LollygaggerRN

I've assisted with plenty of unsedated colonoscopies. It has always been the patient's choice. Sometimes the patient wants to be able to go to work afterwards or just doesn't like sedation. I've even assisted with a colonoscopy in which a physician was the patient. He rolled off the stretcher afterwards, got dressed and went off on rounds. If it is the patient's desire to go without sedation I truly feel it is the nurse's role to help them through, not try to convince them to have sedation. I talk with unsedated pts and try to distract them or coach them through Lamaze type breathing. I certainly don't feel as though as I am a bad or unethical nurse because I am assisting a doc with an unsedated procedure. On the other hand, if the pt desires sedation but we are unable to safely provide enough sedation to keep them comfortable I always step up and ask the pt if they want to continue or come back at a later time with an anesthesiologist. So far they have all chosen to continue and work with me on breathing, etc. Who wants to go through the prep again? Additionally, it has always been my experience that the docs prefer sedated pts. A napping patient makes it easier on the doc as well. I can't imagine why a doc would request no sedation. Makes no sense to me at all unless they fear the pt is too ill to tolerate the sedation- and why do a procedure on somebody that fragile?

At my facility we do both RN propofol sedation and fent/versed sedation. The RN procedures are different for each type of medication, but you seem to do only fent/versed so I will speak only to that. I work at an outpt facility. Our docs typically come in to the procedure room, do the time out and make a medication order. A typical order would be "2mg Versed, 50mcgs fentanyl". Some docs will ask us to repeat the initial dose at 2 minutes, some will not. After the initial order is given the doc leaves the room to document or speak to a patient and returns in just a few minutes. Some docs we do have to "chase down", but they are really only a few feet away at a computer station. After the patient is asleep/comfortable/calm- whatever the case may be we typically stop giving meds unless they express that they are in pain. We rarely end up giving more than 6/150 although I have given 10/200. The sedation RN is the only staff in the room with the doc for colonoscopies. The RN sedates and monitors the pt, documents, and collects and labels specimens. If there are many specimens or a pt requires intense intervention a tech or additional RN is just the push of a call button away. There are two staff in the room for uppers. The pt is wheeled out of the procedure room after the procedure as long as they are stable. We do an aldrete and it would be unusual for a conscious sedation pt to have an aldrete of less than 7 or 8. When the doc signs the electronic chart at the end of the procedure he is signing his verbal orders. I don't see anything too odd about your facility's practices. The ASA 4 is concerning, but I have sedated plenty of ASA 3s in a hospital GI setting- not at my current facility. Also, the three sets of vitals at the end before coming out of the proc room is strange. I can't see any value in the pt hanging out in the room for an additional 6 minutes or more when they could be moved to recovery and monitored by an RN in that setting. If the pt isn't stable that is one thing, but in my 4 years of GI experience it is very rare that a pt is not stable after a procedure. Six minutes is a long time when the room could be cleaned and turned over in about half that time.

I am an endo nurse. Started at an ASC then went to hospital. Hated the hospital. Sure, the procedures were more interesting, but being on call was awful!! Dragging my butt out of bed at 2am to drive in to retrieve chicken out of someone's esophagus was no fun. The on-call $ were awesome- but not worth it to me. I am back at my original ASC and am soooo happy. When I go to bed, I get to stay in bed. On weekends I drive by the hospital and am so thankful that I am on my way to my kid's baseball game or whatever rather than setting up for an ERCP. You certainly do have some additional considerations with daycare and whatnot- but, in general, the quality of life at an ASC is so much better than the hospital. My opinion.

Re: administering sedation I work in an outpt facility which utilizes anesthesiologists only one or two days per week. The other days of the week the RNs administer fent/versed for one set of providers, and do NAPS for the other. When doing the fent/versed the RN will also assist with bx, etc. as much as they are able. A GI tech is always available if necessary- if there are too many specimens to collect or the pt requires constant hands on attention. When administering Propofol that is all the RN does. No specimen collection. We are always right by the pts head monitoring airway at all times. I really enjoy both types of sedation. Though my RN job is easier when the anesthesiologist is present, it is also less interesting.

