?PACU Nursing

painreliever · Sep 10, 2003

I work in a 7-bed pacu. My duties include taking care of 1-3 patients at a time during the regular shift and taking care of as many emergency cases as might come through the door when on call. I've had 4 at one time alone and have worked 29 hours straight before alone. We do ortho, gyn/ob, general surgery (includes laps, vascular, trauma, etc.), ophthamology, endoscopy, conscious sedation for procedures like insertion of dialysis catheters, chest tubes, etc. and assist at the same time. On a usual day, the 6:30-3 person does all the morning chores to prepare for the day, such as crash cart check, equipment check, oversee ordering of supplies, attempt to obtain in-pt. beds for the sugeries du jour, inventory narcs in pixis, etc. Then await arrival for first case(s). We have 1-2 8-4 rns, 1 9-5:30 rns, and 1 10-6:30 rn who takes call from 6:30p-7a. The 9-5:30 rn must stay late to assist call person, if needed. We also act as overflow for ICU cases, which is another topic altogether as I've seen noted in other posts. We do anywhere from 12-25 cases on the usual day. Then they add the emergent cases as the day progresses. We have one CNA (most days) and no clerk. We do all the lab, radiology, PT entry on computer. We draw our own blood and start our own IV's. We make post-op clinic appointments for our pts. I work in a charity/teaching hospital. Our acuity level is very high; and we have a high rate of AIDS, hepatitis and serious infections r/t our indigent clientele. I worked in med-surg prior to PACU, and I can say I really enjoy my job most of the time and would never want to work on the floor again. Also, it's great to work in a teaching facility where residents are always available, we have greater autonomy and less bs than is involved in working in a private facility. We also take weekend call once or twice a month which is either Fri 12.5 hrs and Sun 24 hrs or Sat 24 hrs.

flowison · Sep 11, 2003

Hey,

I come from an education standpoint as well as a PACU nurse. There are 2 schools of thought on new grads. 1. Bring them in fresh out of school, train them the way you want them and in 6 mos. to a year they will be fine. 2. Have them get 1 year of experience on a med-surg floor first to gain some knowledge, assessment skills and foundation under them before they go to a critical care area.

It must be your choice. You need to check out if you will have a preceptor and for how long, do you also get a mentor?? What and who will be your support? Remember, it's now your license that you must protect as well as yourself. If you feel that a med-surg unit would not be the place for you, why not ER? That is an excellent place to gain knowledge and skill.

Don't misunderstand PACU is wonderful but you have a limited view of the patient population. You might want to find out your policies, the average number of cases and nurse/pt. ratio's as well as the expectations of your functions before you make a decision.

Welcome to the wonderful world of nursing!

Best of luck!

flowison

PACU_Lily · Sep 13, 2003

Hi there. I have worked in Recovery, PACU, for many, many moons... close to 12 years of Recovery, and another 11 years as an Anaesthetic nurse. [a different role in Australia, compared to the USA].

I enjoy recovery nursing, it is varied, and interesting, and the patient contact is pretty satisfying......and some times it sure is great to be able to send on a troublesome [i mean rude] patient back to their ward after half an hour of their company. Our recovery unit is only fairly small with 6 adult bays, and 2 paediatric. Our theatre complex has 5 operating rooms, and occasionally we also get dental patients who have their ops done in the Day Surgery Unit, and who have had general anaesthetics. [usually paed cases, and adults who are a few sandwiches short of a picnic].

We don't do hearts, chest, burns, neuro type cases, so most of it is fairly low key in comparison to some hospitals. We don't work night shift, weekends, or on call, although that may change one day.

What do I like? well, the fast turnover of patients, especially when its people who are rude and demanding...like young guys who demand to have their cigarettes NOW, and abuse you because the ward staff and orderlies are taking so long to take them out of recovery, so that they can get back to their rooms, grab their cigarettes and go outside for a smoke. The varied casemix, great people that I work with, team spirit and all that, and especially the hours.

The downside...... rude and obnoxious patients, ditto for doctors, although that doesn't happen much at all, anaesthetists who dump their patients without a handover, and without filling out medication charts/anaesthetic charts, which means you have to chase up all of that. Another sad part is that often, as recovery staff, we are on the outer from the rest of the unit. Not often, but on quiet days when the other staff are allowed to leave 15 minutes early or so, no one bothers telling us in recovery.....same thing on evening shifts sometimes...... we wander around looking for the rest of the staff at knock off time, only to find they all left a while back...... Grrrrrrrr.

The upchucking, bleeding and sputum covered LMA's don't bother me either.

Give PACU nursing a go, I think you might like it.....but remember to work as a team member. We are all there to help each other.

PACU_Lily · Sep 14, 2003

I forgot to add something before about dislikes about pacu nursing......here goes....... Have you ever looked after a patient who arrives from the OR, sleeps soundly between observations [snoring loudly even], then the minute the ward nurse arrives to take them to their ward, and asks them how they are they immediately respond....."Oh, I'm in such terrible pain, its awful!!!!!", making you feel low as though you had deliberately not medicated them so as to avoid keeping them that extra 20 minutes or so. Or the ones who sleep soundly, have to be woken upfor wound checks/obs etc, when asked if they have pain, they say "oh, yes awful pain...terrible". Ask them to give a rating from 0-10 with 10 being absolute agony, screaming out loud, jumping from the bed type pain, they say its a 9 or 10. You go fetch the meds and they are back sound asleep again.......GRRRRRRRRR!

javagirl · Feb 25, 2004

Hi,

So for a student interested in PACU work, the career path is med/surg for a year, then PACU? Thanks.

wheezer · Apr 30, 2004

Hi,
So for a student interested in PACU work, the career path is med/surg for a year, then PACU? Thanks.

I would highly recommend 1year med/surg then 1 year of ICU before PACU. Although a lot can be taught in the PACU if you have a really good orientation, there are many things that require a good critical care and critical thinking background. There are many times that you may find yourself alone in the PACU with a pediatric patient and/or an adult recovering , and also an ICU patient with lines/etc. You are alone, and if you are not comfortable with critical care, then you could get yourself into trouble.

Just my two cents.