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

🩺 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.

© 2025 Central Valley Medical Education | classinformation@morethancpr.com

You're Not a Trauma or Pediatric Hospital? That’s Exactly Why You Should Be Prepared.

Let’s talk about something that’s been making me absolutely nuts—and if you’re a fellow ED nurse, I know you’ll feel this in your bones.

I’ve had far too many conversations with Emergency Department Directors, Nurse Managers, and even CNOs who push back when I ask why their staff aren’t required to have TNCC or ENPC certification. The answers?

“We’re not a trauma center.”
“We’re not a pediatric hospital.”
“It’s the cost…”

Let me be crystal clear: that is exactly why your staff need this training.

You’re not a trauma center. You’re not a pediatric hospital. So what happens when a multi-system trauma patient rolls into your adult-only ED? Or when a critically ill child is brought to your doors because the parents panicked and went to the nearest hospital—not the “right” one?

Are you really going to tell the parents of a seizing 2-year-old, “Sorry, we don’t usually take care of kids”?

You think the community cares about your trauma designation in that moment? They don’t. They care that you’re the hospital. They expect you to be ready.

Let’s unpack that other excuse: “the cost.”

What is the real cost of not preparing your staff?

• A child dies due to improper airway management.
• A trauma patient is mis-triaged because your nurses don’t recognize the signs of hemorrhagic shock.
• Your hospital makes the evening news—not for saving a life, but for failing to do so.

The cost of unpreparedness is reputation, litigation, and burnout.

Because nothing will make a good nurse walk faster than feeling unsupported and unprepared in the face of a dying child or trauma victim.

If you’re in leadership—ED Director, Nurse Manager, CNO—you hold a license too. And with that license comes accountability.

If you are not willing to invest in the education and competency of your emergency nurses, are you truly vested in patient safety? In your team? In your license?

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This isn’t just about checking a box. This is about doing what’s right.

Trauma and pediatric emergencies don’t wait until your team is ready. They come when they come—and when they do, you either rise to the moment or you fail it.

So stop hiding behind your hospital’s designation.
Start preparing your people.
Require the training. Fund the training. Be a leader.

Because when a child codes in your ED, the letters behind your name won’t matter. What will matter is whether your team knew what to do.