NEW YORK NURSE: September 2008
by Randi Hoffman
It took a ruling from the New York City Department of Health (NYCDOH), but the RNs in New York Presbyterian’s operating room no longer have to operate the C-arm x-ray machine.
On May 9, the NYCDOH sent a letter to the hospital, notifying it of code violations for allowing unauthorized personnel to operate x-ray equipment.
The C-arm is a portable x-ray machine that is six-feet tall and three-feet wide. It is shaped like a half moon (hence the name) and is commonly used in operating rooms for instant x-rays of bones and fractures. It also is used to ensure that catheters have been placed correctly, check bile ducts, and locate pacemakers.
Before the ruling, nurses were required to move and operate this equipment. “We didn’t know what we were doing, but the doctors were telling us to operate it,” said Jeannette Hoffman, an operating room RN. “The law clearly states that a licensed, certified technician is supposed to operate it. They go to school for two years to learn this. And when we do this, it keeps us from performing nursing tasks.”
According to NYSNA Nursing Representative Roberta Murphy, hospital management didn’t want to spend the money to hire radiologic techs, so RNs were ordered to operate the C-arm. “This had been going on for a number of years,” she said.
Murphy explained that a nurse brought the issue up at a routine LBU meeting. “NYSNA wrote a cease-and-desist letter, to which the hospital replied that the operating room had a special protocol, so health department regulations did not apply,” Murphy said. At that point NYSNA filed a grievance.
“An in-service program was held for the OR nurses, during which the hospital’s radiation safety officer told the them that C-arm operation was the duty of a radiologic technologist,” Murphy continued. “While he agreed with us that only rad techs should be handling the machine, during the grievance hearing he was mute.”
At the same hearing, the hospital denied that it was in violation of the law. When the grievance was denied, the issue went to arbitration in March 2008. “The hospital kept saying that running the x-ray equipment was no different than moving a tray of instruments,” Murphy said.
During the arbitration hearing, the arbitrator left the room to consult with the hospital’s lawyers. When she returned, she refused to hear the case and suggested that the nurses pursue the issue through the city Department of Health.
NYSNA filed a formal complaint with NYCDOH, which sent inspectors to New York Presbyterian. It sent the hospital a letter stating, “Our inspection revealed that your physicians order nurses who are not licensed to operate the x-ray unit in positioning and operation of the controls of the x-ray units during patient’s radiography/fluoroscopy . . . We hereby issue a stop order from continuing the above practice of using unlicensed personnel in the operation of the x-ray unit.”
Murphy sent a letter to the director of operating room services at New York Presbyterian Hospital, attaching the NYCDOH notice of violations and outlining each specific C-arm duty the nurses were not to perform, including moving, positioning, raising and lowering, and pushing and activating control buttons. She warned that a follow-up complaint would be sent to the city if the hospital did not comply.
The nurses are no longer operating the machine. A sign has been posted by the City Health Department: “Nurses, secretaries, receptionists, physician assistants or nurse practitioners may not expose patients to radiation unless they are licensed and currently registered as radiologic technologists with the New York State Department of Health. The technologist’s license must be conspicuously posted and its content clearly visible to the public.”
In the weeks since the nurses stopped operating the C-arm, New York Presbyterian apparently still has not hired radiologic technologists to do the job. “We’re making the surgeons operate it themselves,” said RN Virginia Balinong.