New Grads in the PACU

liquidblue · Jan 19, 2007

I too am interested in working PACU, whether it be after a year or two of ICU experience, or right out of school. What I was wondering is if anyone knows of any hospitals that offer training programs for new grads that wish to go directly into PACU. I seem to remember someone posting something about a hospital that did offer such a program, however I may be incorrect about that.

Thanks in advance for any help!

KrustyTheNurse · Jan 20, 2007

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.

liquidblue · Jan 27, 2007

Thanks so much for the information! You sound like a nurse manager that I'd enjoy working for. :)

I am interested in ICU or ER as well, so I'll most likely just go one of those two routes to get a good base. I am keeping my fingers crossed in regards to doing clinical time in PACU...

KrustyTheNurse · Jan 29, 2007

Good luck!!

MoriahRoseRN · Feb 14, 2007

Can you believe I interviewed for a PACU job, & I was told the orientation was usually 2 weeks. The manager said it is a little longer if you are a new grad, but she did not specify. I don't think they will be calling me back, as I have no acute care experience, only just about one yr in LTC as an LPN (I don't know why they didn't look more closely at my resume). I'm shocked this is all the orientation they would provide, but it is a day surgery position. Would that make any difference?

jamonit · Feb 14, 2007

i would not want to take on a pacu position as a new grad. icu experience would be the only way to go, from my prospective. as krustythenurse explained, it is an acute icu, so there are many, many things a nurse with fine-tuned assessment skills and critical thinking must be aware of. i'd be extremely weary of a position that does not require any background in critical care, moriah. 2 weeks orientation is definitely not enough to learn the intricacies of the pacu. even with same day surgery, as protecting the airway and extensive assessment/monitoring skills are required just in case. (you would have to have acls training, among other highly-specified orientation). that job sounds great, moriarose, if you want to lose your license (a lot can happen in the pacu if you aren't really prepared). i say run for your life from that position and transition into the icu if you are interested in pursuing a future career in the pacu.

good luck!

best intentions,

--j

RN34TX · Feb 14, 2007

i would not want to take on a pacu position as a new grad. icu experience would be the only way to go, from my prospective. as krustythenurse explained, it is an acute icu, so there are many, many things a nurse with fine-tuned assessment skills and critical thinking must be aware of. i'd be extremely weary of a position that does not require any background in critical care, moriah. 2 weeks orientation is definitely not enough to learn the intricacies of the pacu. even with same day surgery, as protecting the airway and extensive assessment/monitoring skills are required just in case. (you would have to have acls training, among other highly-specified orientation). that job sounds great, moriarose, if you want to lose your license (a lot can happen in the pacu if you aren't really prepared). i say run for your life from that position and transition into the icu if you are interested in pursuing a future career in the pacu.
good luck!
best intentions,
--j

I second the above post as I went to PACU with an ICU background and I still had 3 weeks of orientation and needed every bit of it.

Any PACU that would take a new grad and turn them loose in two weeks is not a job you want. Even if they did take you as a new grad which I don't recommend either, you would need a full length ICU internship type of orientation and you would be looking at months, not weeks.

Way too much to learn that basic nursing school just does not cover in enough depth.

In addition, off shifts like evenings, nights, weekends, etc. there is often only a very slim crew (like 2 RN's only) so everyone working in there needs to be well-seasoned.

MoriahRoseRN · Feb 14, 2007

Jamonit & RN34TX, I totally agree. I still can't figure out why they would interview me for a position like this without offering a lot more orientation time. When I first got the call to interview, all that was in the back of my mind was, they must have gotten my resume mixed up with someone else's.

DUECSON · Feb 19, 2007

I am an LPN and I also work in PACU and Same Day Surgery at a military hospital. I have been a nurse for 3 yrs and have been in the peroperative services for almost 2 yrs. I love PACU, but i'm wondering once I graduate with my RN Degree and look for a job will they hire me on since I already have experience? I oriented in PACU for six weeks. If I did not want to become an RN so badly, I would never leave my job.

amnesia · Mar 25, 2007

The PACU is not a very forgiving setting for learning the basics as listed by KrustyThe Nurse. I would encourage you to get previous ICU/ED experience and then try for PACU. Good luck!

pat022351 · Apr 28, 2007

And another thing to think about - most ICUs and EDs will not hire new grads either. At my hospital, our ICUs and ED require at the very least one year of med/surg floor experience.