Scope of practice

[Meigsfla]

So I have a question regarding scope of practice. I work for a large hospital and the word on the street I'm hearing from my Nurse Manager, charge nurses, and co-workers is that the hospital is phasing out most of our Profusionists. Right now it's voluntary but soon I hear we will all be forced to become LVAD certified and manage the machines ourselves while the pt is in pacu. Currently when we receive a post op sx pt that has an LVAD a profusionist accompanies the pt and manages the machine while I manage the pt and they are there if something happens. Now also to mention I might get a LVAD pt maybe once a year if that our unit doesn't receive very many. So with little exposure is taking a one day 8hr class really sufficient enough and safe practice when the profusionist goes through years of schooling and experience to care for these patients? It all seems fine until one day something happens and a sentinel event occurs and the nurse is blamed. I feel like I need to watch out for my best interest and license and what's safest for the patient. I Also wonder if managing these machines is in our scope of practice? I am contemplating contacting the board of nursing to clarify just wondering how other PACU's deal with this type of patient? Thanks!

[Rose_Queen, BSN, MSN, RN]

Do you mean perfusionist? Our perfusionists aren't even involved in the management of a VAD. They are solely responsible for running the cardiopulmonary bypass pump during surgery, and these healthcare team members don't actually have years of schooling to manage VADs- that schooling focuses solely on CPB.

We have VAD coordinators who are responsible for the management of the VAD itself. They are nurses and NPs who have gone through additional training, are very involved during the VAD implantation period, and accompany patients who already have VADs both to preop and through the post-op phase for surgeries that don't require direct admission to ICU (bypassing PACU). Nurses in ICU and the designated post-OHS floor have also received additional training on VADs, but have access to the VAD coordinators if needed.

[CCU BSN RN]

1. Perfusionist* They're critical members of our team, we should probably get their title correct.

2. What state are you in? State laws regarding RN v. Perfusionist scope of practice varies WIDELY, so that's highly important info for anyone who wants to provide legitimately useful information to you.

[CCU BSN RN]

Also ditto Rose Queen, we have a VAD coordinator and team who manage VAD patients specifically.

My main issue with phasing out perfusionists would be management of ECMO more than anything else. Obviously they're not phasing out the perfusionists managing bypass in the OR...I mean, literally who else could do that job? (Seriously, if there's an answer to that I'm curious as heck)

[Here.I.Stand, BSN, RN]

Years ago I worked in a CVICU, and we managed patients with VADs by ourselves all the time. I've occasionally seen perfusionists run ECMO if no trained RN was available, but never a VAD.

[Meigsfla]

Here at my hospital in fla the word on the street is the cvicu nurses have to train on ECMO now as well. As far as in the OR I am not sure. I guess what I am wondering is if a one day class and little exposure to this pt population is safe or maybe this is normal practice all over the country.

[Greenclip]

I had a one day class to train on LVAD. We have LVAD patients in recovery. Our main task with the LVAD is to get them off battery and onto wall power for their PACU stay. Having said that, we have been told over and over again that we don't even have to do that if we are not comfortable with it. (We can either leave them on battery or call the VAD coordinator to switch them over to wall power.) When they are ready to go to their post-op floor. the VAD coordinator comes for transport. We also call the coordinator if we have any concerns, even minor ones, about the VAD.

Obviously this doesn't apply to patients who are going straight to the CVICU, only to those going to a high-risk cards floor.