nmred

Don't know where the PACU Forum is... but I'm both CPAN and CAPA and I used The Core Curriculum for Perianesthesia Nursing Practice by Litwack. The ASPAN/ABPANC site has a full list of references. Also there are practice test on the website, they are really helpful. Best of Luck

I keep my wrappers as well. The scrub should be keeping all sleeves and sterile wrappers. I NEVER toss/remove the trash from the room until the case is completed. Just in case you have to go digging for items.

The hospital is saying the individual does not work under my license, no matter how many pages from AORN, DOL, ASPAN, Federal Code are placed in front of them. I have already thought about having to return and be around all of these individuals. Not a nice thing.

My supervisor objected to the incident report, and I'm being punished for it. S/He was angry about the write up, not about the situation. It was clear S/He was angry that the report was seen by her/his supervisors not about the hostility. Alos, it's clear I'm not wanted in the unit.

I'm glad some one gets it. I still can't return to work (my time off is on my dime), and this guy is still working. He's making money. What about my financial obligations? What about his abuse? Apparently it's being condoned. Abuse is never acceptable.... PS: BTW... Writing the incident report is what got me in trouble....

I'm not a "Newbie". S/He didn't have anyone in to relieve her/him. The hospital is only saying they had permission to leave to CYA. As a matter of fact the surgeon told s/he to stay and the individual continued to walk out. Let's see, that's insubordination, pt abandonment, failure to complete duties, creating a hostile work environment. All of which are unacceptable. PS: This individual has hit me in the face with instrumentation in the past... Why are they still employed?

Met with HR, everyone/everything backs my statement except the individual getting permission to leave the room. HR and my supervisor are mandating I receive counciling for calling this disruptive individual a perjorative. In the mean time, s/he is STILL working. They (upper management) state "One Tech may tell another Tech to break scrub and leave the room". According to State and National standards the Surgeon is the immediate supervisor. The point is...this individual in question is not being held accountable.

Not a union hospital. Apparently, everything/everyone has confirmed my statement. I'm being punished and s/he's been let off the hook. National Standards: S/He is directly responsible to the surgeon. MD said stay, s/he walked.

S/He threw an object at me. I called him a perjorative. Questionable: the pt at risk. I am not accountable for her/his behavior. Abuse, verbal or physical, is never acceptable.

I recently had an altercation with a CST in which s/he provoked, and admitted provoking, a response from me (the circulator). The surgeon reprimanded her/him for the behavior. S/He broke scrub and exited the room without mine or the surgeons permission. The hospital is saying that s/he had permission to leave the OR from another ST who was in the room as an assistant, not to relieve her/him. The hospital has placed me on administrative leave saying I provoked the incident. They are investigating me. The CST is still working. Apparently no one is collaborating my statement. Any thoughts?

Start with the DOL in your area. I live in NM and on our DOL webpage there is a statement of forcing personnel to work over 16 hours straight- not allowed. Which means the hospital must have some policy in place with step by step instructions, who to call, when to call, how much time to give them to find a replacement, etc. The problem is enforcing the policy. There is always ONE nurse who will choose not to follow it and that will set the whole unit up for failure. ASPAN's standards for 2008-10 (?), it's the latest ones, has a call/exhausted check sheet for PACU nurses. You go down the list and check off the boxes. If you feel you are unsafe it guides you through the proper steps and channels. Maybe presenting this to your Superiors will help clear a path for safer patient care. Remember: The Superiors are at home sleeping... you're the last thing on their minds.

My hospital recently hired a JCAHO consultant to "walk" through the hospital and advise the department managers of "potential" problems with the units and how to "beef up" the areas for the next Joint Commission inspection. One of the "requirements" for PACU is for Anesthesia to list the order in which pain medications are to be given (if there is more than 1 option). The consultant stated Joint Commission is watching for this now. So our anesthesia providers have to mark next to the medications what order the meds are to be given and the nurses MAY NOT deviate from the list. The nurse MUST give ALL of med #1 prior to advancing to med#2 and so on. It makes no since to me. Where is the critical care aspect of nursing? Especially in the PACU. Has anyone else come across this issue? Until now, I've never heard of such a thing. Is it a true Joint Commission reg?

