"Abandonment" to help with adjacent emergency

[ISoNitrous]

Colleague came to me with this and I don't think it's quite cut and dry. Wanted to get the sense of the general sentiment of the populace.

Anesthesiologist is staffing 3 offsite locations - 2 GI suites (ERCP room, colonoscopy room) & 1 IR room. 3 CRNAs.
IR patient intubated and stable. ERCP intubated and stable. Colonoscopy for morbidly obese patient underway and going fine.

As far as logistics, these NORA locations are about a 3-5 minute walk from the main ORs/central scheduling area (where the board runner is). The 2 GI suites are in the same hallway, doors maybe 15 feet apart.

Because roughly 20% of the CRNAs called out that day (with a short staff to begin with), anesthesiologist is asked to give lunches to all the rooms. He goes into the intubated ERCP and sends CRNA to lunch. Minutes later, he's told that the patient in the room 15 feet away (morbidly obese colonoscopy) is desaturating, about to code.

Anesthesiologist calls for help (CRNA - I need you back from lunch now! Board Runner - I need help down here NOW). He walks over to the room 15 feet away, lends sets of hands to treat morbidly obese obstruction vs. laryngospasm. Sats come back up, patient recovering and moving great air. Eventually the help arrives from 3-5 minutes away to see situation is ameliorated. In the meantime, the CRNA who was on lunch ran back to the ERCP room that was left without a provider. Altogether, maybe 1.5-3 minutes where no anesthesia personnel was in the intubated ERCP room.

In the end, anesthesiologist gets lambasted by for abandonment, fireable offense, etc.

Is this as cut and dry as, "You left the bedside, you are wrong?" I think I would have done the same thing as him, due to the proximity of these two locations. We never know if that "immediate" help from the central location is going to be 5 minutes or more...And you can get from one place to the other in about the same distance as taking the long way around the OR table from placing a right sided IV.

Curious to hear everyone's thoughts and ethos. Thanks.

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[coffeebythelake]

He did the right thing given the circumstances. However he should never have been in these circumstances to begin with.

ERCP intubated isn't going to have a respiratory event and presumably was stable during that time.

 

[Dr. Rude]

He did the right thing given the circumstances. However he should never have been in these circumstances to begin with.

ERCP intubated isn't going to have a respiratory event and presumably was stable during that time.

Next step(s) should include requesting written guidance what should happen going forward. This guidance to come from hospital leadership, group leadership, employer and to be shared with all docs, CRNAs, proceduralists.

Options include
1. No lunches for CRNAs
2. Delay cases so CRNAs can get break.
3. Repeat above scenario and cross fingers.

Please advise.😀

 

[kb1900]

I’m curious what attendings who supervise experiences are with this. Surely you’ve been in a position like this before where you are breaking out one of your rooms and your other room “needs” help to some degree. What do you do?

I had a horrible spasm once and just told the nurse to call the desk for an extra set of hands as step 1. Step 2 was to let my attending know (who was 10 minutes away in the basement). I wonder if the order of these steps was reversed and my attending was next door how that would play out.

 

[cytocide]

20% called out - seems about right. Was it a Monday by chance?

Seems like the only correct option. But it’s either a toxic environment or the guy isn’t people’s favorite.

 

[Ashers]

When I was medically directing, I couldn't give a break to one of my rooms if I had more than one room going in case of an emergency in a room. What we did when was we would assign a CRNA or AA to be the break person. If I was working in 3 rooms, and 2 rooms were out at the same time, I'd run into the 3rd room and ask if they wanted a quick break before the break person could get to them. Some days, we had no break person, and we told the AA/CRNA and sometimes resident to eat quickly between cases. It was a unique situation, and they didn't always get a 30min lunch, but sometimes they got done at 10am and sometimes they got out late. We had a good group at that hospital who worked together well, so it worked out.

 

[coffeebythelake]

In the end, anesthesiologist gets lambasted by for abandonment, fireable offense, etc.

