out--they had long since gone home--none covering OB, either, as this small hospital had no OB unit.

I expressed my concern to their supervisor about this--with some trepidation--I knew it would not be well received since I was not staff. Her answer? "We do it all the time--and anyway, if they run into trouble, they can call the ER doctor."

Right. Like he is going to drop whatever he is doing (perhaps handling his own code!) and rush right over to bail someone out of a situation they should not have been doing in the first place.

(When I voiced THIS, I was given a blank and hostile stare--and, not called to work there again, surprise--as if I would have wanted to return to this hotbed of sentinel events in the making.)

What do the rest of you think? Why are nurses taking on this role? If you have no other objection, just consider this one---they just do not pay us enough to do it.

[SuperSGirl]

Professionals should be able to debate without belittling one another. Constructive criticism gives us the opportunity to look inward and grow.

It is not fair for you to state somebody feel Oh so important just because they like giving moderate sedation are are comfortable with it. Please retract that statement.

[shodobe]

stevierae, I totally agree with you. I don't think cecumseeker has been around this site long enough to see how secure you really are. I just hate it when anesthesia will refuse to give any anesthesia to a patient for one think or another, but it is perfectly OK if the nurse gives a "little" sedation just to get the patient done. I think it is ridiculous to think that we as nurses are going to give better anesthesia to a patient because the surgeon says so. We should be able to refuse if it makes us feel uncomfortable. I give CS when asked and ALWAYS give far less than the surgeon tells to give because they haven't a clue to the backlash, "nurse give 4mg Versed to a 89yo female who has respiratory problems and that is why anesthesia wouldn't do the case in the first place!" Luckily I always have an anesthesiologist in house in case of an emergency, and yes cecumseeker, I could handle it without them if necessary, but would rather not. I think from cecumseeker name, he or she, must work in the GI lab, which is not the OR, and they give CS in about 99% of their cases. Change jobs? I don't think so, between stevierae and me we probably have 60 years or more of OR experience and do know the difference between what is exceptable and what isn't. I also think this is NOT part of perioperative nursing, because it has only been used more and more in the past 10 years or less. I have worked at the same place for 27 years and only until INSURANCE stopped paying for anesthesia in certain procedure did CS become more prominent. We always had anesthesia for all procedures except locals, which I DON'T consider CS because no drugs are pushed. The problem with you, stevierae, is you have too much respect for your career and always questioning why we do something. Too many sheep being led down the path. I just love threads like this. Also you can give me CS anytime because I know you care.Mike

[lynswim]

I absolutely HATE doing CS. If I wanted to administer CS, I would go to CRNA school :)

Lynswim

[SuperSGirl]

I worked in O.R. 10 1/2 years before changing 2 years ago. I am perfectly up on what goes on in the O.R. That is not nice to belittle me for changing jobs.

Perhaps contacting AORN or ANA could help you clarify moderate sedation.

[SuperSGirl]

I do not know why you are attacking other areas of specialty. SR was the one who came in passing judgement on patients by referring to their financial status and how he thought he was underpaid to give moderate sedation which is part of perioperative nursing.

It is too bad that my stating an opinion upset you. I was trying to give you a different perspective. I would never attack fellow colleagues or their profession or area of expertise that is different from mine. You seem to be belittling me for working in an Endoscopy Unit. Just because somebody chooses to change careers doesn't mean it is a bad thing. Change keeps us healthy and non stagnant. My 10 1/2 years as O.R. nurse is valuable. I think two different areas in 13 years of nursing shows stability.

[shodobe]

Give it up! You are justing beating a dead horse with this thread. Everybody has their opinion. I will give CS if necessary and won't if I feel uncomfortable. I have been doing this for 28 years and nobody will tell me if I'm doing it right or wrong. At least I stayed in one area of expertise and didn't move to another area. I am very good at what I do and feel very competent in my specialty. I do belong to these organizations that you mention and do not agree with everything they purpose, but that is just me. I wouldn't be an MD or CRNA if you sent me to school for free. I like what I do and wouldn't do anything else. Compensation? I get very well compensated in what I do, so money isn't the issue. What is the issue is someone who isn't even in the specialty telling people who have far more experience than you will ever have that they are doing something wrong. Stevierae is someone who is very opinionated and stands fast to their ideals so bad-mouthing them gets no where fast. I would suggest that you use a little more constructive approach instead of jumping to the conclusion that they are wrong. Also in the years that the GI lab has been opened in my hospital, approx 12 years, there have been more codes called than I can remember, and these are with nurses who have more years experience than you. Kind of makes you wonder what is right or wrong. So lets just get back to posting our opinions and stop judgemental jabbing. CS is like doing abortions, if you don't feel comfortable or it is against your better judgement then let your Director know and hopefully they won't put you into that position.

[RNPATL, DNP, RN]

I am posting a warning to this thread. Please focus on the topic at hand and debate the topic. Personal attacks of any nature are a violation of the terms of service and are not acceptable on this board.

If the personal attacks continue, I will close the thread. Thank you.

[carcha]

Shodobe, you and all the rest are a lot braver then I am. I am a nurse first and foremost and would under no circumstances wander out of what I consider nursing practice. Giving C.S. to me goes into the medical realm and is not what I am all about. Our profession is so watered down already with non nursing personnel trying to put their 2 cents worth in and now nurses are squabbling about whether we should give C.S. just because some places allow it. Why dont people who want to call themselves nurses train to be RN's and those who want to take their responsibilities further by sedating patients train to be medical staff. I just feel that by changing the goal posts continually we are losing our own identity and what we are trying to achieve.

