Small, rural hospital: OR RN's recovering their own patients

[wilbur1]

I really need some help here. I am a new manager of a Surgical Services Department at a rural hospital. All of this is new to me, but especially that of working at a small rural hospital where the "rules" seem to be quite different to that of a large hospital. What I am REALLY struggling with right now is trying to get a understanding of the OR RN's recovering their own patients. All that is required is that they be ACLS certified and receive a brief orientation. As we all know, just because you have earned your ACLS certification that doesn't guarantee that you have a clear understanding of the knowledge that is needed. We also do not have any designated PACU RN's-only the OR RN's. This whole thing just scares me to death-and keeps me awake at night.

Unfortunately, this practice is not exclusive to just this rural hospital. There are other surrounding rural hospitals that perform this practice. Now, my background is exclusively in the operating room-I do not have Pre-op or PACU experience-but this doesn't seem right. My perception has always been that the PACU is an area that requires RN's that are skilled and well-versed in the many different scenarios that can go wrong. I don't see my OR RN's being that knowledgeable (not as knowledgeable as they should be, in my opinion). I am also pretty sure that these RN's have not taken a basic EKG course either.

I know that rural hospitals tend to be much tighter with their money, thus forcing departments to have to take on many different roles. Am I off-base here? I have only been working at this hospital for a couple of months and am dealing with SO many issues. I am going to talk to administration about this next week, as I am gathering as much data as I can to support my position. I am going to present my findings and ask that the legal department look into this, as I really need to know what is right and what is wrong. Also-there is only 1 RN that is recovering each patient. From what I understand, there should be 2?

Thank you.

[PostOpPrincess, BSN, RN]

Please do yourself a favor before you get into BIG trouble. Visit ASPAN.org for the standards of practice.

Do it NOW.

[Laney123]

OH MY... I agree with JoPACU.... BIG mistake having OR RN's with no pacu experience recover PACU patients. There are so many things you need to watch for and be prepared to act on. Good Luck

[katkonk, BSN, RN]

I agree with above (wise) nurses. You are right, PACU has a different set of skills than an OR nurse, although sometimes some nurses have done both (but that is a rarity). Since the management that holds the purse strings call the shots, approach it from a business angle/bottom line. OR nurses are always in high demand, because it is such a specialized skill set. The OR nurses would likely be better utilized for fast turn overs in the OR and the ability to minimize OR surgical staff manhours (including anesthesia and surgeons) if the OR nurse was able to leave their patient with the PACU nurse and return to turn over the room and begin the next surgery. I am sure that doctors don't like waiting. The PACU nurse then has the special skills to recover patients and discharge to home or to the floor. I have recovered patients by myself many times (especially when called in, in the middle of the night) and it was fine, AS LONG AS THE ANESTHESIOLOGIST OR some other staff are only a call bell or code button away. Assistance, if needed, is needed immediately. There would be no reason to tie up 2 nurses for one patient. If two patients are in there at once, transportation help is needed, because one may need to go to the floor or home, and you cannot leave the other patient. Good luck with your new job. It sounds like you have a lot of "old ideas" you will need to conquer.