This is the most ridiculous b.s. I've ever heard. The anesthesiologist should be getting praise and a pat on the back. He had a responsibility to all his patients

 

[MirrorTodd]

From a technically legal perspective, he was wrong...somewhat similar to how someone would be technically wrong to go help intubate a neonate during a cesarean. I would've done the same thing as him though as long as my patient was stable. I've had to run out to the bathroom when I was solo late at night. Communication is key I would say. Inform the proceduralist that you need them to watch the patient while you respond to the emergency etc etc

 

[coffeebythelake]

From a technically legal perspective, he was wrong...just like someone would be technically wrong to go help intubate a neonate during a cesarean. I would've done the same thing as him though as long as my patient was stable. I've had to run out to the bathroom when I was solo late at night. Communication is key I would say. Inform the proceduralist that you need them to watch the patient while you respond to the emergency etc etc

He had a duty to all his patients. The mother/baby example isn't the same.

 

[kidthor]

Assuming they’re medically directing then you’re violating this rule by giving lunches in the first place: “Remain physically present for all key and critical portions of the procedure, and be available for immediate diagnosis and treatment of emergencies.”

Then yes, the abandonment part is a violation of any anesthesia service model. The hospital however presumably put them in this position and is also happy to punish them for basically following orders. The overlords want to have it both ways… they want you to be “efficient” to the point of inducing dangerous conditions but then wring their hands of any culpability when the system repeatedly breaks. Any patient harm is then on you, not them.

On the upside, as mentioned above, this is an opportunity to get the hospital to tell them all what to do when this comes up again - which will likely occur again starting Monday if not today.

 

[MirrorTodd]

He had a duty to all his patients. The mother/baby example isn't the same.

Didn't mean to say it was the same. Editing my post now.

 

[neutro]

1. Depends on the state
2. Depends on the bylaws.
3. The anesthesiologist can technically “delegate” the vent mgt to the circulator for a brief moment. Communicate with surgeon and help.

I do not think that there is any basis for firing or offense here simply because the anesthesiologist was always immediately available in case there was another issue with ERCP - which there was not.

I tell everyone and everybody that these situations will become more and more common given labor shortage and hospitals forcing to do cases.

The correct course of action here would have been to not let the crna go for a lunch.

Suck it up. Grab a snack bar during break and do your job. You’re not going to die not having lunch one day.

 

[neutro]

Assuming they’re medically directing then you’re violating this rule by giving lunches in the first place: “Remain physically present for all key and critical portions of the procedure, and be available for immediate diagnosis and treatment of emergencies.”

Then yes, the abandonment part is a violation of any anesthesia service model. The hospital however presumably put them in this position and is also happy to punish them for basically following orders. The overlords want to have it both ways… they want you to be “efficient” to the point of inducing dangerous conditions but then wring their hands of any culpability when the system repeatedly breaks. Any patient harm is then on you, not them.

On the upside, as mentioned above, this is an opportunity to get the hospital to tell them all what to do when this comes up again - which will likely occur again starting Monday if not today.

This

 

[Dr. Rude]

From ASA standards:

1. STANDARD I
2. Qualified anesthesia personnel shall be present in the room throughout the conduct of all general anesthetics, regional anesthetics and monitored anesthesia care.
   1.1 Objective –
   Because of the rapid changes in patient status during anesthesia, qualified anesthesia personnel shall be continuously present to monitor the patient and provide anesthesia care. In the event there is a direct known hazard, e.g., radiation, to the anesthesia personnel which might require intermittent remote observation of the patient, some provision for monitoring the patient must be made. In the event that an emergency requires the temporary absence of the person primarily responsible for the anesthetic, the best judgment of the anesthesiologist will be exercised in comparing the emergency with the anesthetized patient’s condition and in the selection of the person left responsible for the anesthetic during the temporary absence.

 

[Dr. Rude]

Assuming they’re medically directing then you’re violating this rule by giving lunches in the first place: “Remain physically present for all key and critical portions of the procedure, and be available for immediate diagnosis and treatment of emergencies.”

Then yes, the abandonment part is a violation of any anesthesia service model. The hospital however presumably put them in this position and is also happy to punish them for basically following orders. The overlords want to have it both ways… they want you to be “efficient” to the point of inducing dangerous conditions but then wring their hands of any culpability when the system repeatedly breaks. Any patient harm is then on you, not them.

On the upside, as mentioned above, this is an opportunity to get the hospital to tell them all what to do when this comes up again - which will likely occur again starting Monday if not today.

Maybe. Maybe not. Depends on the interpretation of "immediately available"

 

[abolt18]

If my patient is rock solid stable and nothing major going i.e. not about to perform sternotomy or make incision or pull a lymph node off the aorta, then I'd tell the circulator I need them to watch the patient for 2-3 minutes while I do this and call me if XYZ happens. In and out of the room before the blood pressure even cycles again. It's not a regular occurrence, but it is something that happens at times.

