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.

[cnursegreen]

You should really take a look at the ASPAN standards when it comes to nurse patient ratio. I too was just an OR nurse until budget constraints forced me to become a preop and pacu nurse. I would encourage you to have an experienced PACU nurse available in the unit when the other not so experience OR nures are recovering if possible. Also, you can purchase the ASPAN competency that you and your nurses can work through to give them some background knowledge. If your upper management insist on you using them as your pacu nurses then you insist on educating them! I am currently a Director of two facilities and don't find this an unreasonable request. We cross train everyone. I will admit that he PACU and Preop nurses transition better to the procedure room than the OR. The OR nurse seem to transition to pre-op better than PACU, but to survive in this economy you've got to continue to educate your nurses and provide them with the education and knowledge to make them successful. Trust me...I know this is a hard concept...I'm an OR nurse at heart and always will be :)

[wilbur1]

Thank you, CNurseGreen-

I think that you are exactly right! Knowledge IS power-plus adding positions in this economy is next to impossible. If you are interested in sharing any of your competencies, I would be very grateful!

[chelleanne]

I also work in a rural hospital as a new grad. It's common practice at our hospital that if a patient surgery has just ended at say 3pm when the OR nurses were scheduled to be off ...the patients are automatically put on the med surg floor for recovery. I had my regular med/surg patients plus a post surgical patient, fresh out of surgery. With the pain and nausea issues along with frequent vitals getting them up to pee, etc, I didn't have much time to assess my other patients and care for them until later in the shift. I really resent having to do this...I'm also a new grad....I don't feel prepared to recover patients from surgery while having a full patient load to boot. It's not easy working in small rural hopitals, we don't have a pharmacy department after 4:30pm.

[valenelove]

Does your hospital have a formal rapid response team in place. That would make me feel better if I were you.

AWHONN standards say that OB nurses can easily recover a post op cesarean section patient (without having ACLS) if there is an in house 27/7 rapid response team