Navigating Nurse-Administered Sedation: Protecting Your Patients and Your License
- Advocate Maggie MSN RN
- Sep 17, 2024
- 6 min read
Updated: Oct 26, 2024
This month, we’re diving into sedation practices in procedural areas, like Interventional Radiology, where sedation is often nurse-administered. If you’ve ever questioned how to navigate administering sedation safely while keeping your license intact, this edition is for you! Along the way, we’ll be touching on key safety practices, advocating for your patients, and what to do when you’re placed in unsafe situations. And as always, self-care is paramount. Let’s keep ourselves mentally healthy as we provide quality care to others.
What’s Happening Around the Nurse’s Station?
What’s Trending in Nursing Procedural areas, like interventional radiology and cardiology labs, are becoming more dependent on nurses to assist with sedation, often without the presence of anesthesia. It’s a practice that can put nurses in tough situations. Trending across social media are hashtags like #ProceduralSedation, #SedationSafety, and #NurseSedationRisks, which raise awareness about the pitfalls and challenges that come with nurse-administered sedation.
We’ve seen recent cases in the media where nurses faced legal consequences for sedation errors. It’s clear that there’s a gap between hospital policies and nursing protocols, which puts nurses at risk when proper guidelines aren’t followed. In this month's case review, we explored an instance where sedation was administered without proper preoperative screening, leading to a patient fatality. Let’s unpack the learnings and see how we can protect ourselves while maintaining the best patient outcomes.
Did You Know?
Procedural sedation administered by an RN requires additional education, training and knowledge to administer, whether in radiology or outpatient surgery centers, and is not the same as sedation performed by anesthesia providers. LPN’s do not administer procedural sedation. Nurses who are asked to administer sedatives like Versed or Fentanyl must ensure that screen and advocate for the patients and that they:
Have completed proper training.
Understand the sedation protocols.
Refuse to administer sedation if the patient is high-risk without appropriate clearance (e.g., cardiac screening or anesthesia evaluation).
Here’s a tip from my experience: Always ask if the patient has a history of sleep apnea or narcotic allergies before sedating them, as these conditions can drastically increase the risks during sedation. Many nurses I’ve mentored tell me they didn’t realize how crucial this step is in protecting themselves from legal risks.
Learning from Real Cases:
This story fits perfectly into this month’s case review on procedural sedation. Just like in the case we discussed, standing up and using the chain of command can protect both the patient and your professional license. So many nurses are afraid to say "no," but as you can see, that simple act can be life-saving. You matter, and so does your judgment!
Always advocate for yourself and your patients! We are nurses—advocates, protectors, and the last line of defense for patient safety.
Advocacy Corner: Speak Up for Patient Safety
In our Advocacy Corner this month, let me share something close to my heart—nurse advocacy in action. As nurses, we have a duty to keep our patients safe, even if that means standing firm when others want to push forward with a procedure that isn’t safe. It’s never easy to challenge a physician, but it’s necessary when our gut and knowledge tell us something is wrong.
I’ll share a personal experience with you to highlight why speaking up and using the chain of command is so critical. I once had to refuse to sedate a patient in a cardiac cath lab who had a known allergy to Versed (Midazolam). The patient was scheduled for a generator change, and while the EP doctor hadn’t screened her thoroughly, I knew her history because I had taken the time to review it. This was an elderly patient with complex medical issues. Her trachea had been nicked during a previous procedure, and she was unable to mobilize her own secretions. Not only that, she was morbidly obese—over 300 pounds and just 5 feet tall. It was clear that nurse-administered sedation was not appropriate for her.
When I went to the doctor to explain my concerns and recommend rescheduling the procedure with anesthesia, he got close to my face and said he’d consult with another nurse. He even asked if I’d consider administering Benadryl or Phenergan instead, both of which are not reversible and not safe for nurse sedation in such a high-risk case. But I held my ground, explaining that the patient needed Lidocaine only if she wanted to proceed, or we needed to reschedule with anesthesia involved.
I immediately used my chain of command. The nurse manager got involved, and so did the hospital’s head of anesthesia. The situation escalated quickly—there was yelling, the doctor was frustrated—but I stood firm. I knew if something went wrong, if that patient went apneic during the procedure and I couldn’t bag her because of her obesity and compromised airway, I wouldn’t be able to defend nurse sedation. And the head of anesthesia backed me up. They confirmed that anesthesia needed to be involved, and I didn’t sedate the patient.