 

[Arch Guillotti]

Good grief. I wonder who snitched?

 

[neutro]

Good grief. I wonder who snitched?

Probably a nurse
Or scrub tech


They tend to be the common culprits

 

[PpfSuxTube]

Who was providing sedation for the colon and who was supervising it?

It's tough but he was simultaneously morally correct but legally in the wrong.

If gastro nurse was sedating thr colon then he is a good Samaritan but if a crna under his supervision was sedating the colon then he is naive and shouldnt have allowed the ercp person to go to lunch break at that time.

He does deserve a slap on the wrist. You just cant leave an intubated person alone in the eyes of the law... see Rex meeker or whatever his name was. Supervisors have to be aware of their environment at all times...

BTW I would probably have done what he did!

 

[Dr. Rude]

Who was providing sedation for the colon and who was supervising it?

It's tough but he was simultaneously morally correct but legally in the wrong.

If gastro nurse was sedating thr colon then he is a good Samaritan but if a crna under his supervision was sedating the colon then he is naive and shouldnt have allowed the ercp person to go to lunch break at that time.

He does deserve a slap on the wrist. You just cant leave an intubated person alone in the eyes of the law... see Rex meeker or whatever his name was. Supervisors have to be aware of their environment at all times...

BTW I would probably have done what he did!

Disagree. Very simply he had a conflict of duties. I think that if he hadn't left the intubated patient he would have breeched his duty to the other patient.

 

[abolt18]

Who was providing sedation for the colon and who was supervising it?

It's tough but he was simultaneously morally correct but legally in the wrong.

If gastro nurse was sedating thr colon then he is a good Samaritan but if a crna under his supervision was sedating the colon then he is naive and shouldnt have allowed the ercp person to go to lunch break at that time.

He does deserve a slap on the wrist. You just cant leave an intubated person alone in the eyes of the law... see Rex meeker or whatever his name was. Supervisors have to be aware of their environment at all times...

BTW I would probably have done what he did!

Except that intubated/sedated patients are left alone in the ICU with minimal physician intervention most of a 24hr period. You can reasonably delegate to a nurse to monitor a stable, intubated patient for you for 5 minutes while you handle an emergency, or if you have to pee and you're the only person in house.

Rex Meeker's lady was NOT intubated, leading to her hypoxic brain injury and eventual death.

 

[NightyNight]

This is why medical direction sucks when there are not enough floating CRNAs. Admin don’t care until something bad happens and then single out the provider.

That’s why docs need to never sign up for AMCs in particular. Northstar, USAP, Sound, etc. They don’t care about your license. You are just a disposable margin. And ASA doesn’t care about upcoming grads by being in bed with these type of systems paying for their conferences.

Flex the 1099 and/or stipulate contractually to only cover 3 rooms with floating CRNA always available. CRNAs can get lunch themselves if they wannabe docs. Never asked for a lunch break in a decade. Rarely ever to take a piss.

 

[neutro]

Who was providing sedation for the colon and who was supervising it?

It's tough but he was simultaneously morally correct but legally in the wrong.

If gastro nurse was sedating thr colon then he is a good Samaritan but if a crna under his supervision was sedating the colon then he is naive and shouldnt have allowed the ercp person to go to lunch break at that time.

He does deserve a slap on the wrist. You just cant leave an intubated person alone in the eyes of the law... see Rex meeker or whatever his name was. Supervisors have to be aware of their environment at all times...

BTW I would probably have done what he did!

Nurse testifies against plastic surgeon in patient’s death

Dr. Geoffrey Kim is accused of ordering his staff not to call 911 for more than five hours after a 19-year-old lost consciousness while undergoing a breast enhancement procedure.

kdvr.com

Seems crazier every time I read this.

 

[chessknt]

Does the ERCP room have a RN in the room who is sedation credentialed? I mean its an emergency, asking that person to watch vital signs and come grab the anesthesiologist if something is wrong and/or give them a stick of phenylephrine and tell them to push it is an imperfect but better solution than leaving the patient with nobody watching them.

Agree situation was untenable and dangerous, exposed issues in staffing that need to be fixed, not a problem with the provider.

 

[narcotics999]

At the last two hospitals I worked, the GI rooms will have a gap of 30mins so everyone has a lunch break.

