Chuckie

I've been retired from the 446 th AES sq. McChord AFB Wa. for nearly 15 years now. It sounds like it has changed a lot I was on the C 130 and C 141 with some C 9 experience Loved it

I've worked GI for ten years we pull a lot of call and have a multitude of different physicians that like sedation given a different way. One hospital the Anesthesiologists have written the procedural sedation policy and for the most part it is fine. One hospital is different in the sedation and how it is given. The physician tells you how much you give at a given time. I also work in an out patient setting that has different rules. The sedation thing mainly goes with gut feeling and a good patien assessment. The assessment thing is sometimes challenging because I am not always the one that admits the patient and a lot of the times I am walking in after the physician and he is ordering me to give sedation without knowing the patient. You just have to step up and say wait. I'm 55 years old and I would just say hang in there that GI lab is usually the best hours of any other area in the hospital and things rarely go wrong. I've worked the floor before and was always scared that something wasn't done or that I take problems home with me. Like what did I forget to do on my shift. I feel GI is something that you go home at the end of the day and can leave work at work. Hang in there you'll love GI

Phase 2 are all conscious sedation gi patients or bronch patients usually Demeral/Versed, Fentanyl Versed and nearly all get Benedryl for sedation. We are free standing somewhat across the street from the hospital. The OR patients go to phase I they are sedated by the Anesthesiologist and not the procedure nurse. Phase II only has one person in the room with 6-8 or even more patients. I would like to add a person to the room but the understanding is that it is always 6 patients to one nurse everywhere. That is the law. Only other place is ICU,ER and Phase I recovery where it is 3 patients to one Nurse. This is a nationally set and written in stone everywhere in our hospital. They figure since it is a recovery room and most of the patients are asleep then they do not need extra help. That the patients are requesting a lot of help and you just get your vitals for 30 minutes and either discharge them or send them back to there room

We are somewhat free standing. We are in a hospital but only admit and recover our patients GI lab and Bronchs. We have one person RN in the room with 6-8 beds this person answers phones admits discharges recovers and calls the floors for patients to come over from the hospital. They are all conscious sedation usually demeral/Versed, Fentanyl/Versed and nearly all of them get Benedryl for sedation. By 1000 am it is full and they are all fairly heavy sedated especially if they have had Benedryl.

What is the nurse patient ratio in aPhase 2 GI lab. Recovery room? We have one RN with 6-8 patient slots. Usually full with post bronch and gi patients. The rn is responsible for admitting in patients and recovering all patients with no other support from anyone else. She is unable to leave the area and rarely gets lunch or breaks. I was wondering if there were any guidelines for the ratio in the phase 2 recovery. Most patients are very sleepy and I know a lot of phase 1 recovery will have a 2-1 ratio for heavy sedated patients.

What is the nurse patient ratio in the phase 2 recovery room. We have 6 to eight slots in the gi lab. And one Rn. The rn admits all in patients and recovers and discharges all out patient. This is somewhat dangerous and. I was wondering if all facilities use the 6 to1 ratio for phase 2 recovery.

We run two rooms a day 10 hour days 18 cases per room each day. Two Nurses in recovery room 1 RN at least other is PCA, Ma, or LPN Two admit nurses either RN or LPN One RN in each room and one either LPN,MA or Surgical Assistant, PCA One Scope washer Scope washer takes down the dirty scope and the assist person washes down every thing between cases and sets up for next case while the RN takes patient out to recovery room and gives report. Admit person brings next pt in to room and hooks them up. Works well if we are short a person then the assist person usally floats from room to room most colons are pretty easy with one RN in the room unless Snaring when we do uppers we usually need two in the room to help. Two secretaries usually one to break down charts and set up followup apointments . One to check patients in. We do 0700start 0730 Colon 0800 Colon 0830 Upper 0900 Colon 0930 Colon 1000 Upper 1030 Colon 1100 Colon 1130 Upper 1200 lunch 1230 Colon 1300 Colon 1330 Upper 1400 Colon 1430 Colon 1500 Upper 1530 Colon 1600 Colon 1630 Upper 1700 Clean up go home

