I'm glad you're asking these questions. From my perspective as a nurse manager I might be of some help and guidance. I manage an 18 bay PACU within a 400+ bed, level I trauma center. Our job descriptions and requirements call for critical care nursing experience, either from ICU, NICU, ER or a telemetry unit. At least two years experience is required within the last four years. I view PACU as an acute care ICU and, in fact, ICU is considered a step-down unit from the PACU. Every patient that comes into our PACU is a potential ICU admit depending on how well they recover from their anesthesia. We receive patients at the most vulnerable and unstable status a patient can experience - immediately after anesthesia - where there are so many potential problems that need immediate and seasoned experience (airway and respiratory instability, hemodynamic and cardiac implications, emergence from anesthesia with complex pain management). For new grads to succeed in this setting you must possess thorough critical thinking skills and have done well in any critical care classes from nursing school
. Understanding fluid management, vasoactive drugs, narcotics, antiemetics is essential. All this needs to be done expertly and safely in a very fast paced environment (it's not unusual for my nurses to take care of 6 to 7 patients, some requiring 1:1 care, within an 8 hour shift). The ADN programs do not offer these types of experiences for their graduates due to the short duration of the nursing program. Even BSN grads may not have a good opportunity to have exposure to the experiences required to orient to PACU. New nurses to our PACU must have a broad understanding of A&P, be familiar with various types of surgical procedures and expectations from those surgeries, be quick to pick up on problems that a solid background in critical care will give you. I also require ACLS and PALS certification - patients do code in the PACU. Unless you apply to a hospital with an extensive (4 to 6 month) critical care class with didactic and practical instruction/experience, it may be difficult for a new grad to successfully orient to PACU. I wouldn't give up on eventually working in PACU but any nurse working in this area needs a solid background in critical care. Working in ICU is a great beginning as you have 1 or 2 patients for the entire shift and would have time to digest and understand their disease process, learn EKG monitoring and interpretation, become familiar with vasoactive drugs, be part of airway management with intubation and ventillator management.
Good luck in your future nursing career. If you truly want to move toward PACU, secure a job in ICU or ER, get some experience and then see what PACU can offer to you. The major concern as a nurse manager is whether the nurses I hire are safe and experienced practitioners. Perhaps you can find a hospital that will provide an extensive training program in order for you to work in PACU sooner.