 

[Coffee PRN]

Is it actually law that CRNAs need a morning and lunch break bc they are nurses? Or myth?

 

[ERRES2288]

Who is he in trouble with? His own department or the higher up?

 

[ISoNitrous]

I’ll try to fill in some of the blanks raised by the group. And thank you all so much for your input.

He was supervising the colon next door, with an experienced CRNA in said colonoscopy.

The turnover for a busy GI day is such that there will not be a time when that colonoscopy room is empty for any more than 10-15 minutes; ergo, he cannot wait till it’s empty to give a lunch to ERCP room.

ERCP patient was intubated and rock solid stable.

I’m unsure who had “called him out” and given him the talking to.

Another related question. Certainly under normal circumstances you don’t leave the patient. Various comments say that the practice of stepping away is “illegal.” Can anyone produce proof of this law or illegality? The only “official” document I’ve seen posted is the ASA standard that effectively has a carve out clause for emergencies which puts it in the hands of the physicians judgement. Where is the law that says “You cannot step out.” Perhaps I’m just not facile with judicial search queries.

I agree that it’s the fault of the system and not the fault of a human here.

 

[abolt18]

I’ll try to fill in some of the blanks raised by the group. And thank you all so much for your input.

He was supervising the colon next door, with an experienced CRNA in said colonoscopy.

The turnover for a busy GI day is such that there will not be a time when that colonoscopy room is empty for any more than 10-15 minutes; ergo, he cannot wait till it’s empty to give a lunch to ERCP room.

ERCP patient was intubated and rock solid stable.

I’m unsure who had “called him out” and given him the talking to.

Another related question. Certainly under normal circumstances you don’t leave the patient. Various comments say that the practice of stepping away is “illegal.” Can anyone produce proof of this law or illegality? The only “official” document I’ve seen posted is the ASA standard that effectively has a carve out clause for emergencies which puts it in the hands of the physicians judgement. Where is the law that says “You cannot step out.” Perhaps I’m just not facile with judicial search queries.

I agree that it’s the fault of the system and not the fault of a human here.

I think you should share those guidelines with said individual and they can take it to their critics and say "It was an emergency. F you".

 

[Bryan O’Blivion]

So, left a stable intubated patient temporarily unattended while informing the CRNA at lunch of the emergency, and assisted in reversing an emergency event? That’s what I would do. If department doesn’t back you up on this, find a new job. Post haste.

 

[neutro]

Who is he in trouble with? His own department or the higher up?

Probably some nurse and un important bystander who does not know much but is causing problems. His career, reputation, and credentials are far more important than whoever it is that complained, to be harmed by this. If its the surgeon - then I would have a talk with him in a very frank manner and refuse to cover his cases.

Main thing is - was there any harm done In this case? If none. So move on.

By the way, for non opt out states, Medicare has purposely left the term "immediately available" vague. They have not attached any time limit to this term. They have not attached a building requirement to this term, but any reasonable person knows that for an anesthesiologist, immediately available cannot mean being at home, or a separate building. You should always remember, in a trial, the jury of "common people" (thank god for that) needs to understand in basic terms what you did or did not do.

Don't let these AMC super lords manipulate him and reprimand him. You were dealt with reduced staff.

The other issue is facility Bylaws and Rules and regulations. That is very important. Some facilities are ok with anesthesiologist leaving for a bathroom break, others are not. These are important considerations when working solo or if you're the only anesthesiologist in the hospital or facility.

We studied this and similar issues to this at great lengths recently along with attorneys. This will become more common with labor shortage and again, I am saying this for the umpteenth time, please make sure you familiarize yourself with legality of staffing and compliance especially with new jobs and new sites.

Honestly, if they give your friend a hard time, they should terminate their employment and get an attorney. Your friend is an employed anesthesiologist, correct? That means that the billing is being done by the company. He personally does not benefit monetarily in any way shape or form from his decision to help the desaturating patient. It was strictly a clinical care issue.

He is just doing his job as per normal service.

 

[ProwlerturnGas]

This is one of the many many reasons I absolutely refuse to work in a CRNA direction model. F that

 

[Arch Guillotti]

This is one of the many many reasons I absolutely refuse to work in a CRNA direction model. F that

Just don’t give them breaks.

I have partners who will not give a break under any circumstances and they are sort of boorish.

I will give a brief bathroom break or whatever if the “coast is clear”. Never a lunch. Ever.

