Which comes first: PACU or ICU?

  1. 0
    I'm in my first year of nursing school, and so far I have loved the ICU, the CRNA was my favorite role in the OR, and I'm hoping for a full PACU day but have taken 2 patients to the PACU and loved it, too.

    I've seen threads on this board where people said that to be a good PACU nurse, you need ICU experience. However, I just read another thread saying that ICU was better prep for CRNA than PACU because it involved more skills; this would suggest that to be a good ICU nurse, you should start in the PACU.

    So, experienced PACU and ICU nurses, I am not trying to start a war , but I am interested in both of these areas. Can you tell me which path seems most helpful? Thanks!

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  2. 17 Comments...

  3. 2
    which is the better path to crna? i have yet to see an anesthesia school that accepts pacu as critical care experience for admission to a crna program.
    Meep,RN and fiveofpeep like this.
  4. 0
    That's a good point. I guess I'm thinking more of whether you need ICU experience to work in the PACU or if you need PACU experience to work in the ICU. I'm observing in the PACU tomorrow, so I'll feel out those nurses, too. Thanks for the info!
  5. 2
    ICU first. It is very, very difficult - especially in this economy - to get a PACU job right out of school. Very few nurses on my unit have managed to circumvent ICU. And they definitely struggle. One year in ICU should do the trick for PACU, the best area of nursing IMHO.
    Quark09 and fiveofpeep like this.
  6. 0
    There are several factors that can make someone successful or not in any environment. Personal motivation, ability to learn, preceptorship/orientation, previous experience etc can all determine if someone will do well or not. I have met some ICU trained nurses that could not handle PACU. PACU is definitely a specialization that requires very unique training to be a real PACU nurse! I started out in PACU as a new grad and did great! I had a really good preceptor and I had previous experience but not as a RN that helped.
    Most CRNA schools do not look at PACU as a Critical Care environment. I would suggest meeting the requirements of the school by what they state or contact a program advisor. One of the PACUs I worked in had really sick patients and big cases. So we all had to know our ICU stuff. Plus we boarded ICU patients all the time.
    On the flip side, having PACU experience I think is a wonderful skill to have for CRNA school. It gives you the ability to see what happens in the immediate post op phase. You have to work really fast to control pain, nausea and sometimes even fix fluids & replacements. Set a reasonable goal to get to CRNA school and dont rush it. The more experience you have the better!

    :-)
  7. 0
    Quote from MC1906
    There are several factors that can make someone successful or not in any environment. Personal motivation, ability to learn, preceptorship/orientation, previous experience etc can all determine if someone will do well or not. I have met some ICU trained nurses that could not handle PACU. PACU is definitely a specialization that requires very unique training to be a real PACU nurse! I started out in PACU as a new grad and did great! I had a really good preceptor and I had previous experience but not as a RN that helped.
    Most CRNA schools do not look at PACU as a Critical Care environment. I would suggest meeting the requirements of the school by what they state or contact a program advisor. One of the PACUs I worked in had really sick patients and big cases. So we all had to know our ICU stuff. Plus we boarded ICU patients all the time.
    On the flip side, having PACU experience I think is a wonderful skill to have for CRNA school. It gives you the ability to see what happens in the immediate post op phase. You have to work really fast to control pain, nausea and sometimes even fix fluids & replacements. Set a reasonable goal to get to CRNA school and dont rush it. The more experience you have the better!

    :-)
    Just interested-my country has no Nursing Council recognized course for PACU. What training do you undergo for PACU in America?
  8. 0
    I tried to get a job in ICU but there was none available in my hospital (I was on the medical floor at the time). I ended up going to PACU and have been there for 6 months now . . .and love it! It is possible to go from a medical floor to PACU and not need ICU experience per se . . .i personally feel that new nurses should start on a medical floor and get comfortable with nursing in the real world before trying something more specialized like ICU, PACU, OR etc.

    In my experience researching schools . . .CRNA programs want you to have ICU experience and will not count PACU for that experience.
  9. 0
    Good question. ICU skills are necessary to work in the PACU. You'll never know what drips, PA caths, artlines a patient will come out of the OR with. And a PACU nurse must be competent to handle all critical patients if need be. Pretty much any situation you will encounter in the ICU, you will see in the PACU. In our PACU, only ICU experienced nurses who are who are ACLS , PALS and BLS certified are allowed to work there. I would first get a few years experience in a busy surgical ICU before going to the PACU.
    Med-surg nursing is probably the best place to start off initially. There, you get your basic nursing and organizational skills down. Building up to advanced nursing skills from med-surg will help you in ICU and PACU. To become a CRNA, you definitely need to be experienced in ICU nursing. I hope this helps in your decision.
    Last edit by sandyteele on Sep 4, '10
  10. 0
    I have been a PACU nurse for 7 years. I recently started my process in applying to CRNA programs. I have found that they are starting to look at PACU as an exceptance to ICU experience. There is one school in my area that has already started excepting PACU. ICU and PACU are both critical care areas but each have their own specialty. ICU work more with hemodynamic monitoring and PACU work more with airway management Both interlink with each other. An ICU nurse can recieve post op patients directly from OR and we recieve ICU patients directly from OR. PACU is great in that we also recieve many types of patients that range from age and severity of cases. Pretty much we see everyone that has surgery. Pediatric patients are my favorite which is usually not the case for all PACU nurses. We must have ACLS, PALS, BLS and most of the nurses in my department have our CPAN/CAPA certification. Airway managment is extremly important for critical care. We also specialize in pain control, nausea/vomiting control and overall stability of the patient before transferring to the next phase of their recovery. Many times we hold ICU patients overnight or until they are stable enough for the surgical floor. My advice to you is check with your local CRNA programs if that is where you are heading. Being a new grad in either area will be hard but its definatly doable. Make sure you have a strong, understanding preceptor and a long enough orientation to meet your needs. The first time the recovery doors swing open and the patient is in distress the anesthesiologist will need your help. We run our own codes and you must know your way around a crash cart and ambu bag ie..you and your fellow nurses in recovery are the code blue team in PACU. Also, it would be wise to study all the medications the doctors use during surgery and what reversal agents go along with them. At times anesthesia leaves you with the patient and the patient will crash (it happends..trust me), so you must be confident enough to react approprialty to do whats best for your patient. My point is PACU is high stress, busy and fun! I am proud to be a recovery nurse and I have to say we are the best kept secret in nursing. You almost never hear about PACU in nursing school. Why? I dont know...but I do know its a great place to work. PS I started out on a ORTHO/Neuro floor which also gave me great experience to carry over to PACU. We rarely look at new grads for PACU because we feel its important to get a little experience under your belt before you join us. But I have to say I have seen some pretty competent new grads that would fit in perfectly. Its all in how much stress you want to walk into right out of school. Goodluck with career...Kim
  11. 0
    I think having ICU experience would give you a level of confidence you may not have coming from the floor when dealing with post op lines/drips/airways. And it has already been said that most graduate programs require ICU experience for anesthesia school. So I think ICU would be your best route, considering it can lead to both CRNA school and PACU nursing, whereas if you start in PACU you will have to go to ICU for a while before school. I personally think a busy PACU with critical patients is pretty good prep for anesthesia, but I don't run the schools!! Good luck with whatever path you choose!


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