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Reflections of a Postanesthesia Care Unit Night Nurse
Reflections of a Postanesthesia Care Unit Night Nurse ELLEN
L. POOLE, MS, RN, CPAN, CCRN
The American Society of PeriAnesthesia Nurses has long held the standard that two licensed personnel will be in the PACU during phase I of recovery. Not all areas of the country have been able to adhere to this standard. This is one nurse’s reflections on the time spent “working alone” in the PAW. This article was written before the November 1995 ASPAN position paper on stafing issues. The author strongly feels that with the position paper in place, facilities will make a stronger effort to adhere to the standard and working alone will become a matter of historical record. 0 1996 by American Society of PeriAnesthesia Nurses.
A
NUMBER of years ago, I decided to return to graduate school. As with most graduate students, continued employment was a necessity. I was able to transfer to a full-time night position in the PACU close to my home. Did I mention that I was the only employee? I held that position for 4 years. What follows are my answers to the numerous questions asked of me throughout the time period in addition to the questions that I asked myself. QUESTIONS
TO MYSELF
Why nights? I am a “natural night owl” who can sleep during the day without difficulty. Working nights gave me the flexibility needed for a varying school schedule. Why by myself? This was the job available. I had already worked “call” by myself within the hospital system. It was that experience that prompted the next question. What do I have or need to make this safe for the patient as well as my professional license? This required some reflection on my skills and Ellen L. Poole, MS, m, CPAN, CCRN, is an Assistanf Professor of Nursing at fhe Samaritan College of Nursing, Grand Canyon University, Phoenix, AZ. Address correspondence to Ellen L. Poole, Samaritan College of Nursing, Grand Canyon University, 3300 West Camelback Rd, Phoenix, AZ 85017. 0 1994 by American Socieg of PeriAnesthesia Nurses. 1089-9472/96/1106-0006$03.00/O
402
Jam%‘/
qualifications-Clinical nurse III (top of our clinical ladder), CCRN and CPAN certifications, ACLS certification, and many years in ICU/ PACU giving me both excellent assessment and organizational skills. In my initial interview, I checked on back-up systems, types of monitoring equipment, accessibility of help, and adequate orientation before assuming the position. QUESTIONS
ON THE JOB
The anesthesiologist or the OR nurse would ask “Don’t your standards say two personnel . . .?” I would answer “Yes, they do. Thank you for staying in the PACU until I am comfortable with the patient’s status.” The surgeon would ask “How soon can the family come in?” I would answer “Ask them to wait about 20 minutes, and then they can come in.” Nurses from other units would ask “What do you mean I have to come and transport the patient?” I would answer “I have (or am waiting for) another patient besides yours.” An ICU nurse would ask “Why did you bring your patient straight to the ICU?” I would answer “Would you like to take care of this patient by yourself with no one within calling distance?” My supervisor would ask “Bathroom break?” I would answer “I am not asking to eat, just the time for a bathroom break.” Patients would ask “What do you do in the daytime?” I would answer “I am at home of PeriAnesthes;a
Nursing,
Vol 11, No 6 (December),
1996: pp 40’2-403
REFLECTIONS
403
asleep, the day shift takes care of multiple patients.” Parents would ask “When will my child wake up? Isn’t this taking a long time?” I would answer “Does your child sleep ‘like a rock’? It’s 2:00 AM, with the anesthetic he will sleep. I expect him to wake up, recognize you, and then go back to sleep. This is normal.” QUESTIONS FROM ASPAN MEMBERS THROUGHOUT THE COUNTRY
“Working by yourself is against ASPAN standards. How can the hospital allow this?” It is the “norm” in my city. Multiple back-up systems are built in (emergency call lights, phones at each work station, people to call in, etc.) “Why are you doing this? Are you concerned about safety?” It meets my personal (financial) and professional (educational) goals at this time. I am concerned about safety, so I am quite careful to know my resources and to plan ahead. No, I would not recommend this to someone with little PACU experience. QUESTIONS
IN GENERAL
“What memories do you have of this time period?” As with many nurses, I remember both patient and work incidences. Patient incidences include: the tears shed with the young mother whose baby did not survive the cesarean section when just she and I were in the PACU, or another cesarean section when the young husband asked his wife if she heard the radio playing “their song’ ’ when their baby was being born, or the young man I “over” medicated and then called the surgeon at 4:00 AM because the his pain still
was not under control. Work incidences include: nights assisting in the OR, following the patient to the ICU, returning to the PACU for a cesarean section and wondering if I could complete my charting and have the PACU ready for the day shift, or four back-to-back cesarean sections in one g-hour shift, or discharging outpatients at 2:00
AM.
“What did ~OLI gain?” Though I already knew the value of collegial relationships, this emphasized the importance of collaboration, teamwork, and communication. I gained the respect of my nursing colleagues (my assistance was welcome on any unit) and the respect of physicians (we collaborated on the best care for each patient). I learned more abut cesarean sections than I ever hoped to know. The most important lesson was talking to the patient as everyone else prepared her for an emergency cesarean section. “Would you do it again?” I do not regret the time I spent working alone. I found it very challenging but isolating. The isolation from peers temporarily decreased my ability to work within a team. It was difficult to return to a more “regular” unit with others giving input to my patient care and my time within the unit. I would not say “never again”, but I would prefer not to work alone. There is safety in numbers. Though professional autonomy is wonderful, it should not be traded against patient and professional safety. I certainly functioned in an autonomous and expanded role. However, one does not need to work alone to be autonomous. The constant vigilance needed to maintain safety is stronger when shared.