In washington state the only thing an OR tech is able to do in the GI Lab is clean scopes. They have worked in our GI lab for the past 10 years doing nearly everything but sedate the patient which takes an RN. About 6 months back someone found a piece of paper that said that they can not sever tissue which was to understand that the could not biopsy inject, or snare or cut on and ERCP or clip so they trained all the RNS to do there jobs and they were eliminated from our GI LAB. Now the same paper that was found somewhere says that an RN is not allowed to sever tissue. So does that eliminate our jobs too? We also do the cuts for PEGs which on bad days we are told we are not allowed to do and on good days we are told we are allowed to do. go figure

Two Rooms Two Doctors One Admit Nurse, Per room RN or LPN Sedation RN Per Room, 1 tech per room or if short Floats most of the time Most often this person doesn't exist. One Scope tech 2 Recovery room Nurses either RN or LPN All meds drawn up at beginning of day by sedation nurse

We sit on our butts and eat bonbons.

Day care at Good Sam is from 0630 to 1800 for infants to kindergarten. After Kindergarten they have a summer program that the kids love. Summer program goes up to age 12.

we do18 cases per room per day 0730 colon 0800 colon 0830 egd 0900 colon 0930 colon 1000 egd 1030 colon 1100 colon 1130 egd lunch hopefully 1230 colon 1300 colon 1330 egd 1400 colon 1430 colon 1500 egd 1530 colon 1600 colon 1630 egd 1700 clean up go home Patients are asked to come in 45 minutes prior to procedure time for IV and admission. If they are late they get rescheduled even if prepped. There rides are not allowed to leave the building and Recovery time is 30 minutes. Very efficient business. Yes it is a business an endoscopy business not a hospital.

Oh yes, LPNs can not sedate in the state of Washington. However they can work in GI doing to Physician assistant side of things. This does free up the RN to do the Sedation and monitoring of patients.

What state are you from? In Washington state OR tech's are working out of there scope of practice if they are working as GI Tech's. We are hiring RN's in the GI lab and are asking for experienced GI Nurses. Puyallup WA

No pay difference from Diploma, ADN or BSN. I went back for my BSN in order for a Military Promotion. I retired a year after getting my BSN without the promotion because of personal reasons. The BSN did help me get better jobs rather than just floor Nurse and I have been a manager on occasion. I didn't like management but I like patient care and like getting off the floor. I work in several different areas that will only hire a BSN. Areas like Cath lab, GI lab, Radiology, PACU, Special Procedures, and Care Coordination. When I had the diploma my job applications would be put at the bottom. Another thing I noticed is to get certified in everything possible. ACLS, Pals, IV Therapy, Specialty certifications. It may not increase your pay but it could get you the job.

If anyone can help me with this I live in Washington State. The problem was Gi was always under Surgical services and at some point the surgical techs followed to Gi lab out of the surgical suite and the idea was that if they were able to do all the surgical services then why not GI. Cautery is technically done by the physician and nothing is done in the room that is not done under the direct supervision of the physician. Many hospitals in Washington state still use Surgical technicians to assist the physician and are supposedly not following the Scope of practice. I believe the management at the hospital I work believes they want a full RN Staff and created policies that they want us to abide by. We have had surgical techs working out of there scope of practice for over 10 years and it was never discussed that they were not working in there scope of practice. Now all of a sudden they are getting layed off after they teach the RNs the assisting side of GI. It isn't like I don't want to learn it I feel that if they are not qualified to do the job why are they qualified to teach the job. They are loosing there jobs shortly after teaching us this has created a lot of problems in a department that has always ran without any problems.

Yes go for it. It is so funny to me I retired at age 40 after 22 years in the military. Joining was the best thing I ever did in my life. They paid for my nursing, diploma,degree and masters. Go for it.

