Nishstar1

I do feel like I made the right choice. During my time there, I had documented and time stamped my actions and the responses. I filed them in a binder along with a print out of the state law. I made copies and kept one set. If an EGD is done, you would spend all your time doing all the other busy work and barely look at the patient themselves. I would not want to be at the receiving end of a complication because I was busy charting for the doctor.

I'll work on that right now. It is extremely difficult to get through to someone in the state BON, but I'll start with the medical board. Thank you

True. Also, would like to add this is an outpatient ASC with no anesthesiologist on site for conscious sedation and likely not within a 5 mile radius (they leave after mac sedation cases are over). There were so many red flags, I hightailed it like anything

Thank you all for responding and supporting my stance. I've been a nurse for one year and the nurses I work with have been working in ICU and ER For over ten years, but I've been taught to go with my gut instinct. I have quit working there (unlike me to do this) but there had been no changes and nobody can plan when an emergency should happen. http://www.rn.ca.gov/pdfs/regulations/npr-b-06.pdf Here you go, JKL33 Also, to elaborate on interruptible tasks, this includes labeling the GI specimen, filling out the entire pathology requisition form, clicking on the cecum tracker, entering in, start times for procedure on one laptop, drawing up meds, selecting and making notes on the docs computer (to show that the doctor did physically assess the patient) which he does not auscultation he heart and lungs as TJC wanted,(this was a safety feature, which the nurses override by having the doctor log in in the morning and he does not do his own charting or reassessment).

I've resisted into going in while this is happening and told her I'll stay out in pre/PACU. The day of, she tells me that I am to relieve her for breaks because there isn't nobody else. Since when does consensus overrule patient safety? She says she will have my back but doesn't come back in when I expect her. She tells me if I need anything to call for her but I feel so anxious about it all.

"It looked different on the ultrasound!"

Good afternoon, I need to know what to do when state law contradicts a policy in a facility. This is related to conscious sedation where state law says that an RN cannot be performing any other tasks when administering sedating medications. The policy, however, states that the RN CAN perform interruptible tasks (and this is currently happening) unless patient falls under deep sedation. To me, I think the RN should be fully concentrated on the patient, the IV Demerol and Versed is quick acting and can provide undesirable effects suddenly. If the RN is distracted, how would he/she identify a change in a patient's condition? This is not safe for the patient and the Director is not on board with my observations and concerns even when I presented the website for the board that states this clearly. What should I do?

I agree with a lot of your points. A littleore background to this is that I came in as DON and there were two RN's who were really great but they had gotten burnt out and had quit one week before I joined...so I picked up the pieces and worked in the OR/PRE-POST OP and really hadn't had time to get to know each section of the P&P's, California law (I moved from texas) and other information that I needed. So once we hired two new nurses, I had trained them to work bedside so I can regain my focus onto DON issues. Honestly, I feel like I've been stretched too thin and it's costing me a lot. I've contemplated throwing in the towel and letting somebody else lead them. I haven't even had time to write up everybody (yes, all four of them have been hostile and verbally abusive) and the things they have done should actually have them on probation. As for lunches, short of pushing them out of the door, I've tried. I've told them that they can stagger their lunches once they finish their patient and let me know and I can cover. I haven't had a nurse tell me she wants to take a break. One of them prefers to work through because she can't focus on relaxing and the other one just likes to tell me days later. Do I need to create a lunch schedule? It doesn't work when one patient takes longer to recover or we have a dull moment earlier in the day. I have so far protected them when they are seen by the doctor as sitting on their chairs playing on the phones while in recovery, when the surgeon thinks they are goofing off. It might be getting to me that I'm working almost 80 hours a week and my work is being compromised and my decisions are being undermined.

Rose Queen : I read your message and have been trying to absorb/back track on things I have missed. Another factor is that they are so young and haven't developed the ability or realize the importance of professionalism and there is tempers flaring, profanity, blatant disrespect, etc and it has created an aversion for me to try to go to them to figure out what's going on because there's also slander during their explanations.

I'm not sure, and I didn't identify a problem because I regularly interact and communicate with staff (almost daily). It so happened one day that one nurses started venting to me after she couldn't come in to do her own work and expected me to drop what I was doing and do it for her. Shortly afterwards all four staff members were venting from an emotional outburst and I couldn't determine what the reason was. After 30 mins of trying to read between the lines and wasting enough company time, I decided that the only real problem is the hours and I told them I'm working on covering each of them so they can take lunch,etc. They said they didn't see me as a leader but it's because I've been trying to learn this company's policies and procedures (in transition since January)

I would like advice on how to handle sabotage from staff nurses and technicians. As Director of Nursing within an ambulatory surgery center with an upcoming Joint Commission inspection, there is an increased focus on getting the surgery center up to regulation. Our staff so far is made up of two new nurses and three scrub technicians, and four of out of these five are reluctant to follow much needed direction. The question here is what can I do to protect my license? so far, I have documented what has happened and my steps to counteract and improve the environment so that patient safety comes first. I have placed PRN nurses who are specialized in pediatric recovery from general anesthesia to offset the minimal experience the current staff has. What other approaches can I take to counteract intentional sabotage and burnout and to fix the problem that theses nurses are causing that they have confessed are intentionally keeping me out of the loop?