Monday, October 7, 2013

RN - Per Diem, Specialty Surgery Center at Fountain Valley Regional Hospital


The Peri-Anesthesia Registered Nurse will adhere to and support the Association of Peri-Anesthesia Room Nurses (ASPAN) Recommended Standards and Practices. By following these standards and practices the Registered Nurse will act as patient advocate, providing continuity of care designed to meet individual patient needs. The RN will collaborate with all other members of the health care team to achieve optimal patient outcomes. The Peri-Anesthesia Registered Nurse will support the surgery center's philosophy, objectives and goals as they relate to patient care, stewardship of the assets of the facility, and efficiency in practice. The Peri-Anesthesia Registered Nurse will develop a plan of care that includes patient assessment, implementation of the plan of care and completion of the plan of care to include adult, pediatric, neonatal and adolescent patients. The Peri-Anesthesia Nurse will support the philosophy, objectives and goals of the ASC Registered Nurse and will ensure quality care to the individual patients preparing for and recovering from surgery including but not limited to geriatric, adult pediatric, neonatal, and adolescent patients.

The Peri-Anesthesia Registered Nurse will be responsible for the overall preparation of the patient for any surgical or other treatment or procedure as well as the post anesthesia recovery, teaching and follow up after discharge of the patient. With duties to include but not limited to:

  1. Assessment and development a patient plan of care based on the physical, emotional, and educational needs of patients and their families during the pre-operative, post operative and follow up phases of their surgical experience. Demonstrates knowledge of types of anesthesia and intra-operative drugs and the reaction they may elicit in the surgical patient.

  2. Identifies abnormal diagnostic data and clinical changes in the patient's condition and communicates to appropriate individuals.

  3. Based on changing patient needs, evaluates, revises and updates patient care plan during the pre operative and postoperative phases. Updates and revises chart as patient's needs change. Coordinates patient care needs with team members and others as appropriate.

  4. Communicates with the surgeon, operating room Registered Nurses, Anesthesia Providers and other members of the clinical team throughout the patients stay regarding patient changing needs or status.

  5. Utilizes knowledge of surgical procedures in planning for pre operative. Intra operative and post-operative care.

  6. Maintains all of the necessary equipment in preparation for receiving the patient into the pre-operative or recovery patient care areas. Reports any equipment malfunction, removes it from service, tags the equipment per policy and assures follow up with supervisor.

  7. Acts as a resource person to other nurses and departments within the facility or at receiving facilities. Serves as a role model for others. Assesses the learning needs of less experienced nurses and students and contributes to their learning experience.

  8. General duties of the Peri-Anesthesia RN opening Pre Operative and RR areas for the day include:

    1. Check all patient bays and assure Oxygen and Suction are functional and that all bays are stocked appropriately for the first patient of the day. Restocks at the end of the day.

    2. Completes daily log of quality controls on all CLIA waived equipment.

    3. Checks and completes daily log of refrigerator and warming cabinets.

    4. Assure that Rx pads are locked up but assign staff to retrieve as needed by the physicians.

    5. Check Crash Cart, MH Cart and Difficult Intubation Cart along with portable Oxygen on carts and document

    6. Count narcotics with another RN and develop new supply order as necessary at both the beginning of the day and at the end of the day.

    7. Check refrigerator temperatures and document. Restock as necessary. (both drug refrigerator and patient nourishment refrigerator)

    8. Assure all cabinets and doors are locked at the end of the day. Secure the facility doors as necessary at the end of the day.

    9. Secure in a locked area all Medical charts, prescription pads and log books.

    10. Assure all Computers are logged off.

    11. Complete post case data entry into Advantx system per policy.

    12. Turn off all lights prior to leaving for the day.

  9. Direction or participation in the ordering, receiving, and stocking, auditing and documenting all medications used in the facility DEA and California State Board of pharmacy regulation.

  10. Follows proper procedures regarding exposure to Category I tasks and follows proper procedures for handling hazardous waste materials.

  11. Assists with patient monitoring during surgical or pain management procedures within the Operating Room as requested.

  12. Assists in total cleanliness of environment. Performs and oversees cleaning of the Peri-Anesthesia areas. Cleans patient carts after patient discharge, redresses the patient cart with clean linen and wipes down equipment and counter tops prior to receiving a new patient. Changes out all tubing and empties suction containers. Assists with intermittent and terminal cleaning of the Peri-Anesthesia suites and all areas within the Peri operative setting. Restocks linen and patient care supplies as needed. Maintains a patient care environment that is clean, orderly and supports patient care.

  13. Performs routine skills safely according to protocol.

  14. Uses supplies judiciously and in a cost-effective manner. Evaluates utilization of resource (i.e.: supplies and equipment in relation to cost effectiveness).

  15. Assists in developing and maintaining nursing service policies in conjunction with facility policies. Based upon assessment/evaluation of current and past methods, makes suggestions for improving patient care.

  16. Assumes the charge nurse position as assigned.

  17. Attends and participates in staff meetings, staff development programs and remains current with all activities within the facility by checking the communications book or attending staff report at the start of each shift.

  18. Completes all Post Operative phone calls of previous days' patients to check patient outcome and conditions. Documents findings of phone call in patient medical record. Develops a variance report and notifies supervisor and patient's physician should a hospital admission, visit to the emergency room or any other unexpected incident have occurred.