[SuperSGirl]

Wow, that's crazy that a GI Lab would have that many codes. I hope that administration is viewing the issue through and OPA&I plan to find out what the problem at hand is. We have had only one and it was before the procedure ever began or any meds were given. The patient went into V-Fib and luckily was at the right place to get quick intervention.

Give it up! You are justing beating a dead horse with this thread. Everybody has their opinion. I will give CS if necessary and won't if I feel uncomfortable. I have been doing this for 28 years and nobody will tell me if I'm doing it right or wrong. At least I stayed in one area of expertise and didn't move to another area. I am very good at what I do and feel very competent in my specialty. I do belong to these organizations that you mention and do not agree with everything they purpose, but that is just me. I wouldn't be an MD or CRNA if you sent me to school for free. I like what I do and wouldn't do anything else. Compensation? I get very well compensated in what I do, so money isn't the issue. What is the issue is someone who isn't even in the specialty telling people who have far more experience than you will ever have that they are doing something wrong. Stevierae is someone who is very opinionated and stands fast to their ideals so bad-mouthing them gets no where fast. I would suggest that you use a little more constructive approach instead of jumping to the conclusion that they are wrong. Also in the years that the GI lab has been opened in my hospital, approx 12 years, there have been more codes called than I can remember, and these are with nurses who have more years experience than you. Kind of makes you wonder what is right or wrong. So lets just get back to posting our opinions and stop judgemental jabbing. CS is like doing abortions, if you don't feel comfortable or it is against your better judgement then let your Director know and hopefully they won't put you into that position.

[SuperSGirl]

Perioperative Nursing has changed through the years. 30 years ago, laparscopic cholecystecomy was not being performed. Now, we do laparoscopic appys, colon resections, assisted vag. hyst, thorascopic wedge resection. The anesthesia gases have improved and just with the simple intervention of the pulse oximeter, moderate sedation and anesthesia are safer. Though nurses giving moderate sedation may not have existed 30 years ago, it does exist now and is now a part of perioperative nursing. In order to grow in our profession and not be stagnant, we must change with the times.

[stevierae]

Huh, I just came upon this thread, which has not had any activity since February. Well, I have not changed my stance on nurses giving conscious sedation, and here is one of the problems--in too many situations, it quickly slips into moderate or DEEP sedation, and we are simply not trained or qualified to give moderate or deep sedation--to do this, it means we must be qualified to give general anesthesia. I know what I don't know.

I just do not see why ANY nurse would do something she is not trained--let alone PAID ENOUGH--to do. Propofol, especially, has no place in a non-intubated patient--yet, tooo many endoscopy nurses think it's somehow OK to give it to non-intubated patients-- a very, very dangerous practice.

cecumseeker, please read the thread entitled "Propofol" under gastroenterology nursing. You will see I am not alone in my views. Many, many anesthesia providers feel as I do. I would never attack anyone in any thread, and never have. I am simply calling attention to a dangerous practice which has NO place in nursing. One of the nurse who works in a GI lab stated that they even have LVNs giving CS!!! And she thinks that that is acceptable!!!Unreal!

I have written letters to ASA and the Oregon nursing board, as well as to key politicians, to call attention to the dangerous practice of nurse administered Propofol in an endo lab in Southern Oregon. Hopefully, this practice will stop soon.

That old argument--"perioperative nursing is changing and we must change with it--" is management speak for getting RNs to do more work---housekeeping, anesthesia, transport orderly, secretarial, etc.---on top of nursing responsibilities---with fewer resourses and less money---so that they can cut their budgets and ensure themselves fat end of year bonuses for doing so. Don't buy it. When we do housekeeeping's work, we are often crossing over into another union and keeping THOSE minimum wage people from putting food on theri tables. Why should we do anesthesia's work simply to open another room, or let them take off early or sit in the lounge? Oftentimes, they get paid regardless of whether they do the case or not, if they stay in house! I think that EVERY patient deserves a highly skilled anesthesia provider givng his anesthesia--not someone who has had a few classes taught by pharmacy and maybe ACLS every two years. Intubating an maanequin is NOT the same as intubating a real, live human being. I do not think it is safe patient care to yell for the ER doc or RT or hope for a free anesthesia provider when one gets oneself in over his or her head.

I remember when that argument--"Nursing is changing yada yada yada..." was used when I worked home infusion--we were supposed to spend hours on the phone, often on hold, jumping through various hoops and checking on insurance eligibility and filling out various forms because they did not want to pay the TRAINED insurance people--whose area of expertise this was, and who WANTED those hours-- to work after hours or on weekends. I said, "Hasta la vista, baby" when the director tried to lay that old argument on me about how now, in addition to driving out into the boondocks in the middle of the night for a flat $25 a night (NOT an hour) I had to now deal with insurance forms as well as my own infusion nurse duties to "keep costs down, because nursing, and health care everywhere, is changing--we must change with it." You didn't see HER handsome salary cut one penny, or let her various "administrative assistants" go!

Thanks, shodobe, as always for your support.

By the way, cecumseeker--I am not a "he." :)