[dolcebellaluna]

I'm a nursing student and have recently gotten a "nursing student" position in local community hospital's out-patient surgery unit. Because I can't really circulate surgeries as a student and they're not going to pay me to just observe surgeries, I'm either going to be working in holding or recovery room. I haven't seen when things go wrong post-op, only small children with tonsillectomies having a hell of a time coming out (confused, fussy, etc) so I'm just curious as to why you chose PACU and if you would recommend it to a new grad.

[texascowgirl]

no i would NOT recommend it to a new grad. i do believe that you need to have some ER or critical care background, and just some experience under your belt, because you need to develop critical thinking skills, which are honed once you actually go to work and utilize the knowledge you gained in nursing school.
i chose PACU because i just got burned out on the drama/trauma of ER, and wanted better hours.
i work mon thru fri 8 hour shifts (not 12's like i did in ER), and i work days only, no holidays, no weekends.
it's much "cleaner" than ER. i got tired of dealing with the nasty overdoses and traumas and unruly folks.
i am losing my skills though...my ER skills. if i don't start working a second job pretty soon, i wont be able to work in many areas again outside of recovery

[Zoe's Mom]

I went to PACU with no critical care experience. I had a great preceptor and very strong co-workers. I did not take call alone for several months. Guess my boss was either desperate or believed in me! I stayed there for 3 years. I am recently back in PACU at a different facility (due to a move) and love it! I didn't realize how much I missed it! PACU, like most areas of nursing, has it's own personality!

[Siss]

I wouldn't work anywhere else.

[RN :)]

I too work in Pacu from floor nursing and love it! I do agree that you need nursing experience first though and critical care is a plus but not required. I feel that my organizational skills are helpful and I am easily able to juggle a couple patients especially if I am working in our discharge area without beoming stressed due to my floor nursing experience in which I had 6-10 pts while sometimes even being in charge. While I do wish i had more critical care experience, those nurses that do are great resourses and I am learning more and more each day! I think I will be in the PACU for a long time. It is a much nicer envirnment than where I used to work. Get some experience and go for it!

[PACUJennifer]

Gosh,no,I'd not recommend PACU to a new grad either.Being a critical care area,it is really important (as it is in the rest of nursing of course,but even more so here), that you build on your entry level competencies and flesh out your critical thinking skills. I have heard about new grads going to ICU in posts on this site,but it's not something I personally support.

If I had to say which of my nursing experiences has been #1 in providing me with a stable base on which I've built an ICU career,it was without a doubt, working on a general surgery floor - a really broad,rich experience. You have lots of time to specialize.

P.S. In answer to your question - I LOVE PACU because

- no two days are EVER the same -it's a constantly changing "soup" of different services,different surgeons,different anesthetists,different surgical procedures, different patients -so,exciting in its own way.

I love starting with an empty room and ending with an empty room - it gives me a real sense of satisfaction that we're part of this forward moving process of guiding a pt through his/her required surgical procedure.

I absolutely love that feeling of satisfaction I always get from receiving a pt who may be just waking,disorientated,cold,in pain (sometimes in agony) and,through TLC and good nursing skills,send them out smiling,warm and comfortable and relieved...of course it doesn't always happen like this every single time,but often enough that that is what happily sustains me in this area of nursing

Lastly,and I hate to say it,but the nurses here will understand - there are some pts who you are glad to see the end of - there's no other way to say it. They test every fiber of your patience and understanding with some peculiar personality trait

I'll give you one example - I had a 40 something woman yesterday who was a chronic pain sufferer -she'd had surgery 6yrs ago to fix a bunion on her foot. Unfortunately,the surgeon hit a major nerve -and she's been in pain ever since and has required a tremendous amount of medical care over the years.She was having the leads of a dorsal column nerve stimulator repositioned to help her with the pain.

For the 5+ hours we had her (the average pt goes through PACU in 1 1/2-2 hrs), she looked 100% snowed,despite having a very short-acting analgesic in the OR and sedation which should largely have worn off - she couldn't seem to keep her eyes open - not even long enough to finish a phrase,never mind a sentence! She couldn't seem to stay awake long enough to confirm her allergies,tell me if she had any numbness in her feet,sip from a straw....she would do absolutely NOTHING for myself and the RN who I relieved for lunch for 5 solid hours.

When I took over from her on MY return from lunch, she was majorly puzzled - the pt had woken to use the bedpan,helped get herself off and on,chatted a bit then resumed this complete unresponsiveness. Hmm...I bagan wondering if some acting was at play here ...

Well,the woman should have won an Oscar! When the anesthetist and the surgeon stopped by the bedside and called her name,her little eyes popped OPEN and she was RIGHT there...there was not a shred of drowsiness in that face - she smiled at them from the moment she opened those peepers and had no problems whatsoever in engaging in witty banter with the two men. It was just so manipulative. We had had ORs on hold several times through the afternoon and could certainly have used the spot.It is such a relief to wave "bye-bye" to pts like these.

Maybe I've just seen too much over the years -I'd be more insane than I already am if I had to face pts like this day in day out on the floor. I should hasten to add that 90% of patients are lovely people,very appreciative, with normal personalities!

Since I sound like such a beast, I have to add (in my own defense) that I have been complimented more than once over the years about my ability to remain patient with difficult people...but some take all you've got and more.....

jen

[Babs0512]

I do not think any nurse should come to PACU right out of school. It is a critical care area and requires critical care experience. I would get a year or two of med surge under my belt and maybe a year in ICU or ER before coming to PACU. You will need to be ACLS and PALS certified, and have taken the TNCC as well. The 40 hourse arrythmia course as well.

Good luck

I wouldn't work any where else either, I have found my niche again. And, while I HATE call with a passion, you have to take the good with the bad.

What I like most about it is the automony. Once anesthesia gets to know you, you can take some liberties - for instance. I gave morphine to a post op who developed hives traveling up her arm from the IV site. I call anesthesia to get a benadryl order. Ten minutes went by and now she was getting hives on her face, so I'm worried about her airway. I went ahead and gave the Benadryl without an order. Ten minutes after that, the doctor called back, and I told him what happened and he covered me. Techenically illilegal, but I wasn't going to watch her die when I knew what to do to help her.

[ava'smomRN]

odd ball here.... i am a little biased as i am a new nurse working in a very busy PACU. it is tough and i second guess my choice sometimes... but i work with an amazing group of experienced and helpful supportive nurses. i also had a very intense orientation with a lot of class time.

no, i do not have the critical care experience or time managment, but i am learning so much everyday. idont think i would be successful as a new grad in the pacu without my coworkers.

oh yeah, i like the pacu because like someone has said the forward moving is nice. i like when patients come out of surgery scared and in pain, but when they leave PACU they are comfertable and with either no pain or tolerable pain. most of our patients leave happy and stable and thats very rewarding

[ativanni]

Our PACU is adults, peds, NICU, SICU, out patient , transplants etc.
Sure many are stable but people crash too. The constant change is great.
No one wakes up the same way. You never know what you will roll through that door. You have to know something about every thing.
Plus CALL on a weekend beats working EVERY OTHER weekend or every THIRD weekend. We only take 2 holiday calls a year too.
I worked the floor for years and went to IMC and ICU prior to PACU.
love the change every day. You don't have the same patient with the same issues EVERY SINGLE DAY for the entire time they are in the hospital.
You don't go to work dreading that you will get MR. So & So that was screaming at you the day before.
Some of us like I job where you anticipate what is happening and AVOID the crashes! Nursing isn't about a crisis everyday. Hats off to your PACU if you never see anything happen.