Leaving ICU for PACU

  1. Hello all! Looking for any thoughts or words of encouragement from some PACU nurses out there.

    I have been working in an ICU for almost 2 years now (1.5 years medsurg prior to that) and have just recently accepted a new position in another hospital in the PACU.But I am just nervous about taking the leap into the great unknown. In my current job I have a good manager and fantastic co-workers. I love the team work and I love flexibility of the schedule with working 12s. BUT…I hate nights. I do rotating nights and days and have been for years and I think it's killing me. While on days I feel fantastic and alive, and while on nights I feel like I am walking around with a sheet over my head. There is really no option to ever not be rotating either…at least not for 30 years.

    I have always thought PACU would be a good fit for me, so this is not just some leap to take anything that offers days. I Like a fast pace and I think I will enjoy not caring for the same patient for 12 hours day after day. The constant meds, bed changes, baths, and charting of ICU are what I don't like. I am nervous about being on call but was assured it isn't that likely to be called in overnight all the time. I also peaked at the schedule and it doesn't seem that people are on call all that much.

    I think I am just afraid of leaving something I am comfortable with (although not entirely a great fit for me). I think PACU will fit me better, but I am having doubts that I imagine have more to do with being faced with a major change. Any words of wisdom? ANyone make a similar switch and not regret it? Or regret it even?

    This is pre-op and post-op PACU and I can work 3 12 hour day shifts or 1 12hr and 3 8hr days. On call nights (although eventually you get only on call days with seniority) 1 weekend about every 6 weeks and a weeknight thrown in there occasionally. 1 on call holiday a year. Oh and 2 more dollars an hour than my current job. Any thoughts would be appreciated!
    •  
  2. 6 Comments

  3. by   Mavrick
    Well, I consider PACU my reward for 20 odd years in ICU. DGMW, I loved ICU but once I was convinced I could handle "anything that come through that door" it started getting tedious. My buds started disappearing and I found them livin' it up in PACU. First time I heard the phrase, "PACU is where burnout ICU nurses go to die" So, 10 years ago I made the switch.

    In the 6 PACUs I have worked I found it can really differ from unit to unit. I have mostly been in a hospital setting which usually has a mix of inpatients and outpatients. The shifts will stagger throughout the day. Pre-op nurses will come in at 0600 start cases then move to the PACU setting later in the morning. Other nurses arrive at 0800, 0900, 1000 and can work 8, 10 and 12 hour shifts with the bulk of your staff during the mid part of the day and the final two PACU nurses staying until 1000, 1100 or 1200.

    Sounds like you know about call. People seem to either love it or hate it. You can almost always find a "call-wh*re" to take your call if you don't want it. I actually like call most the time. One patient at a time with a buddy to share/alternate the work. Nothing like seeing one of your stylish workmates with bed-head at 0200!

    My ICU experience has been most useful in preventing crisis rather than dealing with it. You really don't want an elective/routine surgery to end up as an ICU admission. Knowing how to draw blood from an Art line, manage vents and start drips comes in handy. We work closely with our Anesthesiologists but they're really not all that close once they've started the next case. So, you gotta be on top of airway obstruction, hypotension, nausea and pain control and may have to start intervention before the Doc gets back to you. The professional nurses you work with will expect you to handle your own cases but you will also have to be alert to what is going on in the unit, hence the open bay concept. Ask for assistance when you need it and appreciate help when it's offered. Move 'em in and move 'em out is how we stay fast-paced and don't back up the OR!

    Once you have a year in, get your certification (CPAN or CAPA). That dollar or two combined with standby, eve/night/weekend diff, callback and incentive pay can really add to your base salary.

    I will probably die as a PACU nurse. I can just hear those new-grads perk up their ears.

    Best to you and welcome to the ranks!
    Last edit by Mavrick on Apr 4, '15
  4. by   plinytheRN
    I am in the same boat, ICU making the PACU change! Hope all is going well!
  5. by   Lev <3
    My dream job! One day I will "retire" in PACU hopefully as a COB, unless I do this NP thing...
  6. by   twozer0
    Having the ICU background will make your transition into PACU much easier. It's really a personal thing on how comfortable you are managing airways (thats the big thing). You get the easy patients that come out and spend the next hour sleeping with no pain and you get patients that bleed into their abdominal cavity at 3 am, pressures drop, belly gets distended and you cant reach the surgeon. You have had this patient now for 3 hours, anesthesia is unavailable because they are putting in an epidural and the guys pressures are reaching low 70's systolic. Eventually you get the surgeon and he shows up 5 minutes later and 5 minutes after that anesthesia shows up. You head into the OR 5 minutes after that to operate the level 1 machine and give the poor guy 4 units of packed cells all the while you are contemplating just giving the guy a stick of neo to keep him maintaining his pressure because your pressure is 60's over palp. In the OR they are dumping football sized clots on the floor to find the bleed and ligate it and plan on taking the patient to ICU. The ICU doesnt have staff to do the post op and forces you to go with the patient who will be vented and recover the patient in the ICU. It's now 7am, and you have been at work for 20 hours and the past 8 hours have been with the same patient. As you are leaving they say they are going to do a closed reduction under anesthesia and they might need you to recover the patient because its a 2 minute case. At this point, the first fresh nurse arrives and you finally get to leave.

    This is a real story that happend to me. I wouldnt have been prepared to take care of this gentleman had I not had a good background in acute care. As PACU nurses, we do have resources but sometimes we dont and its up to you as the nurse to shoulder that responsibility and keep the patient from dying. The patient was extubated a day later and he eventually went home a week after that.

    I hope you enjoy your new job. It can be cake or death! Just make sure you're always eating cake!
  7. by   JeanOfAllTraits
    This is my situation too. I'll be leaving my adult ICU float position for Peds PreOp/PACU. I'm excited buy also terrified of leaving what I know I good at, where my opinion is respected by other staff (even the ocassional Doc ) and going to a new hospital, new population and new area. But it's time. I've been dealing with a work related injury for nearly 18 months. It's time to pull away from the bedside while I still have a back!
  8. by   LovelyOverload
    Quote from JeanOfAllTraits
    This is my situation too. I'll be leaving my adult ICU float position for Peds PreOp/PACU. I'm excited buy also terrified of leaving what I know I good at, where my opinion is respected by other staff (even the ocassional Doc ) and going to a new hospital, new population and new area. But it's time. I've been dealing with a work related injury for nearly 18 months. It's time to pull away from the bedside while I still have a back!
    How did this transition work out for you? I'm leaving adult ICU for Peds PACU.

close