2 in PACU at all times?

  1. Does your PACU (Level I) have "ratios"? We are trying to justify have 2 nurses at once in the room every time a pt is being recovered. One is giving care to 1 or 2 stable pts, or 1:1 if a child or unstable. The other nurse is the backaup. What happens in the middle of the night when your pt goes bad, OR is gone and you are alone with pt circling the drain? What happens if a combative pt hits the nurse (who is alone) and she/he is knocked out? The answer escapes me. I am not wanting to explain to the jury why I think I was Supernurse who was so cocky that I thought I could handle this pt by myself.
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  2. 7 Comments

  3. by   dphrn
    When I first got here to VA, I interviewed for a PACU position. Hours would be 12:30pm to 9:30pm (yuck!) and from 6 pm on I would be on my own. Thanks but NO THANKS! The nurse manager acted surprised that I thought this was an unsafe situation. After 6pm, another nurse would be on call. A lot of good that does me when a pt is crashing. Thank God there are many options for us out there. Needless to say, I didn't even consider this position.
  4. by   suzanne4
    The certification group for PACU nurses has 2 nurses listed as the minimum of safe staffing any time that there is a patient in PACU..................and it means two people physically there, not one of them in the OR and only available by phone......................
  5. by   MsHB
    Quote from sharann
    Does your PACU (Level I) have "ratios"? We are trying to justify have 2 nurses at once in the room every time a pt is being recovered. One is giving care to 1 or 2 stable pts, or 1:1 if a child or unstable. The other nurse is the backaup. What happens in the middle of the night when your pt goes bad, OR is gone and you are alone with pt circling the drain? What happens if a combative pt hits the nurse (who is alone) and she/he is knocked out? The answer escapes me. I am not wanting to explain to the jury why I think I was Supernurse who was so cocky that I thought I could handle this pt by myself.
    During the week with scheduled lists there are always 2 in the room, but after hours for emergency cases we have just one nurse, but the OR staff are always close by and available for any probs.

    It also depends on the experience of the nurse, if he/she wants a second nurse in the room after hours, that is arranged, but if they feel happy being there alone, with the option of getting the OR staff if there is strife, then that is acceptable too.

    The OR staff here do not leave until the patient is returned to the ward.
  6. by   kyti
    We have at least 2 RN's at all times during reg. hours. On call we have one pacu Rn and one other person who may or may not be an Rn. Based on the condition of the pt I can request the circulator or scrub tech to stay with me for easy stable pts the supervisor will send whoever is available usualy an rn or lpn from ob. One of our anesthesiologist actually stays with his pts untill they are ready to go to their room. We like to be on call with him. Even then another person must be there.
  7. by   sharann
    Thanks to you all for responding. I am going to be using my 2nd call person all the time.
  8. by   carcha
    yeah, we always have 2 in the room regardless whether the case is minor, major, local or general. I believe it makes sense if the patient collapses one can stay while the other gets the team coming.
  9. by   Daqueengene
    Quote from sharann
    Does your PACU (Level I) have "ratios"? We are trying to justify have 2 nurses at once in the room every time a pt is being recovered. One is giving care to 1 or 2 stable pts, or 1:1 if a child or unstable. The other nurse is the backaup. What happens in the middle of the night when your pt goes bad, OR is gone and you are alone with pt circling the drain? What happens if a combative pt hits the nurse (who is alone) and she/he is knocked out? The answer escapes me. I am not wanting to explain to the jury why I think I was Supernurse who was so cocky that I thought I could handle this pt by myself.
    I work in a small hospital and after our pacu facilitators became certified in pacu nursing the tide changed indicating that two RNs needed to be available for all recovery patients. We work it out during the day easily due to the number of staff that are around all the time but on call and late at night the RN on call for OR has to stay in the pacu until the patient is recovered and off to the floor. It is a good idea especially late a night or on the weekends. If we have back to back cases on the weekends there is a second PACU RN on call that has to come in until the OR is not working and then can go home while the OR RN stays until the patients are out to the floor. It can make for a long call especially if you as the OR RN have been there for hours before the PACU RN comes in, which is the case sometimes. But I dont mind staying it makes sense to me to be there for the dreaded What If. We all know that post operative patients can be tricky and can turn on you in a second. I sure wouldnt want to be there alone trying to take care of a patient who is taking a turn for the worst. It is hard getting patients to the floor alone too so we help each other transport to the floor.

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