Unsafe Interventional Radiology Practice

[ElleFur]

Hi. Looking for some career advice. I recently started working at a private- physician owned Interventional Radiology Clinic. I am an RN and was hired as a sedation IR Nurse. Since starting here- it has come to light that none of the nurses administer medications with physician orders. When I questioned administration about this- they claimed we work within ' verbal orders' but during procedures— the doctors are not giving any orders and nurses are expected to administer conscious sedation before the MD enters the room. Now, the practice claims that they can not find nurses to work so they are hiring EMT's to 'recover' patients post conscious sedation. Sometimes we are doing sheath removal for arterial puncture, placing foleys,  accessing ports, etc. Are EMT's trained to even do this??? Looking for any advice. I feel like my nursing license is on the line here ! Thank you 

[Been there,done that, ASN, RN]

Please clarify.  A nurse cannot administer any medication without a doctor's order. Are there standing orders  somewhere?

[ElleFur]

No, we have an outdated electronic system and all of the nurses charting is paper charting. But there are NO standing orders, no sliding scale, no signature on anything the nurses do... the nurses push however much versed or fentanyl they feel is appropriate for each patient without any oversight from MD. There are no CRNA or APRNs in our practice... only RN and now EMS... 

[chare]

ElleFur said:

... Now, the practice claims that they can not find nurses to work so they are hiring EMT's to 'recover' patients post conscious sedation. Sometimes we are doing sheath removal for arterial puncture, placing foleys,  accessing ports, etc. Are EMT's trained to even do this??? Looking for any advice. I feel like my nursing license is on the line here ! Thank you 

If they are EMT paramedics, possibly.  In some states, paramedics are allowed to work in health care facilities.  Your state's office of EMS should be able to help answer this question.

ElleFur said:

... But there are NO standing orders, no sliding scale, no signature on anything the nurses do... the nurses push however much versed or fentanyl they feel is appropriate for each patient without any oversight from MD. ...

If a nurse is administering these medications without orders, he or she is practicing far outside her or his scope of practice.  If there was an adverse outcome related to this practice, the nurse would likely be solely held responsible.

If it were me, I would not do this.

[NRSKarenRN, BSN, RN]

What is your state BON regs/position re conscious sedation???    Make sure your malpractice insurance is up to date. SO many RED flags here, skating on thin ice.  RN staff should demand a meeting to get written standing orders --even if just hand written on computer paper, dated and signed by physician posted in procedure room better than nothing when event occurs.

Joan Rivers death comes to mind... complication of conscious sedation.

[Been there,done that, ASN, RN]

ElleFur said:

No, we have an outdated electronic system and all of the nurses charting is paper charting. But there are NO standing orders, no sliding scale, no signature on anything the nurses do... the nurses push however much versed or fentanyl they feel is appropriate for each patient without any oversight from MD. There are no CRNA or APRNs in our practice... only RN and now EMS... 

So, the nurse  has no doctor order to administer medication. Why is this even a discussion?

[Been there,done that, ASN, RN]

You need to run. There is a reason the facility cannot find nurses.

[delrionurse]

Sounds like an easy way to get thrown under the bus. The reason for the sloppy rules in that office seems to be that doctors don't have to watch their back like nurses do. 

[lifelearningrn, BSN, RN]

None of those duties should be without orders! Run, run away fast. 

[floydnightingale]

Well documented verbal orders should be okay but I have never participated in a conscious sedation without a staff physician, usually  a resident but ALWAYS a staff doc, at bedside. And usually a pharmacist too. Twenty years in level one ERs where EMTs performed duties performed by MAs in other settings and I wouldn't trust most of them to walk a dog. Their decision making skills just aren't there. Sounds hinky to me. Consider getting our ASAP.

[C.Love, MSN, NP]

This is very wrong, and basic information our nursing schools should be teaching. We as RN's can't give medications with out an order, otherwise we are prescribing which is not in the RN scope of practice. Plus how are controlled substances accounted for in this facility? I'm very concerned where our health care system is heading. There are plenty of nursing jobs out there, why stay at an unsafe and unscrupulous place like this. We all need to be looking out for our patient's best interests and do what is right. I'm glad you asked this group. It helps to hear the opinions, which most likely are reinforcing what you know to be right. 

[delrionurse]

floydnightingale said:

Well documented verbal orders should be okay but I have never participated in a conscious sedation without a staff physician, 

And doctors don't need an order to give procedural sedation meds. They won't have their licenses  under investigation for ridiculous things not under their control. Nurses can't have 25mg of Roc or Propofol missing or undocumented/unaccounted for just because it was an emergency.