Here is a direct copy of the ASPAN position on RN staffing in Phase I PACU; this info came from the website:
It is, therefore, the position of ASPAN that two licensed nurses, one of whom is a Registered Nurse competent in postanesthesia nursing, will be present in the Phase I Postanesthesia Care Unit whenever a patient is recovering from anesthesia.
There is also further description of this postion (which is in the ASPAN "Standards of Perianesthesia Nursing Practice" book but not on the website), which further clarifies that "present" means in the PACU
and NOT nearby in the OR or in pre-op, for instance. I did some research on this topic when I recently changed hospitals and found out that my new PACU was only using one RN and a tech on the weekends. We are also a Level One Trauma, so of course this situation was unsafe. I brought the standards to the attention of my NM, and now we are requiring 2 RNs at all times for Phase I!
By the way, if you would like to see other perspectives on this issues, there are a few threads on the chat boards on the ASPAN website. The overwhelming majority feel that it is incredibly important to abide by this staffing standard.
As for the discharge question, we do discharge outpatient surgical patients from our PACU as a rule. There is an outpatient surgery center, but if the surgeon wants to do the case in the main OR anyway, we get the patient in our PACU. The previous hospital I worked at had a short-stay discharge area, so I have worked both ways. In my opinion, it is much better to be able to send a patient to another area to do the discharge work. However, we do make our situation work, and have policies in place regarding d/c'ing pt's from PACU. Basically, we are required to have kept the pt one hour, they must meet a PAR score of 9, be taking PO without N/V, and have appropriate pain control. Then we send them home with a responsible adult. This also includes peds. For the record, I felt really uncomfortable doing this at first, but like anything, it becomes easier with experience. Just make sure you are following your hospital and units policies, and it should be possible to do a PACU d/c.
Hope this helps!