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?
Specializes in OR, Nursing Professional Development.
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.
Really? The skill set between OR and PACU is completely different. At least where I work, critical care courses are required to be a PACU nurse, but OR nurses aren't even required to have ACLS certification. In the OR, anesthesia is right there in the event of airway issues. In PACU, it's just the nurse, particularly on off-shifts, which is all I work. My hospital does not offer any cross-training to other areas. I would refuse to be assigned to PACU with no training, no critical care course, and no ACLS.
That is part of the training regiment I put together for new OR nurses. I Have all of the able to recover patients with competency checkoffs and acls as well as pals now. I personally feel that as a specialty RN you should be well versed in your support departments as well. I'm not talking about recovering an icu quality patient, I'm talking about your standard routine surgery kinda stuff. If we Have an emergency gallbladder that takes 15 minutes to do and pacu has not arrived yet, I want them to be able to recover the patient and send them on to the floor. All of my OR nurses also do conscious sedation for endoscopy am have to recover those much more regularly.
Specializes in ICU, Trauma, CCT,Emergency, Flight, OR Nursing.
Outside the US ,its fairly common for Scrub RN's to recover their own patients in small rural hospitals and in bigger hospitals after hours when the OR does not operate on a 24hr basis. Many private hospitals and smaller rural hospitals do not have OR personnel on duty 24/7, so they have the RN's come in on an on-call basis. Once the surgery is complete, the patient is taken to recovery room and the Scrub nurse recovers the patient and then takes the patient to the ward with a porter or one of the ward RN's. The anesthesiologist is nearby in the OR suite should the RN need their help and has to authorise and sign off the patient's release to the ward/ floor.
ICU cases were usually taken directly to the ICU by the Scrub RN, anesthesiologist and surgeon and the patient is managed further there.
I think specific training is what is required along with some rotation in ICU and in anesthesia so that your OR nurses (Scrub/ circulators) are comfortable with recovering patients ,and you are too!
Rose_Queen, BSN, MSN, RN
6 Articles; 12,051 Posts
Really? The skill set between OR and PACU is completely different. At least where I work, critical care courses are required to be a PACU nurse, but OR nurses aren't even required to have ACLS certification. In the OR, anesthesia is right there in the event of airway issues. In PACU, it's just the nurse, particularly on off-shifts, which is all I work. My hospital does not offer any cross-training to other areas. I would refuse to be assigned to PACU with no training, no critical care course, and no ACLS.