  19. Follow all policies and procedures to include but not limited to:

Review and development of plan of care based on the pre operative telephone interview, the History and Physical provided by the scheduling physician and personal interview and nursing physical assessment and patient interview at the time of admission.

Assures the patient is aware of their Patient Rights and Responsibilities and the RN acts as an advocate to assure the patient's rights to privacy, dignity and confidentiality are maintained.

Has knowledge of the admitting office processes and procedures. Is knowledgeable of the legal aspects of admission, the informed consent and HIPPA guidelines.

Contact all patients at least 24 hours prior to admission. Reviews health history and procedure to be performed. Provides all required preoperative instructions applicable to the procedure being performed. Give patient time to arrive at the Center and start time of the procedure. Assures that patient has an adult responsible party to drive them home and care for them at home.

Responsible for completion of nursing pre-admission documents, confirmation of that the patient has received an Informed Consent. Will advocate for the patient should they have any need to further discuss the plan of care with either the anesthesia provider or the scheduling surgeon.

The Peri-anesthesia Registered Nurse is knowledgeable of and responsive to emergency situations, i.e. cardiac arrest, malignant hyperthermia, drug reactions, fire or any internal disaster, etc.

Cooperates and shares responsibilities for the improvement of patient care with other staff nurses, medical staff and other surgical center personnel. Serves as requested as a participant or team leader on Infection Control committee, quality improvement committee, safety committee or others as deemed necessary to accomplish a high quality and safe environment for patients and staff at the surgery center. Assists with Nursing Research as indicated Based upon assessment/evaluation of current and past methods, makes suggestions for improving patient care.

Responsible for the maintenance of PAR levels and restocking of the pre operative and post operative work areas, linen storage and patient nourishment areas.

The Peri-Anesthesia Registered Nurse will rotate between patient pre operative admission duties and those of Post Anesthesia Patient Recovery.

Pre-Operative Functions are but not limited to the following:

Preoperative documentation and verbal communication of:

- Known or suspected allergies

- Medications taken at home

- Absence or presence of dentures, contacts or other appliances

- Pertinent Medical conditions

- Pertinent Past medical History

- Confirmation of informed consent and consent for treatment

- Confirmation and documentation according to policy of the correct operative site

- Confirmation of patient and family understanding of post operative care, who will be accepting responsibility for patient care at home and that the patient and caregiver understand protocol for accessing emergency care should the need arise.

- Follows appropriate Pre-op admitting policies and procedures

- Provides preoperative instruction and family/teaching related to the perioperative experience including what to expect before, during and after the procedure is complete and the patient is at home using approved materials.

- Assures that the patient understands their rights and responsibilities.

- Completes a nursing physical assessment and documents findings.

- Notifies anesthesia and OR R.N. of any special findings or patient needs or requests. Notifies Anesthesia Group of next day's OR schedule. Reviews with Anesthesia the health histories of any scheduled admissions that do not meet the center's admission criteria. Follow up on any specific orders given by the anesthesia provider.

- Reviews or takes physician orders either verbal or written prior to the day of admission. Monitors that orders or preoperative testing requests from either the admitting physician or anesthesiologist have been received prior to day of admission.

- Assures that all outside testing, the H & P, consent, etc. are on the patient's chart prior to entering the Operating Room.

- Airway maintenance.

- Monitoring for stabilization of vital signs.

- Assuring safe emergence from anesthesia.

- Documents vital signs, nurse's notes and drugs administered on Recovery Room Nursing record.

- Monitoring and evaluating patient's level of pain and nausea and control of pain and nausea by administration of drugs.

- Orientation of patient to surroundings.

- Administration of special equipment (i.e., ice bags, post-op shoes, slings).

- Offer nourishments.

- Completes an immediate assessment of each patient as s (he) arrives in recovery and documents the assessment in an accurate, legible and complete manner.

- Utilizes the recovery room record to document and communicate patient information in a concise and orderly manner. Completes required reports and forms accurately.

- Notes physician orders and assures completion of such

- Provides report and supports anesthesiologist in the care of the patient

- Completes all STAT and routine orders as written by the surgeon and/or anesthesiologist.

- Reviews discharge instructions and educates patient and responsible adult with appropriate information to alleviate fears and maintain optimal post-op care in the home environment.

- Gives report and obtains discharge order from either the anesthesiologist or surgeon (if local) prior to discharge.

- Assures patient is safely discharged to personal vehicle and completed medical record appropriately.

- Completes end of day narcotic count and reports any variances according to policy.

Performs all other duties reasonably related to the job as may be requested by the Director of Nursing.


Current licensure as Registered Nurse in the State of California.

Knowledge necessary to obtain Registered Nurse license in the State of California.

Current CPR, BLS, and ACLS certifications.

Pediatric Advanced Life Support (PALS) certification preferred.

Recent acute care with ASC or hospital Peri-Anesthesia experience preferred.

Ability to perform the following functions or their functional equivalent with or without reasonable accommodation:

- stand and/or walk at least five hours per day;

- lift and/or carry over 20 pounds on a regular basis; and

- push/pull over 25 pounds on a regular basis.

Cooperative work attitude toward and with co-employees, management, patients, visitors and physicians, and ability to effectively communicate with others.

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