I work in a large teaching hospital and we frequently care for ICU patients when the ICU is full. We are probably very lucky because we have close links with the ICU and current management is hoping to strengthen them further. Out of a staff of 35 there are now about 8 of us who were very experienced ICU nurses before moving to the PACU, and others are now expressing an interest in making the move. Most of our E grades have had placements on the ICU, and this week we have a study day specifically aimed at our D grades on caring for ventilated patients. On the majority of shifts there is someone available who can care for an ICU patient, and most are willing to help out if needed on a night or a weekend - but this has rarely happened as most of our staff feel confident enough. A D grade would never be left with an ICU patient, though we encourage them to help the E grade to gain some experience. We also have an agreement with the acute anaesthetists that they are always available to us in these circumstances and will stay with the PACU staff at night if they don't feel confident to be left with 2 nurses and one ICU patient - the majority of them have respected this as they rotate to other hospitals where the PACU nurse role is more limited than on our unit, so they seem to appreciate the service we provide. The scrub side usually help out if needed and will reduce the number of acute theatres running if necessary. Unfortunately the overflow from ICU is a problem that is not going to go away, but staff need the appropriate education and training to perform the role. Even though I was a very experienced ICU nurse I think it is harder to care for a patient in the PACU because all the equipment needed is not always available and you are not surrounded by other ICU nurses who can help you - though I enjoy the "challenge" and it stops me losing a lot of my ICU skills!! An outreach team has recently been set up but we don't know yet if they will be involved with patients being ventilated in the PACU - maybe they will be available if the senior on the shift does not feel confident. Nursing in the PACU has dramatically changed since I was a student - though that was a long time ago. Many patients who routinely went to ICU now go to the wards, they just have a longer stay in the PACU. It is no longer a case of maintaining someone's airway and then sending them back to the ward! Nurses expecting that probably would be better working in day surgery recovery (I don't mean that nastily!!!). On your unit you need to speak up and make your manager aware of your educational needs, and the fact that you are compromising patient safety by caring for these patients without adequate knowledge or support. Wave your "code of conduct" at them and put your concerns in writing!!! It is not ideal and I sometimes wonder if the PACU patients we are supposedly there to look after are being compromised when we have to direct our efforts towards ICU patients. It is not ideal for relatives either, we have to restrict visiting when other patients are in the PACU. Hopefully by voicing our concerns we can overcome some of our problems, and can work together to provide solutions to them.