Do or nurses do pacu after hours?

[emmijay]

Any of you OR nurses doing Pacu after hours on call? Our hospital refuses to put Pacu nurses on call. Instead OR nurses are doing surgery then recovery. My training was 1 week in Pacu. Not only is the OR team unavailable for emergency surgery, but we don't do recovery on a day to day basis. I don't feel I am qualified and all the other hospital in the area have Pacu on call. We also cover endo unit which was a 3 day orientation and some of the equipment need for the scopes is up 1 flight of stair in the locked endo unit. Does anyone know if there is any standard of practice that says this is not safe or where to look? I have come in at 7am worked my normal shift till 3pm. Took call at 3pm-7am. Needless to say emergency cases pilled up and I never left. At 11pm I am finishing up surgery only to go onto recovering the patient I had a 20 min. lunch and that was it (maybe 5min here or there to catch my breath). This really doesn't seem right long hours and then changing specialty areas? Imput please!

[MorganO]

I'm with Mattsmom. This OR would not be for me. I guess I'm wondering how you got into this mess. Is this new to your area or something that you agreed to upon accepting this position?

I work in a rural hospital. As a critical care nurse, I have had to recover after hour cases. It is the policy at our hospital to recover these patients in ICU at the discretion of the shift charge nurse. This is to allow the OR call team to clean up and go home. I never felt that the OR team appreciated the relief. In fact, they challenged the decision made by the charge nurse as to availability of staff.

As a nurse who needed to recover these cases, I maintained competencies and ACLS. How else do you not feel incompetent in these situations?

I fear we are losing our capability to make judgements and accept our responsibilities as a professional group at the hands of our piers and other professions.

I hope you get what your hoping for

[lapappey]

I've worked in both and think it's totally inappropriate to pull people from one to the other unless they are completely cross-trained, which is a relative rarity.

There is an anesthesia person in the OR and at least one nurse. If there are no PACU nurses, there is no PACU; what needs to happen is that they need to be kept in the OR, where they can be monitored and intervened with if necessary, until recovered and then shipped up to the floor.

For many reasons this is not an optimal solution, but it is better than putting nurses not skilled in another specialty, let alone tired nurses from another specialty, into an area in which they have no experience and no backup. What really needs to happen is PACU needs to suck it up and either take call or hire people for off hours.

[smhrn]

in my hospital pacu does take call, i personally work in the or but take my call in the pacu, 1 week orientation is NOT enough time to become comfortable in another specialty unit. As for the long hours, well that goes with the territory, however I would hope if you began to feel as though you were not safe working that nsg supe should be able to find back up for you.

[carcha]

Yeah, I work in a huge London hospital and we do PACU after hours. I dont mind it at all actually but would be happier even if one PACU nurse was around if I need to know something . However I have and will continue to refuse cases which I feel are outside my scope of competence. I will only take cases which I am comfortable with. And I never leave the anaesthetist leave the unit until he/she has seen the patient before I return them to the unit. Like many of you our managers wont have on call PACU nurses even though we the workers are left to cope at 0300. I am so against this and have been for years. I am convinced that only when a fatality occurs and I pray to god it wont be me, that then the managers will concede that PACU is as specialised as any other area of the OR.

[chip193]

At our place, PACU is staffed days and evenings. I believe that they are just starting to take call at night.

Before they started call, our Critical Care Float (Crisis Nurse) would do the recoveries. They went through all the critical care areas for oritentation (ICU/CCU/PACU/Endo/ER/etc) and have to maintain each area's competancies! They also do after-hours contrast pushes for CT, and generally do anything that needs to get done around the place.

Chip

[Charity, RN, APRN]

Our main PACU is staffed with 2 RNs (ACLS) after hours. They float to cover the peds PACU after hours. There is an on-call nurse if the main house is too busy to cover peds. As there must be a QUALIFIED PACU nurse and a second nurse present, according to standards, the OR nurse usually has to stay anyway to be the second nurse.

Until we are able to accept report on a patient, that patient is under the care of the anesthesia provider. Anesthesia is better trained to recover them than a nurse with one week of orientation to PACU. Our anesthesia folks have been known (on rare occasions) to have to stay for the entire recovery period in pacu, on those REALLY busy days. I say let the anesthesia provider stay with you to provide the safest care :rotfl:

c