Registered Nurse Patient Care in Troy, Michigan at UnaSource Surgery Center

1. Preoperative Phase

• Patient evaluation should take place sufficiently in advance of the scheduled surgery to integrate an appropriate evaluation, necessary testing and thorough patient education per policy.

1. Phase I and Phase II

• Extubate patients with endotracheal and larynx-mask airway.
• Assess airway quality and function.
• Managing Patient Airway
• Connect airway to t-tube oxygen and suction airway as needed.
• Place oral and/or nasal airways as needed.
• Evaluate breath sounds and document.
• Identify signs and/or symptoms of respiratory distress and intervene appropriately.
• Administer breathing treatments as needed.
• Properly position head for optimal airway function.
• Use bag-valve-mask, suction equipment, oral and nasal airways, t-tubes, suction catheters, oximeters, mist puffers.

• Assess integrity of surgical site.
• Notify surgeon of increased bleeding, bruising, discoloration, temperature, heat, redness or swelling at site.
• Identify signs and symptoms of infection.
• Identify any drains and record amount of drainage.
• Document type of dressing (4x4s, bandaid, ace wrap, etc.) and site.

1. Direct Patient Care – Preoperative and Postoperative Phase

• Assess pain level and need for pain medications continuously until optimal response is obtained.
• Administer pain and other medications with knowledge of dosage and effects.
• Position patients comfortably and teach breathing techniques and alternatives for pain management.
• Locate oxygen tubing, supplemental oxygen masks, t-tubes, and airway supplies efficiently.
• Sign off doctor orders as received.
• Perform surgeon’s orders (ice bags, medications including pain meds and antibiotics, elevation of extremities, etc.).
• Monitor and record IV fluids, incisional drains, empty catheters, etc.
• Obtain temperature and intervene as appropriate with warm blankets or heating or cooling methods.
• Verify and validate patient and family awareness of discharge instructions.
• Ensure that post-operative teaching is understood by patient/family by performance of tasks or repeating instructions verbally.
• Identify discharge criteria.
• Discharge patient according to discharge criteria to a responsible adult.
• Provision of patient care to outpatient total joint and complex spine specialty patients.

E. Discharge Planning

• Establish availability of responsible adult to provide home care and transportation home.
• Verify family and patient education regarding pain management and medication, nourishment, activity, safety and follow-up care.
• Provide written discharge instructions.

• Obtain labs, referrals blood, X-rays using the correct process.
• Competent and proficient in I-Stat testing.
• Perform urine pregnancy tests according to anesthesia criteria.

• Identify proper veins or capillaries to use for obtaining blood samples.
• Competent and proficient in venipuncture.
• Reassure and educate patient before procedure.
• Identify correct collection device and/or vacuum tube for test to be performed.
• Obtain blood sample for point of care and I-STAT testing as ordered by physician.
• Obtain I-STAT for diabetic patients.

• Attach leads and monitoring equipment correctly to patient to monitor patient’s vital signs and EKG.
• Read and interpret values (EKG, B/P, heart rate, pulse oximetry) on monitors.
• Troubleshoot and adjust equipment as necessary.

• Knowledge of Pathophysiology of body systems and how anesthesia drugs affect each body system.
• Knowledge of nursing unit standards of care in the POCU/PACU and patient room areas.
• Knowledge of safety regulations along with policies and procedures (Universal Precautions).
• Ability to verbally communicate accurate data to doctors, surgeons, and anesthesiologists in a quick and thorough manner.
• Ability to write thoroughly enough for nursing care actions that could be defensible in a court system.
• Math skills to calculate IV drip rates, antibiotic dosages, to convert medication dosages to CCs from bulk medication containers, and to calculate appropriate pain medications.
• Reading skills to comprehend training manuals, physician orders, computer information, and data related to patient care in the POCU/PACU.
• Ability to effectively explain and train other nurses.
• Ability to prioritize nursing tasks according to standards of care in the POCU/PACU.
• Demonstrate competency in total joint and complex spine perioperative nursing.
• Annual completion of specified mandatory in-services.
• Annual completion of six hours of total joint and complex spine specialty education.

• See well enough to read written/typed material, monitors, gauges, printouts, computers, etc.
• Hear well enough to receive doctors’ orders over the telephone and to hear monitor alarms at all times.
• Speak well enough to communicate ideas to doctors, other nurses, health care professionals, and family members.
• Strength to physically maneuver patients around in bed.
• Have use of hands and fingers to give injections, draw up medications into syringes, and assist doctor with any procedures.
• Have mobility to move quickly in an emergency, to reach overhead and under beds, and to stand long periods of time.

• Graduate of accredited registered nurse program.
• Valid registered nurse state license.
• BLS, ACLS, PALS certification within one year of employment.
• One to three years’ experience in CCU, ICU, ER and/or PACU preferred.

• Flexible to work unscheduled hours as needed.
• Functions as a member of a multidisciplinary healthcare team, consults and collaborates with colleagues, peers, supervisors and other healthcare providers and promotes respectful relationships among colleagues.
• Delivers care in a non-judgmental, compassionate and nondiscriminatory manner that is sensitive to diversity.
• Delivers care in a manner that preserves and protects patient autonomy, dignity, respect and rights.
• Evaluates factors related to safety, effectiveness, and costs to the outcome of optimal patient care.
• Annual completion of specified competencies and in-services
• Report Incidents and Adverse Incidents per Center policy.