LPN's are not hired at our hospital I guess management feels they don't know enough. Now our surgical techs will be PCA and transport patients. The problems is the cuting tissue with a snare techs are not allowed to do that or inject through a scope. Everything else they are allowed to do. The snaring of tissue is done with the direct supervision of the physician. They have done this for 10 years and are better at it than any RN ever yet they are not qualified to do the job. They are looking into RN's doing the cut on PEG tubes. This is also cutting tissue if RN's are not allowed to cut for PEG tubes does this mean RN's are not allowed to snare polyps?

Does anyone use surgical techs in the GI LAB? We have for ten years now all of a sudden there scope of pactice isn't good enough. The only thing I see which they are unable to do is inject through the scope, like epinephrine and ink. They currently do snaring with cautery under direct supervision of the physician. Cautery is also used in ERCP's and that is also done in direction of the Physician. No they want to get rid of the surgical techs and have the RNs doe that. I know that management is filling us with BULL because the Association of Surgical Technicians states that there job is to use cautery under direct supervision of physician and that most of the other duties of the technician in our department is not as indepth as if they were actually working in the OR. Technically that doubles the RN's job and also the call schedule doubles. We are not to increase our RN's staffing

Where is your union that is bad I wouldn't do it. All RN's get paid the same in our hospital depending on years of experience we get $4.oo per hour for call pay and when we get called in we get paid for 4 hours of overtime even if the procedure is cancelled. We are required to have one RN and one tech in all procedures. The problem we are experiencing now is scope of practice of our Tech. For the last ten years we have had OR techs in procedures and now all of a sudden they are not allowed to inject or cut tissue which means they are not allowed to inject epi or snare. Another issue is RN's doing the cut on PEGS we were allowed to for over ten years now all of a sudden we are not.

What are some of the policies on accessing ports on patients using a spray numbing med. I know our outpatient clinics use them, however the hospital sticks to stricter policies and do not allow this use. I had a patient complaint against me for not using this and thought I would research it a bit. I work in a hospital setting.

We did many IVs in the Military as med techs on base with blood draws. I worked in doctors' offices as a civilian at the time, too, and I found out that I was allowed to do whatever the Dr needed. I did x-rays, blood draws, and IV starts I was not licensed at the time. Later I took the LPN test while I was in school for RN.

How does the Doc do a polypectomy alone. The reason for an assistan is to do the cut with his help.

We measure cecum time which is after reaching cecum desired time to exit is 7 minutes. Some doc's can get to cecum with in a minute some take much longer. Recovery is 30 minutes usually let patient sleep 10 minutes then get them a drink and take off the O2. Get them dressed up in a chair to wait for Dr to talk to them. A lot of patients would sleep all day if you let them we have two spaces in recover room per doctor so if one patient takes longer than this routine we are in trouble.

I work both outpatient endoscopy and hospital GI Lab. In the outpatient we do 36 cases a day run two rooms. You need assessment skills, computer skills, and really good IV skills. The nurse does sedation for gi cases we assist in the procedure with polyp retrieval and biopsies and we take down dirty scopes and hang clean scopes and we also clean scopes. If we get a sick call then you are usually alone in the room to hook up patient, put patient data in the computer, sedate patient, do biopsies, snare, inject, cautery, and retrieve polyps along with abdominal pressure when needed then chart all of this and taking down the scope and hanging the new one. Turn over of nurses is frequent in the outpatient clinic because patients are scheduled every 30 minutes and when you are short a nurse you need to pick up the slack. Good part about out patient clinic no call or weekend shifts. We do 4 ten hour shifts. In in the hospital we do all sedation procedures. We transport patient from rooms to GI then admit sedate recover and return to room, We doEGD's Colonoscopies, ERCP's bronchoscopies, bonemarrow biopsies, Monometries and ph studies and we do all radiology cases like liver bx mylograms, lung biopsies and abdominal biopsies. We do all outpatient IV's and most of the inpatients need IV that come from the floors. I find the floor nurses hope we place all new sites when they come to GI. The disadvantage of hospital is evening and weekend call. Lots of Call