New Grads in the PACU

[Anjann]

I know this topic has been bopped around in here a few times, but here it goes...

I am a 35 year old, second-career, NEW grad RN with a license so new (7 days) that the ink is still wet!

I'm really interested in PACU and feel that I would be a good candidate.

If a PACU position is being advertised as "experience preferred",but does not say "required" does that mean I can apply, or is it pretty much understood that new grads just don't go straight to PACU?

I think I could market myself well if I could get an interview. Anyone have any suggestions on how to get my foot into the PACU door? I did Med/Surg briefly as an extern and I already know that I want to be in an environment where the care is more intensely focused, but the ratio is lower. I want to know what to say that would make PACU take a chance on me as a new grad.

Advice, anyone?

[nickola]

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?

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!

[Rojo33]

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.

[GHGoonette, BSN, RN]

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?

[Rojo33]

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).

[GHGoonette, BSN, RN]

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.

[Rojo33]

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.

[anne74]

I was a new grad in a high acuity PACU. It's a wonderful place to learn how to take care of any kind of patient. Not to mention it's a huge open room, so you're constantly in the presence of other really experienced nurses and you learn a lot from them. I thrived there along with the other new grads. HOWEVER - our hospital has an amazing New Grad residency program, and I had 6 months orientation with a preceptor, and took the ECCO critical care class (along with ACLS and PALS). It all depends on the hospital, and the first thing a new grad should find out is how they handle their orientation and in particular look for a hosptial with a formalized New Grad program.