I'm sloowwly learning Norwegian. The problem is I have no one to practice with. Have you worked there? If yes, what was it like?

Thanks for your responses. Just an update: We just had an incident where an ICU nurse was instructed to move a patient to another unit and receive a patient from PACU. The patient had been here 11 hours waiting for a room, had a craniotomy. The ICU nurse refused to move the original patient until 9 PM. When the charged Nurse tried to resolve the situation she was threatened with "you had better stop your behavior (solving the problem) or you will be in a lot of trouble". She asked the manager "Are you threatening me?" "NO I'm not threatening you, I'm just saying..." The manager now denies the conversation. She has reported the treat to Joint Commission and CMS. We shall see the out come.

I was on the internet the other day, just checking my professional websites, and stumbled onto an article on the ASPAN website about Bullying in the workplace. Anyone else seen this? It's an article about how JAHCO will be mandating a violence in the workplace protocol. The organization must have a policy in place that ID's proper conduct and what steps will be taken to modify inappropriate behavior. All employees must sign the form. It's about time! In the last three years I gone through three jobs because of hostile work environments. And I've been in the field 2o+ years. The problem I have with this is you can't put it into practice. Some hospitals aren't JAHCO certified, so they don't follow policies and standards anyway. There are others who don't follow any standards when they are JAHCO certified. So what's the point? It is estimated 48% of the medical field would be unemployed! Any thoughts?

We have two nurses on call every day. The problem with that is the nurses complain every time you call them in. They want us to recover in ICU. The problem with that is care is compromised because the recovery room nurse is in a different surrounding with equipment she's unfamiliar with. Bottom line is management needs to be more aggressive with patient care and standards. Peace

Anyone out there with experience in nursing in Norway? I read WHO raked their country's medical system at #11. The U.S. was ranked around #38. I'm looking into immigrating to another country and Norway seemed interesting. Any information would be helpful. Thanks so much. :bowingpur

I've only worked in 2 PACU's requiring call. The first was a small hospital, ~ 60 bed including the ER. We were left alone. The Policy was "If you asked the Circulator to stay, they stayed". Lots of luck with that one. They complained so much I had rather be alone. :angryfire :angryfire :angryfire Where I currently work we have to nurses on call at all times. You call them if you need them. I work with anesthesia provider. If they wish for me to stay in the PACU with the patient we work something out. Now we have a nurse who only takes call Monday - Thursday. If she needs assistance she calls in the call 2 person. So far that's working out well. I believe it's a never ending battle.

You'll do just fine. I remember I use to go home every night crying I was so overwhelmed. After about 6 months I was pretty comfortable with "minor" cases. By the end of a year I could recover any patient at our hospital. Best of luck

I second what "The Commuter" had to say. Along with the fact I work in the surgical department. Not only do I work my 40 hours a week but I get to take call about twice a week. That can average around 20 - 30 hours extra. I wonder why on my days off all I do is sleep! And to add insult to injury this lousy government takes all my OT as taxes. That's extra special.

Good answer!

Often enough. What I love is when you contact Pharmacy the response you get is " Thanks for following the 5 R's". That's Special My response is something like... I know the 5 R's, can your team read? What really gets my goat is when I have to call Pharmacy and tell them we are out of a medication. The system has a par level and it should be set. Why do we (the nurses) have to do everyones work?

For the most part, my life is good. I've had a rough 12 months. Lost two dogs, a job and a friend to Prostate Cancer. Not to mention severing a couple of relationships. But, without the bad you can't ID the good. That's the problem with our society... We only want the good. Whatever.

Aspan standard states "2 nurses in the recovery area". It's always a battle. Your hospital doesn't have to comply with the standards. If they refuse then you fall back on "Best Practice Act". Which means you will have to justify why no one stayed. Either have the Circulator or Anesthesia stay. At the hospital where I currently work I call in my back up or we go to ICU to recover (if there is a room). You can't do Pedi's in ICU or out patients. But they are a good resource.

The standard is "Two Nurses" in the area of recovery. But if the hospital doesn't support ASPAN standards you have the right to request/demand your Circulator or your Anesthesia Provider to stay. At my hospital we go to ICU and recover. The problem with that is you have to have access to everything. But it's a good back up.