 

[nimbus]

Is it actually law that CRNAs need a morning and lunch break bc they are nurses? Or myth?

In California, one of the great challenges of a charge nurse is to insure that all circulators and scrub techs get their morning and afternoon breaks. They delay cases in order to make this happen. I don’t work with CRNAs but my friends who do say breaks are mandatory for them too.


Maybe an independent CRNA who is not an employee but bills for their own services is not subject to mandatory breaks.

Wages, Breaks and Retaliation

www.dir.ca.gov

 

[kidthor]

In California, one of the great challenges of a charge nurse is to insure that all circulators and scrub techs get their morning and afternoon breaks. They delay cases in order to make this happen. I don’t work with CRNAs but my friends who do say breaks are mandatory for them too.


Maybe an independent CRNA who is not an employee but bills for their own services is not subject to mandatory breaks.

Wages, Breaks and Retaliation

www.dir.ca.gov

Same here - where I am the nurses are often short (like everywhere else) and they will sometimes shut a room for 30-45 min for lunch. A lot of the surgeons are happy to have the break too, and it makes getting people out for lunch easier on the anesthesia end of things. I think this is the easiest and safest solution.

Have any of you seen the "infinite game" article in A&A that recommends we think to the future of 1:12 supervision due to "technology"?

 

[abolt18]

Same here - where I am the nurses are often short (like everywhere else) and they will sometimes shut a room for 30-45 min for lunch. A lot of the surgeons are happy to have the break too, and it makes getting people out for lunch easier on the anesthesia end of things. I think this is the easiest and safest solution.

Have any of you seen the "infinite game" article in A&A that recommends we think to the future of 1:12 supervision due to "technology"?

Yeah, I'll be quitting medicine before I ever play that game... Honestly it's going to take a lot for me to ever work with a crna again at all let alone 4+ cases at a time.

 

[Dr. Rude]

Have any of you seen the "infinite game" article in A&A that recommends we think to the future of 1:12 supervision due to "technology"?

Only an academic could come up with this horsesheee!t. Good luck implementing this in the actual world that most of us live in.

 

[Ronin786]

Isn't the norm in most academic centers with medical direction that the anesthesiologist gives their own breaks? Was the case for me in residency, fellowship and first job.

Anytime I've queried the "minds above" their answer is there are enough floating hands to help in case of an emergency.

 

[Howard888]

The issue with this is the distance. We frequently give lunches during direction of 3-4 rooms but the crna has phone on and is eating in the lounge thats a 30 second walk from the ORs. Even if they didn’t answer phone I can send the scrub out to go get the crna. They know they can get called back in for something like that.

Can’t give a crna lunch if they are going to be 5 minutes away to come back

 

[Dr. Rude]

I’ll try to fill in some of the blanks raised by the group. And thank you all so much for your input.

He was supervising the colon next door, with an experienced CRNA in said colonoscopy.

The turnover for a busy GI day is such that there will not be a time when that colonoscopy room is empty for any more than 10-15 minutes; ergo, he cannot wait till it’s empty to give a lunch to ERCP room.

ERCP patient was intubated and rock solid stable.

I’m unsure who had “called him out” and given him the talking to.

Another related question. Certainly under normal circumstances you don’t leave the patient. Various comments say that the practice of stepping away is “illegal.” Can anyone produce proof of this law or illegality? The only “official” document I’ve seen posted is the ASA standard that effectively has a carve out clause for emergencies which puts it in the hands of the physicians judgement. Where is the law that says “You cannot step out.” Perhaps I’m just not facile with judicial search queries.

I agree that it’s the fault of the system and not the fault of a human here.

what your colleague should do depends on what their perceptions are going forward. Is this going to be just another incident that gets filed/buried going forward? Or is someone trying to weaponize this incident against them personally or against the group?

 

[DocVapor]

I work medical direction 1:3 at one site we cover - the CRNA's are employed by the hospital. We never give lunches or the mandatory 15 minute breaks to the CRNAs, even if they don't have "break staff." I will pop in a room only in a humanitarian situation - i.e. I'm told "I'm about to pee my pants and the float CRNA's are all busy" plus the "coast is clear" in my other rooms. They understand it's a get to the bathroom, do your business, and get back situation.

This is probably one the few situations where it's beneficial to not employ the CRNA's, since their staffing isn't our problem. I can see where it would get a bit hairy if we were employing them.