L. POOLE, MS, RN, CPAN, CCRN
The American Society of PeriAnesthesia Nurses has long held the standard that two licensed personnel will be in the PACU during phase I of recovery. Not all areas of the country have been able to adhere to this standard. This is one nurse’s reflections on the time spent “working alone” in the PAW. This article was written before the November 1995 ASPAN position paper on stafing issues. The author strongly feels that with the position paper in place, facilities will make a stronger effort to adhere to the standard and working alone will become a matter of historical record. 0 1996 by American Society of PeriAnesthesia Nurses.
A
NUMBER of years ago, I decided to return to graduate school. As with most graduate students, continued employment was a necessity. I was able to transfer to a full-time night position in the PACU close to my home. Did I mention that I was the only employee? I held that position for 4 years. What follows are my answers to the numerous questions asked of me throughout the time period in addition to the questions that I asked myself. QUESTIONS
TO MYSELF
Why nights? I am a “natural night owl” who can sleep during the day without difficulty. Working nights gave me the flexibility needed for a varying school schedule. Why by myself? This was the job available. I had already worked “call” by myself within the hospital system. It was that experience that prompted the next question. What do I have or need to make this safe for the patient as well as my professional license? This required some reflection on my skills and Ellen L. Poole, MS, m, CPAN, CCRN, is an Assistanf Professor of Nursing at fhe Samaritan College of Nursing, Grand Canyon University, Phoenix, AZ. Address correspondence to Ellen L. Poole, Samaritan College of Nursing, Grand Canyon University, 3300 West Camelback Rd, Phoenix, AZ 85017. 0 1994 by American Socieg of PeriAnesthesia Nurses. 1089-9472/96/1106-0006$03.00/O
402
Jam%‘/
qualifications-Clinical nurse III (top of our clinical ladder), CCRN and CPAN certifications, ACLS certification, and many years in ICU/ PACU giving me both excellent assessment and organizational skills. In my initial interview, I checked on back-up systems, types of monitoring equipment, accessibility of help, and adequate orientation before assuming the position. QUESTIONS
ON THE JOB
The anesthesiologist or the OR nurse would ask “Don’t your standards say two personnel . . .?” I would answer “Yes, they do. Thank you for staying in the PACU until I am comfortable with the patient’s status.” The surgeon would ask “How soon can the family come in?” I would answer “Ask them to wait about 20 minutes, and then they can come in.” Nurses from other units would ask “What do you mean I have to come and transport the patient?” I would answer “I have (or am waiting for) another patient besides yours.” An ICU nurse would ask “Why did you bring your patient straight to the ICU?” I would answer “Would you like to take care of this patient by yourself with no one within calling distance?” My supervisor would ask “Bathroom break?” I would answer “I am not asking to eat, just the time for a bathroom break.” Patients would ask “What do you do in the daytime?” I would answer “I am at home of PeriAnesthes;a
Nursing,
Vol 11, No 6 (December),
1996: pp 40’2-403
REFLECTIONS
403
asleep, the day shift takes care of multiple patients.” Parents would ask “When will my child wake up? Isn’t this taking a long time?” I would answer “Does your child sleep ‘like a rock’? It’s 2:00 AM, with the anesthetic he will sleep. I expect him to wake up, recognize you, and then go back to sleep. This is normal.” QUESTIONS FROM ASPAN MEMBERS THROUGHOUT THE COUNTRY
“Working by yourself is against ASPAN standards. How can the hospital allow this?” It is the “norm” in my city. Multiple back-up systems are built in (emergency call lights, phones at each work station, people to call in, etc.) “Why are you doing this? Are you concerned about safety?” It meets my personal (financial) and professional (educational) goals at this time. I am concerned about safety, so I am quite careful to know my resources and to plan ahead. No, I would not recommend this to someone with little PACU experience. QUESTIONS
IN GENERAL
“What memories do you have of this time period?” As with many nurses, I remember both patient and work incidences. Patient incidences include: the tears shed with the young mother whose baby did not survive the cesarean section when just she and I were in the PACU, or another cesarean section when the young husband asked his wife if she heard the radio playing “their song’ ’ when their baby was being born, or the young man I “over” medicated and then called the surgeon at 4:00 AM because the his pain still
was not under control. Work incidences include: nights assisting in the OR, following the patient to the ICU, returning to the PACU for a cesarean section and wondering if I could complete my charting and have the PACU ready for the day shift, or four back-to-back cesarean sections in one g-hour shift, or discharging outpatients at 2:00
AM.
“What did ~OLI gain?” Though I already knew the value of collegial relationships, this emphasized the importance of collaboration, teamwork, and communication. I gained the respect of my nursing colleagues (my assistance was welcome on any unit) and the respect of physicians (we collaborated on the best care for each patient). I learned more abut cesarean sections than I ever hoped to know. The most important lesson was talking to the patient as everyone else prepared her for an emergency cesarean section. “Would you do it again?” I do not regret the time I spent working alone. I found it very challenging but isolating. The isolation from peers temporarily decreased my ability to work within a team. It was difficult to return to a more “regular” unit with others giving input to my patient care and my time within the unit. I would not say “never again”, but I would prefer not to work alone. There is safety in numbers. Though professional autonomy is wonderful, it should not be traded against patient and professional safety. I certainly functioned in an autonomous and expanded role. However, one does not need to work alone to be autonomous. The constant vigilance needed to maintain safety is stronger when shared.