Had I been a "sheep" and followed orders, it could have cost me my license, or worse, cost the patient her life. Imagine performing a generator change with the left chest open and the patient goes apneic—and I can’t reverse the drugs or get an airway! It’s a nightmare scenario, but one that’s all too possible when we fail to advocate for what’s right.
This situation taught me a valuable lesson: You can’t let fear keep you from protecting your patients and yourself. Sometimes you have to stand your ground, even if it’s uncomfortable. And remember, we have a chain of command for a reason—use it! Had I given in, I could have found myself facing Board of Nursing complaints, civil lawsuits, or worse, an unconscionable outcome for my patient. Nurse love means protecting each other and advocating for what’s right, even when it’s hard.
Tips & Tricks: Protect Yourself and Your Patients
Get Sedation Training: Before agreeing to sedate, make sure you have the right certifications and understand the levels of sedation and their associated risks. Proper conscious sedation training will empower you to make better clinical decisions.
Ask About Preoperative Clearances: Always ensure the patient has been cleared by anesthesia or cardiology for high-risk procedures. It’s not just the doctor’s responsibility—it’s yours too!
Use End-Tidal CO2 Monitoring: This is non-negotiable for sedation. It’s an early warning system for respiratory compromise, and every patient under sedation should be monitored with this device.
Document Everything: If you refuse sedation due to safety concerns, document it thoroughly. This will protect you in the event of any legal action.
Escalate When Necessary: If you’re unsure or feel uncomfortable sedating a patient due to their comorbidities or condition, escalate your concerns. Use the chain of command—don’t hesitate to call for anesthesia backup.
Protecting Yourself: Legal and Nursing Tips
Refuse Unsafe Sedation: Just like I did, refuse to sedate if the patient presents significant risks or has not been properly screened. It’s your right and responsibility to ensure the safety of your patients.
Use Your Chain of Command: Escalate your concerns if necessary. Hospitals have policies for this exact reason. Don’t hesitate to call on experts like anesthesia if needed.
Insist on Proper Preoperative Clearance: Always check for cardiac clearance, allergy history, and pre-sedation screening—especially in high-risk patients.
Documentation is Key: If you refuse to sedate or escalate a concern, document everything. That way, if your actions are questioned later, you have written evidence of your advocacy.
Upcoming Events & Awareness
National Suicide Prevention Awareness Month: It’s a tough topic, but one that can’t be ignored. Many of us nurses struggle with burnout, compassion fatigue, and even depression. Let’s take time to focus on self-care, checking in on each other, and seeking help when needed. If you’re struggling, reach out to your support network. You are not alone.
National Recovery Month: This month also brings awareness to those recovering from substance use disorders and mental health challenges. As nurses, it’s crucial that we understand the resources available to support recovery—both for ourselves and our patients. Stay informed and take part in continuing education around mental health.
Conclusion: Protecting Ourselves and Our Patients
This month, we’ve covered the critical role of nurses in procedural sedation and how to protect ourselves from legal risks while advocating for patient safety. Speak up if you’re uncomfortable, refuse sedation when it’s unsafe, and always put the patient’s safety first. Our work is too important, and we deserve to have the tools and support necessary to do it well.
Remember, nurse love means caring for yourself as much as you care for your patients. You matter, your mental health matters, and your well-being matters. Let’s continue to support each other and protect our profession.
Looking for More Resources? I Got You Covered!
Remember my fellow nurses and healthcare providers that Advocates For Nurses is your one-stop shop for empowering your nursing journey:
Online Charting Courses: Stay on top of the latest charting best practices to avoid documentation issues and earn a CE.
"Guide To The Courtroom For Nurses" E-book: Learn how to navigate legal proceedings with confidence, just in case, something every nurse should purchase.
Schedule a Consultation with Me: Need personalized guidance or want to discuss a specific situation? Remember as subscribers you receive a free 15 min consultation!
These resources offer a variety of support, from crisis intervention to ongoing mental health care, and are specifically tailored to the needs of nurses.
Disclaimer: This case review is for educational purposes only and does not provide legal advice. All cases are fictional and are designed to enhance understanding and provide educational support for nursing professionals.
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