ccu to Pacu big mistake

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    Recently left ccu after 7 years for a change. What a mistake. U can't take a critical thinking PCs nurse and expect her to rush pts out the door without addressing all the issues...I get told all the time..just send then to the floor...you don't need to worry about that......I ask about details of a surgery I'm not familiar with and get told if I knew everything about every procedure I world be a Dr.....I just don't fit in..I'm a fixer......I never get my patients out in time because of my attention to detail.....any thoughts......very serious about going back to icu.....I fell like I chart and transport more than I an a nurse!!!!!
    Good Morning, Gil likes this.
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    The PACU is basically a short stay intensive care unit. Your responsibilities are mainly Airway, Ventilation, Hemodynamics, and pain and nausea control. What details are you focusing on? Your job in the PACU is not to fix everything that can be fixed. If you have time to fix things then yes....but once that patient meets criteria for d/c from PACU they need to move onto the next level of care.
    SummitRN and Altra like this.
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    As a floor nurse I thank you!!! What are the issues they don't want you to address? There is nothing more frustrating than getting a patient and realizing the minute they get to the floor that they belong in the ICU (you have a full patient load and on top of that you have to do all the extra work to transfer/monitor a patient who never should have been on your floor in the first place). PACU needs more nurses like you. It sounds like if you can stick it out you would be a great mentor for the other nurses on your floor. If the patient is awake and stable but they might need something repleated or a transfusion it is ok to send them to the floor. The key word is stable! I don't mind hanging a med or starting some blood on the floor, I DO mind having to push narcan 5 min after they get to the floor because their RR is 6 and you can't arouse them (yes that has happened more than once), or sending them to the ICU because I can't get their pressure higher than 70/30 after fluid boluses (yes that also has happened more than once)Don't let them discourage you. If you are really unhappy and you don't feel like you are in a place where you can advocate properly for your patients due to the culture of the unit go back to ICU. There is no such thing as being too skilled or having too much knowledge! Is management backing you up?
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    Quote from meandragonbrett
    The PACU is basically a short stay intensive care unit. Your responsibilities are mainly Airway, Ventilation, Hemodynamics, and pain and nausea control. What details are you focusing on? Your job in the PACU is not to fix everything that can be fixed. If you have time to fix things then yes....but once that patient meets criteria for d/c from PACU they need to move onto the next level of care.
    I guess I'm a little ocd with pt care...blood on gown I change it labs I draw them....something not just right I dig until I figure it out......I will not risk their safety or comfort for a time frame
    Good Morning, Gil likes this.
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    Quote from EmmaZ06
    As a floor nurse I thank you!!! What are the issues they don't want you to address? There is nothing more frustrating than getting a patient and realizing the minute they get to the floor that they belong in the ICU (you have a full patient load and on top of that you have to do all the extra work to transfer/monitor a patient who never should have been on your floor in the first place). PACU needs more nurses like you. It sounds like if you can stick it out you would be a great mentor for the other nurses on your floor. If the patient is awake and stable but they might need something repleated or a transfusion it is ok to send them to the floor. The key word is stable! I don't mind hanging a med or starting some blood on the floor, I DO mind having to push narcan 5 min after they get to the floor because their RR is 6 and you can't arouse them (yes that has happened more than once), or sending them to the ICU because I can't get their pressure higher than 70/30 after fluid boluses (yes that also has happened more than once)Don't let them discourage you. If you are really unhappy and you don't feel like you are in a place where you can advocate properly for your patients due to the culture of the unit go back to ICU. There is no such thing as being too skilled or having too much knowledge! Is management backing you up?
    I worked on the floor for a year before going to icu it's tough....I want to do anything I can to make sure my patient is safe and the nurse I am giving them too is comfortable...I trust my gut....I keep them longer if I have any doubt I critically think if somethings not right.....guess once icu always icu.....
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    Quote from Andrea2107
    I guess I'm a little ocd with pt care...blood on gown I change it labs I draw them....something not just right I dig until I figure it out......I will not risk their safety or comfort for a time frame
    PACU is a unique department in the hospital that I think most all other departments don't fully understand at times. Changing a gown? Awesome. Drawing labs? Awesome! Those are all things that should definitely be done. I would say only draw the labs and send them if ordered in PACU, STAT, or if you really have time to kill and just want/need something to do.

    PACU nursing care is expensive and charged based on their length of stay. Not every nurse can fix everything for every patient every day. The primary goal of the PACU is to monitor and manage immediate peri-anesthesia complications. Once that patient meets the PACU d/c criteria as set forth by the anesthesia department and they have a bed assignment they need to be out of there.
    SummitRN, Altra, turnforthenurseRN, and 1 other like this.
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    You're a great nurse. You really are.
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    Quote from Andrea2107
    I worked on the floor for a year before going to icu it's tough....I want to do anything I can to make sure my patient is safe and the nurse I am giving them too is comfortable...I trust my gut....I keep them longer if I have any doubt I critically think if somethings not right.....guess once icu always icu.....
    It's hard to go from the day to day grind of the ICU to the PACU and having to say to yourself "Things I must do, should do, and could do" It definitely takes time to make the adjustment from having the same patients all day to having 5-10patients in a 12 hour shift.
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    I worked ICU and CCU for decades, and loved PACU, too. I never felt i had to skimp on my care in PACU, but, maybe i didn't work in the PACU you worked in. I worked in several PACUs, in house, and free-standing outpatient surgery centers, and felt we gave very good, veyr comprehensive care to our patients,
    and yes, we did use "critical thinking skills" all the time, all the time. It seemed kinda a slam to PACU nurses to suggest they don't use critical thinking skills, or must not want to solve problems. I'm sure you didn't mean to sound like that, but, it's possible some might think you are suggesting that PACU nurses are half-milers. They aren't.

    Like any other dept, there might be a few staff that are less than stellar, and whenever we are dealing with recently anesthetized humans, there can be unexpected changes and problems. But overwhelmingly, the PACU nurses i've worked with, were dedicated, yes, THINKING and caring, hardworking nurses who'd do most anything to ensure their patient is safe and comfortable. Actually, that's true of any group of nurses i've worked with, and PACU is no exception.

    but yes, learning to streamline your care to try to fit most* of your patients into the expected time frame for recovery, does take some awesome multitasking and focus, no question on that.

    *It's almost never "all" of your patients, cuz of some patients do take longer to reach the criteria for discharge than others.

    PACU is one heckuva expensive dept, and you better have a valid reason to go much over the standard times the org wants you to strive for. (like pain control issues, respiratory issues, etc) BUT, it gets easier to get the rhythm going, to develop an understanding of how much time you do have, how to multitask, how to prioritize, etc.
    Maybe if you give it a little more time, you might find PACU is a great way to nurse. I loved it, anyway.

    Probably, when you first got to CCU, you might have felt a little bit behind there, too, at first. New depts do take some time, i think, to become very good at that dept.

    btw, i did find the stress level in PACUs in free-standing outpatient surgery centers was about half of the inhouse PACUs, imo.
    Altra likes this.
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    also, sorry your coworker said that about "if you knew everything, you'd be a doctor", that was rude, imo,
    hopefully, if there isn't another coworker to share her info, you can jot down names of various surgeries and google them, maybe.


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