New Grads in the PACU - Page 3

I am also a new grad who hired into PACU. I am the first new grad that has been hired by my department. If I had not worked there for 3 years as a tech, I wouldn't be there now. They have given me an extra long orientation to help ensure I am successful. It's a great place to work but I would not recommend it to most new grads. Chin lifts, extubations, wrestling patients, ventilators, labetalol, versed, morphine, dilaudid, and patients from 1 month to 90 yrs old are all part of a normal day. One hour into my very first shift I was doing chest compressions on a pt who had an anaphalactic reaction to a med. (He was discharged from ICU 5 days later.) Any patient could be a breeze or scary. Without a good orientation (16 weeks in my case) I wouldn't be able to take any but the easiest patients. Anyway, I love my job and look forward to recovering people tomorrow.

Hi, I'm a new grad with an interview for PACU coming up... this thread has definitely given me food for thought. I did my senior internship in the ER of a big trauma center, but I don't know whether that background will be enough... I'll definitely want to ask some questions about the orientation. Obviously the unit is welcoming new grads, because this job was posted specifically for new grads and they're hiring a couple of them.

I saw that there are a few of you that are new or newer grads that are interested in PACU. Just to let you know, I am just graduating nursing school this week and have already secured a job in the PACU at a Level 1 trauma hospital. It can be done. I just set myself up an interview, capstoned at a PACU, and they hired me! Now, just have to tackle that NCLEX! Wish me luck.

Ashley

After following this thread, I think I will chime in.

I did an externship in the PACU last year and was offered an RN position upon graduation and offered to stay on as a CNA. I accepted of course.

As I got closer to graduation, I got nervous and started interviewing other places.

My manger offered me 6months of orientation, critical care course, RN residency program, and excellent preceptor and very supportive, educated staff. My manager told me that she wouldn't hire new grads but I am the exception because i have been there and she thinks that I am well beyond capable.

so I will be starting in Feb 2008....

Someone on these boards once said that "PACU seems like an easy place to work until it's not" I think this is especially true in day surgery PACU. If you have learned PACU only in a day surgery setting you are not prepared for all that can go wrong. For one thing, day surgery is much faster paced, and if you can't spot problems quickly & know what to do, you are putting your patients at great risk. If anything, it is even more important to have a good solid HOSPITAL PACU background to work day surgery. Part of what makes one a good PACU nurse is quick assessments for spotting potential problems, and having been in situations where you learned this b/c things DID go wrong. My manager will not hire new grads or anyone for PACU w/out previous PACU experience. With more and more cases being done in an outpatient/ day surgery setting the potential for problems is higher. And you will be alone many evenings w/a support person - LPN or Tech- so you have to be able to function independently & act quickly in an emergency. A couple years in a good solid hospital PACU w/call & all that it entails will prepare you well & give you the needed skills & confidence for day surgery. Good luck!

I see this thread is fairly dated but hoping someone might still check up on it. So I'm a new BSN grad that was hired straight into PACU and I'm the 1st new grad to ever be hired at my hospital for PACU. I have military exp as a surgical tech and got ACLS/PALS certified shortly after NCLEX but am still as green as they come as far as nursing is concerned. I'm 2 months into my 3 month orientation, 1st month was a mix of classes and hands on alongside my preceptor. 2nd month I've been mainly solo but my preceptor was (and I'm sure always will be) available. My last month will be starting call rotations with her and than I'm on my own. I've had all positive feedback about my progress but I'm honestly a little hesitant about getting off orientation next month. I'm generally ok 1:1 but more than that and I get swamped fast. I don't want to jeopardize my position by asking for a longer orientation but I definitely don't want to harm a pt! The other nurses I work with have between 5-30 yrs experience in ICU or ER so I feel incompetent just standing near them lol. But seriously, I want to ask for more time but my hiring manager apparently ruffled a few feathers hiring me and I don't want her to regret her decision or be a burden to my co-workers. However, after reading about orientation at some hospitals being as long as a year, I'm thinking my hesitancy is justified.

Rojo, what kind of cases do you see on a day to day basis and what is the staffing like? Do you do a lot of paeds, and do you see many critically ill patients? Also, what level trauma does the hospital have, and how cooperative are the anaesthesia providers? On average, how often does the staff get called out and are you alone or are there others on duty with you?

Wow, tx for such a quick response. We see a lot of total knee/hips, lum/lams, lap choles, carotids, mysectomies, a little bit of everything. We're not the largest facility with only 9 bays but our hospital has a very good reputation so we stay busy. We don't see a lot of trauma but occasionally we will (lvl II).

Level 2 will mean you see your fair share of after-hours emergencies, with potentially risky patients. I think you may be wise to request an extension of your orientation period, not so much for the increased experience, although that's important, but for your own level of confidence. Speak to your preceptor about it; she may feel you're ready as far as experience goes, but if you feel in any way unsure of yourself, try for at least an extra month.

As regards my other question, will you be alone on call, or is there another nurse with you? When we do call, there are two people called out, an RN and an EN (enrolled nurse, approximately the equivalent of an LPN). The RN usually receives the unconscious patients, wakes them up and then hands them over to the EN in order to receive the next unconscious patient. If there's more than one list running, there should be an extra RN on duty, but staffing doesn't always allow for it. In such cases, where the RN is busy with one unconscious patient, and another rolls into PACU, the anaesthesia provider is supposed to remain with his/her patient until the RN is free to take over.

Yeah I think I will ask for an extension just to be safe. I hope im not coming across as a whiny noob, i just know enough right now to realy understand how much I dont know. As far as call goes, we have 2 ppl. One goes in with the 2nd on standby. We don't have EN's, we manage the pt start to finish. Technically while on call the OR nurse and CRNA are supposed to stay but that from what I understand doesn't always happen.