OR RN's recovering their own patients in a small, rural hospital

[wilbur1]

I really need some help here. I am a new manager of a Surgical Services Department at a rural hospital. All of this is new to me, but especially that of working at a small rural hospital where the "rules" seem to be quite different to that of a large hospital. What I am REALLY struggling with right now is trying to get a understanding of the OR RN's recovering their own patients. All that is required is that they be ACLS certified and receive a brief orientation. As we all know, just because you have earned your ACLS certification that doesn't guarantee that you have a clear understanding of the knowledge that is needed. We also do not have any designated PACU RN's-only the OR RN's. This whole thing just scares me to death-and keeps me awake at night.

Unfortunately, this practice is not exclusive to just this rural hospital. There are other surrounding rural hospitals that perform this practice. Now, my background is exclusively in the operating room-I do not have Pre-op or PACU experience-but this doesn't seem right. My perception has always been that the PACU is an area that requires RN's that are skilled and well-versed in the many different scenarios that can go wrong. I don't see my OR RN's being that knowledgeable (not as knowledgeable as they should be, in my opinion). I am also pretty sure that these RN's have not taken a basic EKG course either.

I know that rural hospitals tend to be much tighter with their money, thus forcing departments to have to take on many different roles. Am I off-base here? I have only been working at this hospital for a couple of months and am dealing with SO many issues. I am going to talk to administration about this next week, as I am gathering as much data as I can to support my position. I am going to present my findings and ask that the legal department look into this, as I really need to know what is right and what is wrong. Also-there is only 1 RN that is recovering each patient. From what I understand, there should be 2?

Thank you.

[GadgetRN71, ASN, RN]

OR RN here..I did take a basic EKG course and had coverage of EKGs in nursing school as well. I guess I'm confused as to what you think the PACU nurses have as a skill set that any nurse wouldn't have? You already said that the OR nurses covering PACU have to have ACLS..We get codes in the OR rooms as well, have patients that start bleeding out etc. Contrary to what some think, OR nurses are real nurses;)

I work in a level one trauma hospital-we are a large teaching facility and our PACU RNs are assigned one to a patient. They'll help each other when needed but they do not assign 2 nurses to one patient as a rule.

[linda2097]

O.R. nurses and PACU nurses are both RN's. The solution is not to forbid O.R. nurses from recovering patients. The solution is to make sure that the O.R. nurses are also highly-trained PACU nurses. If you are not sure, hire a traveling PACU nurse to evaluate and train the nurses. Tell the travel nurse recruiters to specifically look for a PACU nurse who is highly-experienced and willing to train others.

After you do this, if you are still uncomfortable, then just hire permanent PACU nurses and/or travel PACU nurses.

[muffin7]

Yes, OR nurses are real nurses, but PACU nurses can't walk into the OR and do a case and OR nurses can't recover. As an OR nurse, I wouldn't even think of working in the PACU without plenty of training.

I have spoken to my manager and they are going to make sure we are cross-trained to work PACU. I work in an Ambulatory Surgery Center and they would never have us recover without training.

[GadgetRN71, ASN, RN]

Yes, OR nurses are real nurses, but PACU nurses can't walk into the OR and do a case and OR nurses can't recover. As an OR nurse, I wouldn't even think of working in the PACU without plenty of training.

I have spoken to my manager and they are going to make sure we are cross-trained to work PACU. I work in an Ambulatory Surgery Center and they would never have us recover without training.

But, the OP stated that before these OR nurses can recover patients, they have to have ACLS and an orientation. That sounds like training to me. Now, maybe they should make the orientation longer, but it's not like they are just dropping the nurses in there.

We actually have people that can work both areas..with the proper training, it's doable.

[elcue]

Also-there is only 1 RN that is recovering each patient. From what I understand, there should be 2?

I have never seen a 2:1 RN to patient staffing pattern. The common rule I've seen over the years is that there is never only one RN working alone in PACU even if there is only one patient. There is always a second nurse for backup in case of emergency. The typical staffing is 1:1. Perhaps it is this minimum of 2 nurses on duty that you've heard.

I think your anxiety over this situation is justified. ACLS is certainly appropriate, but PACU RNs need to also have detailed understanding of different anesthetic agents & their side effects. Most have critical care backgrounds and/or specific PACU training programs. Post anesthesia care is a recognized clinical specialty.

I have been an OR RN for about 25 years and was a strong clinical nurse on the floors prior to that, but I would not work in PACU, except as an extra pair of hands in a pinch, without formal training. The liability is huge. Patients deserve fully trained nurses in the appropriate clinical area.

Best of luck in your new position.

[mich321]

When I was in nursing school, my leadership rotation was in a small rural OR. The OR nurses also acted as PACU nurses, but were not required to have ICU or ER experience. During the day, there were always 2 nurses in the PACU, with one pt each. If an OR nurse was called in at night/weekend, the OR nurse went with the pt to PACU and recovered the pt- no second nurse there for backup. My preceptor said they lost a lot of good nurses who were uncomfortable being alone in the PACU at night.

I currently work at a large hosptial on a med-surg floor. I went to the OR one day during orientation to observe the surgeries. The OR nurse told me that OR nurses there NEVER work in PACU. PACU nurses are required to have atleast 2 years of ICU or ER experience because PACU is considered a critical care area. Maybe because of the more involved surgeries being done at the larger hospital- transplants, pts on vents, etc.? I'm not sure, but I found the differences between hospitals interesting.

[Rose_Queen, BSN, MSN, RN]

I see nothing wrong with cross-training nurses, but there should be adequate orientation. We routinely hire new grads for our PACU in a 500+ bed hospital. Being rural, what kinds of cases are you doing? Are you doing CABGs, AAAs, cranis, or do these kinds of cases get referred to other hospitals? Do the nurses who are doing both areas feel comfortable? I think it just boils down to training- is there enough or are these nurses just thrown into it?

[SandraCVRN]

I worked in a 25 bed rural hospital. There were only 3 RN's including the Dept Director, (who also circulated and recovered pt when needed). We would recover our own pts most of the time. Of course we didn't do many high risk pts. Usually a doc or anes provider were around for any needed help. If it was late in the afternoon or evening our ICU nurses would recover our pts if they were available.

[CodyRN]

I'm curious as to what conclusions you and your facility have come to in this situation? What's happened since the time you posted?

[Argo]

I don't know but it kind of disgusts me to think that OR nurses and/or their manager would not have faith or ability to recover their patients.

[ORNurse1]

I worked in a small rural hospital as an OR tech where the nurse recovEred their own patients

after surgery. We did not have any major surgeries even on call the nurse recovered the patient

as long as there was another person present. From there I went to a huge university hospital were

there was a separate PACU. I am currently working in a medium size hospital that has a seperate

pre-op, OR and PACU. Each nurse works in one area only however there are a few of us who can

and do work in all three areas and are very compitant in all three. So it also depends on nurses comfort

level and previous experience.