RPNs administering sedation
I work in an oral surgeon's office. We are in the process of hiring another nurse and the surgeon wants to hire an RPN. Many of our clients receive sedation to undergo a procedure. Are the administration of sedation and the monitoring of sedated clients appropriate for RPN practice?
The Nursing Act, 1991 does not differentiate between RNs and RPNs in the administration of medications. However, having the authority to perform a procedure does not automatically mean it is appropriate for a nurse to do so.
A number of different medications can be used to induce sedation, and dependent on the purpose and needs of the client, the desired level of sedation differs. Levels of sedation can be categorized as minimal, moderate (often referred to as "conscious sedation"), deep and general anesthesia. Each level is associated with targets related to client responsiveness, airway, spontaneous ventilation and cardiovascular function.
RPNs have the competency to administer medications that produce minimal sedation and to monitor these clients. Clients who are minimally sedated are described as responding normally to verbal commands, with no impairment to their respiratory and cardiovascular functions. However, the administration of moderate sedation, deep sedation or general anaesthesia and the monitoring of the clients receiving this sedation are inappropriate for autonomous RPN practice.
The College's position on sedation considers the complexity of care needed due to the potential for rapid and unpredictable movement from one level of sedation to a deeper level. The resulting risk of negative outcomes has an impact on the skills required by the nurse (depth of autonomous assessment, monitoring and problem-solving). These principles are applicable regardless of the medication used for sedation, route of administration, practice environment or client population.
- American Society of Anesthesiologists. (2009). Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Retrieved July 23, 2012 from http://www.asahq.org/.
- American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. (2002). "Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists." Anesthesiology, 96, 1004-17