Friday, April 4, 2025

Why RNs Must Be Present in ORs—A Legal & Patient Safety Imperative

Why RNs Must Be Present in the OR – California Law & Patient Safety

🩺 Why RNs Must Be Present in the OR: A Legal and Ethical Priority

Across California—and especially here in the Central Valley—we’ve seen a concerning trend: freestanding surgery centers and pain clinics allowing LVNs (Licensed Vocational Nurses) to manage operating rooms during procedures involving conscious sedation. This practice isn’t just risky—it’s illegal and unsafe.

California law is clear: a Registered Nurse (RN) must be physically present in the OR at all times during procedures involving conscious sedation or anesthesia. Delegating this role to an LVN not only endangers patients but also jeopardizes the LVN’s license and the facility’s legal standing.

📜 What the Law Says

The California Board of Registered Nursing (BRN) states:

“The administration and monitoring of moderate sedation requires ongoing nursing assessment and critical decision-making—core responsibilities of the Registered Nurse.” — BRN

Meanwhile, the Board of Vocational Nursing and Psychiatric Technicians (BVNPT) reinforces that LVNs:

“May not assume roles or responsibilities that require ongoing patient assessment, clinical judgment, or monitoring of conscious sedation.” — BVNPT

🚨 What’s Happening Locally

In the Central Valley, we’re seeing facilities bypass regulations by staffing only LVNs in ORs during sedation procedures. These cost-saving shortcuts put lives and licenses on the line.

❌ Patients are at risk without an RN monitoring vitals and sedation levels.
❌ LVNs face disciplinary action if they perform duties outside their scope.
❌ Clinics may be fined, sued, or shut down for regulatory violations.

⚖️ Key Legal Risks

  • Unlicensed practice of nursing (if no RN is on-site)
  • Malpractice liability in case of sedation-related complications
  • Civil fines or BRN/BVNPT enforcement actions

✅ How to Stay Compliant

  • Ensure an RN is present for every procedure involving sedation or anesthesia
  • Use LVNs appropriately—for pre-op, post-op, and documentation
  • Train all clinical staff on California nursing scope of practice laws
  • Update policies to reflect BRN and BVNPT expectations
  • Conduct internal audits to verify compliance

💬 Final Thought

This isn’t just about ticking a legal checkbox—it’s about protecting patients and respecting professional boundaries. As healthcare leaders, we must ensure our staff are empowered, protected, and working within their licensed roles.

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