Eek! What is PACU nursing? And do they really want to interview me?

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    I just got a call for an interview for PACU/day surgery nursing in 3 days, and I'm not totally sure what PACU nursing consists of... I've been on night-shift on an orthopedic floor for 2 years, am rather bored/plateauing and would like to go to days. A couple of days ago, I applied for two of those rare day shift positions before they got snatched up. I figured, "Leap and a net will appear." I was hoping for the stepdown position, but I got a call back just today for a PACU/day surgery position.

    (FYI, my qualifications: RN, BSN, ACLS, and just got ANCC med-surg certification, plus the 2 years on an orthopedic/med-surg floor on night shift.)

    I do want to move into a more acute area - stepdown or ICU - so I figured PACU was something along those lines. I just did a bit of Internet research, and several posts said that you usually need critical care or ER experience BEFORE going into PACU.

    The job description did say it was for both "day surgery and PACU," and that position will be determined after orientation. So, does it sound more reasonable that the interviewer is focusing on me for a surgery position? Does it sound totally off the reservation that she would consider me for PACU? I know that some places will take new grads for ICU or stepdown - is PACU more difficult than ICU?

    1) Am I out of my depth to interview for PACU?

    2) Can anyone give me some kind of picture of what day surgery and PACU are like? Day-to-day working conditions? What does a PACU look like? I've only been in an OR once, during clinicals, for a C-section, and have never seen a PACU. I'd like to have something relevant to say for the interview!

    I know I sound kind of like a bumbling idiot; I want to go to days, and to more critical care; I just don't want to kill anyone or fall flat on my face or lose my license while doing it!
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    Quote from allthesmallthings

    2) Can anyone give me some kind of picture of what day surgery and PACU are like? Day-to-day working conditions? What does a PACU look like? I've only been in an OR once, during clinicals, for a C-section, and have never seen a PACU. I'd like to have something relevant to say for the interview!

    I know I sound kind of like a bumbling idiot; I want to go to days, and to more critical care; I just don't want to kill anyone or fall flat on my face or lose my license while doing it!
    A PACU nurse is responsible for recovering patients from anesthesia. It could be general, MAC, epidural/spinal, etc. Typically you would care for these patients for about an hour, until they either go to their hospital room (if they're awake enough and stable, bed is available- we've held patients in PACU for an entire shift because there weren't any beds available) or are ready to go to the post-op/discharge area. Lots of pain management, monitoring vitals, dealing with side effects of anesthesia (N&V along with others, but that's the most common), handling emergencies (airways on patients who are unable to maintain their own, the occasional code), sometimes invasive line monitoring.

    Some days can be pretty crazy, depending on the schedule. Other days, particularly around the holidays (Black Friday is the next one for us) there may be a limited number of surgeries and you could have a low census day off. Some days there may be all quick cases, and the patients are coming out of the OR non-stop. Other days they may all be long, involved cases where they trickle out or all come at the same time needing a higher level of care. The typical ratio is 2:1, although where I work it's 1:1 if the patient is ICU/step-down, comes out on a "wake-up" vent, or is a pediatric patient.

    Most PACUs are set up as cubicles divided by curtains (not closed 100% of the time), with the exception of the isolation rooms. If the unit has good teamwork, there's always someone to help you with getting the patient hooked up to monitors while you're getting report. With the open set up, people can also see that you may be in trouble/have your back, etc.

    A PACU/day surgery nurse may be one of three options: only PACU; pre/post/PACU, where you rotate between getting patients ready for surgery, recovering them, and discharging them; or cross training to do some combination of PACU/OR or pre/post/PACU/OR. Whoever interviews you would be able to answer that question, or it may be that they haven't determined which combination of units the person hired will work in until they see who they hire. Good luck!
    umad and Melissa Ladd like this.
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    You spent some time on that answer! Thank you, poetnyouknowit.
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    If I understand correctly, the position is PACU in a Day Surgery unit; if I'm right, then your first step is to find out what kind of operations are performed. Day surgery usually consists of short procedures, light anaesthetic. Patients are discharged the same day, and you wouldn't need the intensive skills that would otherwise be needed. You would have to get to know the drugs that are predominantly used, and to recognize signs and symptoms of overdose and allergic reactions.

    A big question is whether the patients are brought to PACU with artificial airways. I wouldn't leave a new recruit to deal with an intubated patient without experienced supervision, so I'd say you need to find out a little more about the unit. Is it possible that you can contact the unit directly and speak to the manager there?
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    Quote from GHGoonette
    If I understand correctly, the position is PACU in a Day Surgery unit; if I'm right, then your first step is to find out what kind of operations are performed. Day surgery usually consists of short procedures, light anaesthetic. Patients are discharged the same day, and you wouldn't need the intensive skills that would otherwise be needed. You would have to get to know the drugs that are predominantly used, and to recognize signs and symptoms of overdose and allergic reactions.

    A big question is whether the patients are brought to PACU with artificial airways. I wouldn't leave a new recruit to deal with an intubated patient without experienced supervision, so I'd say you need to find out a little more about the unit. Is it possible that you can contact the unit directly and speak to the manager there?
    Job description seems to indicate both light and heavier anesthesia - says Day Surgery, but also states cases are neuro, ortho, vascular, and general. You're right, I need this info; I may just wait until the interview in a couple of days and ask then. Some of the best interview advice I've ever gotten was to remember that the interview goes both ways - I'm there to ask them questions, too, and find out if the job is right for me, not just the other way around.
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    Well, in all of those specialties you do have surgical procedures after which the patient is discharged, but it's highly unlikely you'd get critically ill patients requiring ICU post-op. Even in ortho and neuro, you get cases where only conscious sedation is required. You'll know more after the interview; good luck!
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    Quote from GHGoonette
    Well, in all of those specialties you do have surgical procedures after which the patient is discharged, but it's highly unlikely you'd get critically ill patients requiring ICU post-op. Even in ortho and neuro, you get cases where only conscious sedation is required. You'll know more after the interview; good luck!
    Thank you.
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    This was great information. I just accepted a PACU position after 6 years of being a step down nurse. I am excited and intimidated all at the same time!


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