I am currently a Cardiothroacic stepdown nurse in new york city with 1.5 years experience. My patient load ranges from 3-5 patients to 1 nurse. I get patients from outside hospitals, home admits, pacu, icu, cath lab, and ed. I also take VAD patients. I am used to running around like a crazy person, between admits/DC's, meds, vitals, bedside procedures, emergencies, and radiology/testing. I also have an insane amount of charting to do (my hospital is very repetitive with the charting.) I work 3-4 days a week and I do lots of overtime. (I am required to do a 4 day week once a month, the rest are 3 days weeks. All of my shifts are full-time 7:15 am to 8 pm.) My floor is high stress between being chronically understaffed, on our 2nd manager in the last 1.5 years, dealing with unhappy NPs & surgeons, and having a patient population of adults who think they are VIPs who aren't.
I have an upcoming interview with Ambulatory Surgery/PACU - Days. From what HR told me so far my hours would be 4 days a week. Three of those days would be 11am to 10pm and one of those days would be 11:30am to 8pm. I was told no weekends or holidays. I think this would be a good fit for me. I am looking to move to a unit that is less stressful. I spent a lot of time reading the threads "day in the life of pacu RN" and I did find that some pacus are very busy... I don't have an issue with being busy. I work on a floor that is non-stop busy for 12 hours straight.
Some of my questions though are....
Do you think my experience will help me or hurt me in the pacu?
Do you think that after 1.5yrs in a critical care area will I be ready for pacu?
Do you think that I am wrong to think the pacu may be less stressful?
What kinds of questions should I ask at my interview?
Will ambulatory pacu be different from regular pacu or does it just depend on my hospital? (my hospital is a 1,000 bed hospital in nyc)
Thanks in advance!
Aug 23, '17
Your experience is perfect for an ambulatory PACU.
Ambulatory PACU's are very low stress. (I think, but I am very easy going.)
Regular in hospital PACU's recover critically ill patients. They may come to PACU incubated, have numerous IV drips, art lines, etc.
Ambulatory PACU patients, honesty if the anesthesiologist is good, should not be coming out of OR still intubated. Only one IV running lactate ringer not even on a pump. They should be ready for discharge home one to two hours after leaving OR.
The hardest part of ambulatory PACU is the pressure to get your patient out the door ASAP. I've worked ambulatory PACU's where incident reports have been "threatened" because my patient stayed too long!
Remember the patient is not "sick" they have had a relatively minor surgery. You don't need to do a head to toe assessment.
Ask what type of surgeries are most commonly done. Ask how often the PACU nurses have to stay overtime. OR's seldom run right on time. The case that was suppose to start at 4 starts at 6 and your shift that was supposed to end at 10:00 ends at 0200. Ask what support there is when patients come out late? How many nurses are mandated to be in the PACU, does one RN and one CNA count as 2 staff? Ask what doctor, surgeon, or anesthesiologist, is available when you and your patient are there at midnight. Ask what is the procedure if a patient needs to be admitted to an acute care hospital instead of going home.