Nurses General Nursing


I work in PACU & recently had ALL ON-CALL personnels wages decreased from double time to time in a half. As a result, there were quite a number of cath lab nurses that resigned, & PACU now has to "temporarily" recover OP cath lab pts.(Nothing is temporary in our hospital). We were given a 20 minute in-service (versus a 3 month preceptorship of cath lab staff)...& started receiving these pts a few days after we were told of the administrations decision & in-service. Our unit is also understaffed. Aside from recovering surgical pts, we also do pain management pts. We are 2 hospitals, but our hospital cares for more trauma victims than our sister hospital. There are several cases that may require our surgical pts be intubated, or surg. complications may arise. 2 crisises have occurred w/ these cath lab pts in that one started to bleed excessively while we had a room full of surg pts/ & the other arrived w/ TPA infusing (we were never in-serviced about this drug) & this pt ran into several problems while in PACU. We could not reach the doctor who performed the procedure...no dr's are available for these pts versus PACU pts who have the anesthesiologists there at all times. There's more to this, but this is just the gist of our dilemma. We feel we are dumped on & the pts suffer. Yes, we had a meeting w/ the "higher up" but still nothing has been resolved, no further in-services,no monetary compensations, etc. 2 RN's have quit, & more are contemplating (only 7 of us left & 1 still in training) Takes quite a long time to train PACU RNS'. Any advice?

Be very careful. It sounds as if you may be flirting with malpractice. If you accept an assignment you are implying ability to care for that patient on your license. PACU is a specialty and requires specific training as does the cath lab or OB,etc. If you are not comfortable accepting the responsibility for certain patients due to insufficient training put it in writing as perhaps a risk screening to the "higher ups". Then seek out the chains of command, so to speak, beyond the immediate levels of management, i.e. the union, state health department, etc. Good luck.

You have a right to refuse an assignment. When I am not comfortable with an assignment, I just won't accept it. TPA is a serious drug, and without proper knowledge...I am afraid of the possibilities. Let the "higher ups" come and take the patients.

I agree with the comments/suggestions made by nanjam.

Be sure to document your concerns using your facilities "incident reports" where appropriate. Nurses do have to be concerned about malpractice claims. Do not accept assignments for which you do not feel you are properly trained or skilled. However, also recognize your responsibility to voice your needs and seek out the proper training if you wish to stay in this "changed" environment. Management has a responsibility to ensure that they place only properly trained/skilled professionals in these specialty areas or provide the proper training to ensure safe patient care. As professionals, nurses need to be sure that they stay current with their skills, know their limitations, and do not accept assignments they are not capable of handling appropriately. Don't be afraid to seek the advice of an attorney to help you deal with both the professional and employment concerns. Also, utilize your state's nurses' association and Department of Public Health. Good luck!!

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