RN's and heavy sedation

Altra, BSN, RN · Aug 2, 2007

This sounds like a bad situation, especially if you've already been terminated.

I realize that you may not be able to discuss details here, but your post raises many questions:

1) you administered meds according to your facility's policies/protocols ... but were terminated? Was there a bad patient outcome?

2) Were the policies/protocols reviewed by corporate administration and found to be inappropriate? Were there negative patient outcomes? Was every nurse who administered meds according to these protocols terminated?

3) You say that the policies required you to give meds "beyond your license." If you believed that, why did you administer them?

Employment can come and go. Losing a license and, therefore, losing the means to make a living are two different things.

nanabanana · Aug 2, 2007

Employment is usually at will, leaving little recourse for wrongful termination. Arguing that one was forced to exceed his/her scope of practice will not do the nurse any good, only harm.

A nurse has the duty to refuse to exceed the scope of his or her practice.

Telling the radiologist he or she may give the medication; but, you, the nurse, cannot do so, is appropriate. It is also appropriate to inform the radiologist that X dosage of Fentanyl and Versed cannot be administered without simultaneous ability to entubate and ventilate the patient and if he/she would like to gain necessary support staff, you (the nurse) have no problem giving the requested dosage.

Check with your licensing state board and find out to what degree you can administer conscious sedation.

I'm sorry that you lost your job. Be glad you didn't become involved in a wrongful death lawsuit. If you had exceeded your scope of practice, you would have had no legally defensible stance.

hbspm4nrsg · Aug 3, 2007

Thank you for your response -

No there was no negative patient outcome. The patient was having

brief apnea episodes 30 min, following transfer to floor and I was called back and was told by my supervisor to take reversal. Patiend exceeded discharge criteria when taken to floor. Aldrete was 9/10 and SpO2 was 96% on room air for 30 min with no apnea.

I assessed the patient and he seemed a little more sleepy than upon

transfer and was having apnea -- whether sleep or sedation not clear

gave Romazicon according to hospital standard and no other complications were noted. Pt was monitored continually following reversal admin.

I know the hospital was in trouble for sedation policies in general and all administration was put on notice from corporate.

I think they needed a "scapegoat" to save their own jobs and I was

terminated. They cited that I was acting as a physician and needed an order for the reversal even though the sedation guidelines that the

hospital institued clearly states I did everything according to protocol.

(just like with ACLS, if pt unstable and severe bradycardia is present

Atropine can be given without physician notification/order - it is covered by the certification guidelines).

I am checking to see if they required me to practice beyond my scope of licensure...I was clearly hired to practice heavy sedation. We have

never had a negative outcome or death but have on occasion had to

give reversal.

No other nurses were terminated and I do not know the specifics of the facility violations - only heard that admin. was in deep trouble.

Next thing I know I was fired.

I have been practicing high level critical care nursing for 23 years and have never been written up for anything!

I just want other nurses to be aware that your facility may want you to be certified and credentialed to practice higher levels of nursing -

but, if they are unwilling to stand behind their nurses practicing within

their own set guidelines - you can end up like me...wrongfully terminated for doing your job according to their standards.

Talking to attorneys @ this point,

DutchgirlRN, ASN, RN · Aug 3, 2007

I administer conscious sedation in my job. Versed & Fentanyl. The requirements are a doctors order, an interventional radiologist must be present, must be an RN with ACLS, must first be checked off by supervisor. VS Q5 minutes and PRN. 02 per NC. Outpatients must be monitored for 1 hour following a procedure. And obviously they must have a patent IV.

DutchgirlRN, ASN, RN · Aug 4, 2007

I recently was terminated for following our hospital's guidelines for administering heavy conscious sedation. I completed the competency packet upon hire and was told in my interview that this was a requirement of the job in the CCL. Fentanyl and Versed were routinely given in large quantities by RN's for VBR patients (Vertebral Body Reconstruction) by our Interventional Radiologist. The hospital was being surveyed by corporate for this practice and I think I was the scape-goat to keep administration's jobs. I think I was required to practice by my facility beyond my license and they abandoned me when their requirements were under scrutiny. I was practicing under the supervision of my physician and within the written policy they required. Please let me know what you think. Thanks

What do you consider large quantities of Versed and Fentanyl?

The doctor tells you how much to administer. You note the time and amount of what is given. At the end of the procedure the doctor signs the med orders. No poor patient outcome so where is the problem? If you're pushing meds in reasonable and safe doses, which is dictated by the physician how is this beyond the the limits of your practice?

Are you the same member who e-mailed me? If so, I tried to return your e-mail and the message said "this sender has chosen not to receive e-mails"

clee1 · Aug 7, 2007

Talking to attorneys @ this point,

You are doing exactly what needs to be done.