So all that said - IF somehow I ended up in this position - I would likely have done the same and gone to rescue the crashing patient.

 

[coffeebythelake]

Only an academic could come up with this horsesheee!t. Good luck implementing this in the actual world that most of us live in.

that exists already? isn't that medical supervision?

 

[Dr. Rude]

that exists already? isn't that medical supervision?

Yes. I was referring to the window dressing:

1. Advance a just cause
2. Build trusting teams
3. Study your worthy rivals
4. Prepare for existential flexibility
5. Demonstrate the courage to lead

We now imagine building a new anesthesia approach—named “Infinite Anesthesia”—with each of Sinek’s 5 essential practices as its core values.

ADVANCE A JUST CAUSE​

Sinek advocates 5 criteria for one’s vision or calling to be a just cause. In general, a just cause must be:2

1. For something—affirmative and optimistic
2. Inclusive—open to all those who would like to contribute
3. Service oriented—for the benefit of others
4. Resilient—able to endure political, technological, and cultural change
5. Idealistic—big, bold, and forever beyond reach

--------------------------------------------------------------------------------------

 

[Drwine]

If I would have been in the same situation, I would have made the decision to give a lunch break in the room with the morbidly obese patient under MAC and waited for an easy low risk patient to give the other lunch breaks. I would insist that those I am giving lunch to eat close by in case of an issue. I am much more conservative when covering remote locations. If I have to ever give 3 lunches, I am always looking for a case that is almost finished and give my break then so most of the time I am out of the room on a turnover.
If I was giving lunch in a room next to the board I would have much less concern.

 

[anbuitachi]

was it his case that he ran to?

its a slippy slope. if nothing happened to the patient he left, it'll be fine usually. if something bad happens to the one he left, then hes to blame unfortunately.

 

[gunnershow]

I time all my breaks for induction since I'd be in the room anyway

 

[Dr. Rude]

New directive from Leadership: Henceforth, CRNAs, AAs, Residents, SRNA students will receive no meal breaks from anyone. This will also remove the need for bathroom breaks. This policy will not only save on staffing costs, it will also improve outcome by maintaining continuity of care and eliminating handoffs which have been identified in the academic literature as often being problematic and causing worse outcomes.

We recommend further study on the possible increased incidence of DVTs and coffee emboli in attending anesthesiologists as a result of this policy.


Can I get a promotion or put a point in the tenure bank for this idea?

 

[aneftp]

Unless u are doing ur own billing. Never put urself in this situation when some else is profit off ur backs.

Someone has got to be free for emergencies

I’ve made mistakes leaving my last man(or woman) available during calls
Crna finishing transplant

Neuros

In California, one of the great challenges of a charge nurse is to insure that all circulators and scrub techs get their morning and afternoon breaks. They delay cases in order to make this happen. I don’t work with CRNAs but my friends who do say breaks are mandatory for them too.


Maybe an independent CRNA who is not an employee but bills for their own services is not subject to mandatory breaks.

Wages, Breaks and Retaliation

www.dir.ca.gov

crnas are weird. Probably 50/50 these days who demands breaks and who doesn’t.

I just need 5 min bathroom/coffee break in between.

If I need to eat during solo cases. I can take 10-15 min max.

But some will milk it. 10 min in pacu doing who knows what. Unless I got a super sick patient I don’t spend more than 5 min in pacu. I will hook up patient myself and get vital signs to speed it up.

 

[narcusprince]

Just don’t give them breaks.

I have partners who will not give a break under any circumstances and they are sort of boorish.

I will give a brief bathroom break or whatever if the “coast is clear”. Never a lunch. Ever.

I will go in the room and give a lunch break. However we as a group have established that if docs go into a room to give breaks one doc is out and able to respond to emergencies.

 

[Full Metal IC]

In California, one of the great challenges of a charge nurse is to insure that all circulators and scrub techs get their morning and afternoon breaks. They delay cases in order to make this happen. I don’t work with CRNAs but my friends who do say breaks are mandatory for them too.


Maybe an independent CRNA who is not an employee but bills for their own services is not subject to mandatory breaks.

Wages, Breaks and Retaliation

www.dir.ca.gov

The California break thing is just too much sometimes. We could be doing active CPR on a patient in the cath lab and the charge nurse will pop her head in the middle of the chaos asking one of the staff if they want to take their lunch break.