RN left alone

[LASRN3911]

I wanted to get some other RN insight/experience:

I work peri-op services for same day surgeries. The facility in which I work has a regular practice of leaving RNs by themselves in the department to discharge patients. No one is left on the floor including unit secretary, no MAs, literally no one. The nearest RN (or anyone for that matter) is an OR RN who may not be available (in a case) or a PACU RN who is down 2 halls and through a heavy double door (the OR RN is likewise down hall and through double door). My concern is if pt codes, had major issues - everyone is out of ear shot. We do carry phones, but if I'm holding pressure on a site or doing compressions, for example, it would be difficult to use my phone.

What do you do in your facility?

I got somewhat reprimanded for saying that I did not feel comfortable staying alone on floor. I have never NEVER worked anywhere in my last 11 years that allowed this. What do you think?

[ruby_jane, BSN, RN]

So this is like after "standard business hours" (whatever those are?)

Your concern is real. I don't have a solution, but I see great liability for the entity.

[Sue Damonas, BSN]

That's unsafe and I doubt that's legal.

[EDNURSE20, BSN]

I work float pool, but often work in same day surgery. And my hospital is the same, one rn is left to d/c the pts. Some shifts are hectic, but also some are dead quiet. I’ve never really had any issues in the 2.5 years I’ve been there. I know if I hit the emergency bell everyone will come running. But Most pt are very stable, The ones that can’t be d/c quickly get moved to the floor, so I’ve never had to use the emergency bell.

[brownbook]

6 hours ago, nznurse93 said:

I work float pool, but often work in same day surgery. And my hospital is the same, one rn is left to d/c the pts. Some shifts are hectic, but also some are dead quiet. I’ve never really had any issues in the 2.5 years I’ve been there. I know if I hit the emergency bell everyone will come running. But Most pt are very stable, The ones that can’t be d/c quickly get moved to the floor, so I’ve never had to use the emergency bell.

I agree completely. LASRN3911 are there code buttons within easy reach? An anesthesiologist, surgeon, scrub tech and OR nurse are right down the hallway.

When I worked on call PACU I was alone. The anesthesiologist was down the hallway. A code blue button away.

[FolksBtrippin, BSN, RN]

You were reprimanded for expressing your concern and discomfort with the situation?

That's a really bad sign.

[LASRN3911]

Yes, I know. My current manager has an interesting, very hands off leadership style.

[LASRN3911]

On 2/12/2020 at 10:35 AM, brownbook said:

I agree completely. LASRN3911 are there code buttons within easy reach? An anesthesiologist, surgeon, scrub tech and OR nurse are right down the hallway.

When I worked on call PACU I was alone. The anesthesiologist was down the hallway. A code blue button away.

Yes, we do have code buttons. I guess my concern is that I'm really quite new to peri-op. Determining what is expected pain, bleeding, etc is new to me. One night, for example, all the RNs left, but I asked my manager to stay with me, because I had a deaf patient whose interpreter was leaving, she was having 10/10 pain after her lap chole and then when she got up out of bed, she started bleeding some - she ended up soaking through a few stacks of 4x4s. I didn't think she was critical became her vitals were stable, I held pressure on the site that was oozing, so in that case I wouldn't rly need the code button. But it was super helpful to have some extra hands and to help alleviate some pt anxieties. She ended up being admitted, but the process was so much easier with help. Our OR RN was busy and so was PACU RN. Not sure what I wouldve done otherwise. Plus, the doc was in a looong hemicolectomy and he made me sit on this pt for like 3.5 hours before he finally gave me orders to admit her. So, we don't often get to admit "quickly" even though this girl should've been admitted much sooner.

I think maybe I just need to talk to my supervisor and let him know my comfort level. Of course, some of those easy discharges are totally fine. I just haven't had a lot of luck with lap choles I guess! I've had to admit the last 2 out of 4 because of pain!

[brownbook]

I understand your concerns. You've run into some difficult situations and your manager is an idiot.

Talk to your supervisor. Give him the specific example of the deaf patient. Ask him for suggestions of what to do when you're alone in a situation like this.