The first time she ever heard of propofol was the first time she ever pushed propofol. "I had no idea what propofol was," she says. "I'd never even heard of it."

The last time she ever pushed propofol was a near-disaster. The elderly cataract patient stopped snoring, then breathing. "We bagged him until he came back," says the RN, who asked that we not identify her. "That was the end of it. You never think this is going to happen to you, but here it is. I went to my administrator and said, ?I can't do this anymore.' I resigned on the spot."

At first, yes, she thought it odd that the circulating nurses at the freestanding surgery center she'd just joined were administering anesthetic sedative-hypnotics to cataract patients. But who was she to question how things worked? This was her first ASC experience. And besides, the center got her ACLS-certified in conscious sedation, and it said right there in the policy and procedure handbook that RNs are allowed to administer medications listed (propofol was) on the facility's drug formulary. Administer it she did - 25 times a day, 10 mg at a time, before and during procedures on surgeon's orders, for seven months until the day she quit.

A turning point came while she was researching a term paper for her B.S. in healthcare leadership. "Administration of Propofol by RNs - Is It Safe?" not only earned her an A, but convinced her that the answer to these questions was an unequivocal no.

• Are RNs qualified to administer this drug?
• Is this action appropriate when the circulating RN has duties other than monitoring the patient after administration?

"I was ignorant until I did this research paper," she says. "A nurse's job is to know what she's giving and why she's giving it. I should have known up front."

As our cover story ("RNs Pushing Propofol" on page 24) points out, even RNs who know better are under enormous pressure to induce and maintain general anesthesia. As with most cases of corner-cutting, this one is a matter of convenience and cost - RNs are a lot more plentiful and cheaper than anesthesia providers. "It's not that they don't take good care of patients," says the RN who resigned over the matter. "It's just that they were doing the wrong thing to save money. It wasn't in the best interest of the patient."

The center she left is now using nurse anesthetists to administer propofol. That's a step in the right direction, and infinitely better than RNs pushing propofol.