If tissue is routinely getting stuck on the forceps it could be the doc is taking too many bites. I work with one doc who tries to get 6 bites each pass with standard forceps. We use tweezers to pry off the "hangers-on". Doc just has to be patient while we work at it.

Really, Nurse Beth, a "death sentence"? Dramatic much? I was an older new grad five years ago. MedSurg is not for me. It would never be for me. I can't even imagine doing it for a day. Just not my thing. Five years ago as a new grad I took three PT jobs in three different cities in two different states to avoid the hospital. Fast forward to now and I am working in an outpatient procedure clinic...no nights, weekends or holidays and making $46 per hour. If that is a "death sentence" I'll take it. I know this post is old, but I hope the OP took the position that will make her happy and satisfied!!

The AER is in the clean room in the hospital I worked at. The scopes are also hung in closets in the clean room.

This is funny to me. "Vet nurse" is fine. Who cares???

OP- I was never a "floor nurse". Part of admission to my nursing school was obtaining CNA certification...and I detested every minute of it. I also knew that I could never take care of the same patient for 12 hours. I have so much respect for the nurses who do this, but it is just not my thing. I love procedures and got hired into an ASC right after graduation. I have done hospital endoscopy. I am now in outpatient endo and it is truly my dream job. It is very fast paced and routine. My skill set is much more narrow than a floor nurse: I admit and recover patients, start IVs, provide conscious sedation and assist the physician. We do have new grads there at times. They do well. There are always other nurses and physicians available so no one is ever, ever alone. Just something to think about. I never thought this is where I would be happy, but I truly do enjoy going to work. Don't be miserable. Not worth it. Not at all.

You can read the ASGE position papers. I found those fairly helpful. If you want to familiarize yourself with the processors, scopes, etc. you can Google Olympus and ERBE. Boston Scientific manufactures many endo supplies, they have a YouTube channel that can give you a basic overview of equipment and procedures. You can Google images of ERCPs which will help you get used to seeing stones and strictures using fluoro. I read a lot about patho of UC, Crohn's, polyps, Barretts, varices, etc. Medication wise there is not a ton to learn. Your primary drugs will be whatever is used for sedation (we use fent/versed and propofol). Other than that, zofran, glucagon, Indocin......nothing you're not already very familiar with. I hope you enjoy your new path!

New RNs in Portland,OR metro area hospitals start at about $35 per hour.

I know people who have graduated from each of those programs. All were satisfied, but totally overwhelmed with student debt. I was in a similar situation as you-kids, already a BS in another field. I went a different route. Earned my associate's degree from a local community college in the PDX metro area. Cost was under $10k- no loans. This was four years ago. I work for one of the multi facility health care systems in the area and will slowly work on my BSN online over the next year at a cost of approximately $6k with my hospital picking up part of the tab. Just something to consider. From the schools you listed I would go with Linfield. Seems the most economical and Legacy offers the most opportunity for new grad residency. Good luck!!

I am a school nurse in WA- where we are having the "epidemic". We are taking it very seriously, although, truthfully it is difficult to do much more than inform people and encourage them to get vaccinated. This particular outbreak also seems to be affecting people who have been immunized, which I find tragic. I personally have dealt with a couple of students in this situation- they do everything right and then....shazzam.....end up with it anyway. I am hoping maybe they just got a bad batch of vaccine or something..................

Gina- You can totally despise PCT work and still enjoy nursing and be a fantastic nurse!! In order to be accepted into nursing school we had to be CNAs. I took the course and hated every single moment of it. Truly. Got my certification and never worked a day as a CNA. I never want anything to do with ADLs....ever. Just the way I am. I raised three children and my days of toileting, bathing and oral care are OVER!! You DO NOT have to do these things in nursing if you don't want to. I work as both a school nurse and a recovery room nurse. Haven't wiped a butt yet and I don't anticipate having to anytime soon. If the need arose, however, I would take care of it with a smile on my face. For me the interesting part of nursing is managing care....which I do at the school. The recovery room is exactly the same, only on a very short term basis. Both of these jobs offer tons of autonomy without what I consider the "yuck" factor. There are tons of different things out there to do with nursing- not all of them are in hospitals. I think you could find something you would enjoy a whole lot!!