PACU--a day in the life

sharann, BSN, RN · Nov 27, 2005

I'll try.

Bearing in mind that every PACU is different, I love this area of nursing hving only have worked in Tele previously.

We are a community hospital of moderate size and currently are running about 6 O.R's a day, we could go up to 9 but there are not enough OR crew or aneshtesiologists. We have 9 working "bays", which like in many ED's are separated by curtains only, and from the desk we can see every bay at once. We have a ratio of 1:2 just like any critical care type area, but sometimes we need to 1:1 ir even 2:1 if the patient is combative or critical. Staffing is always tight but we hired a couple new part time staff which will help. We run 17-26 cases a day routinely on 3-4 nurses(tired at night!). We are open all day but run late into the night at times. There is no night shift, but we rotate "call" so we can staff off hours and weekends for emergencies or in house cases that cannot wait. My unit handles infants through adults, but no neonates(they go direct to NICU). We don't take Open heart cases as they go dirdct to ICU. We take crainiotomies, many ortho cases, tubal ligations, laparoscopies, appendectomies, colon resections, hernias, Dand C's,Stable routine C-sections, tonsilectomies,eye cases, some plastics, and more!!!(Is there more?)

The most imprtant skills to have as a PACU nurse is the ability to think very quickly, physical stamina, and great assessment skills for airway and cardiac, You generally should be ACLS and PALS(if you do kids) certified. Prior ED experience is an obvious plus. The pace is feast or famine as I say. We can sit around for and hour then get slammed with every case for 4 hours. If we have space we also take outpatient cath lab cases and GI lab cases that they "can't" recover(don't let me go there:angryfire )

Hope this helped.

RN34TX · Nov 27, 2005

If we have space we also take outpatient cath lab cases and GI lab cases that they "can't" recover(don't let me go there:angryfire )
Hope this helped.

Then I will go there.

Our cath lab has it's own recovery and it's never a problem.

Funny thing, our L&D has it's own recovery as well, yet we often recover c-sections and such that they are too "busy" to do as well.

We were ok with it until we found out that the staff in L&D sat empty and continued to send us patients as long as we were willing to accept them.

They weren't sending patients based on their business, they were sending them based on our willingness to continue to take them whether they were busy or not.:angryfire

I'd be ok with that if L&D were willing to help us out when we got slammed, but obviously, that's not the case.

If it's not L&D related, they aren't taking it.

I'm waiting to hear yet another speech about "teamwork" from them.

sharann, BSN, RN · Nov 27, 2005

Ok, since you were brave and went "there" I will add that our L/D dept does that as well, PLUS they take credit for the deliveries done in our OR!So there stats reflect productivity that we do the work for. Go figure. PACU does seem to become a dumping ground if we allow it. We have begun to say "no" recently(everyone else can, so can we). We don't say no if we are able to take the patients however our priority must be to the main OR.I I don't see cath lab, Gi lab, or Radiology recovering OUR patients when we are maxed out. I happen to have a good work relationship with most everyone in most departments so I feel ok stating this. Teamwork is essential,but if it goes one way....

RN34TX · Nov 28, 2005

Hello.
I have been working in the ER since I graduated 6 months ago. I absolutely love my job, but I can't get on days and I physically can not work nights anymore. I love to be busy, I love the variety and the stress, I love that my difficult patients are gone before I know it.
I saw a job listing for days in PACU. I never had any experience in a PACU in nursing school so I was wondering if you could tell me what the average day is like. What skills do you use most? What do you love about your job?
I didn't really like the actual OR in nsg school--Do PACU nurses usually work in the OR also? Are most units pre and post op or are there two separate units? I love to start IV's and I am afraid I wouldn't get much of that in a PACU. Thanks!

Getting back to the OP's questions before I got off on a political PACU tangent..........

Overall, I really can't complain (but I still will) about PACU.

I've never worked ER so I can't compare it for you but the way you described ER being extremes of business and no patients sound similar to my PACU experience.

I wasn't sure if I wanted to do it, I applied only because my hospital had openings and everyone told me that you have to grab a PACU position when they become available because they generally are competitive premium jobs, from a staff nurse standpoint.

It was good advice and I've found it to be true.

You can always go back to ER if you want to, but it's probably harder to go to PACU from ER if you pass up the chance now and decide to want to do it later.

You have to take the opportunity when the openings occur.

I'm a little concerned that you've only been a nurse for 6 months. They generally (but not always) want ICU nurses with at least a couple of years of experience but that's not written in stone.

Apply for it, interview, tour the unit and just see what happens and see what your gut instinct tells you.

I don't regret my choice and I can still always go back to ICU full time (I currently do both.)

Some smaller hospitals have OR nurses who do everything from scrub, circulate to PACU. Bigger hospitals like mine, the staff is completely separate. OR nurses and PACU nurses are two different things in most big hospitals.

Like I said, I've never been a full time ER nurse but I'd be willing to bet that you'd find some parallels between the two such as turning patients over quickly throughout the day vs. ICU and floor nurses sticking with mostly the same patients in one shift.

Quick, sharp assessment skills (like you do in ER now) and a lot of focus on airway issues and pain management.

Personally, my transistion from ICU involved a lot of discomfort with giving heavy doses of pain meds to non-intubated patients and trying to balance pain management with knocking someone out to the point of needing re-intubation (which of course you don't want).

I was used to giving heavy sedation to vented patients in ICU and that's a whole other ballgame than PACU patients screaming in pain one minute and shallow respirations and dropping O2 sats the next.

I also had to get used to taking patients across the lifespan. I never worked peds in my life but I'm doing it now.

I think (not sure) that most PACU's are adult/pedi mixed. That was a surprise to me when I first interviewed.

For some reason as an ICU nurse, I just figured that pedi surgey cases would go to some pedi recovery room just like a kid would always go to PICU and never to an adult ICU. Wrong.

Anyway, I hope this helped and I hope that other PACU nurses, maybe ones who've worked in more than one PACU can chime in.

That was only my experience in one PACU.

Happy-ER-RN, RN · Nov 28, 2005

Thank you all so much for your responses!:)

sharann, BSN, RN · Nov 28, 2005

RN34Tx nailed it about the pain issues. I cannot believe the amount of narcotics I give some paitents and they are still awake let alone spontaneousl breathing. The fine tuning is an art that comes with experience and knowledge that Narcan is close by if the worst should occur.

amnesia · Apr 15, 2006

I work in a PACU that is always very busy! We do an average of 80-100 cases per day (adults) -- our kids go to a pediatric recovery and run 20-40 each day. We have staffing every day, around the clock. The only call shifts we share are Saturday and Sunday nights. We also rotate 1 minor and 1 major holiday.

Our cases range from vascular, GYN, ortho, plastics, trauma, burns, general surgery, some OB interventions, acoustical, nasal/septal, GI, GU, colo-rectal, etc. You name it. The only patients that bypass our unit is PICU and CABG pts.

Nursing in this area is very fast paced and ranges from minimal to intensive interventions. Ambulatory pts are 2:1 and ICU's are 1:1 and sometimes 2-3:1 depending on the situation. I love the fact that the skills you use for this specialty is so diverse. Truly every day brings a new learning situation. you must have excellent assessment skills and equally matched decision making skills, so that you can CORRECTLY intervene with in seconds. ABC's are our mantra! Pain control is a huge protion of our recovery process. (I am sometimes amazed at how many narcotics some people can tolerate!)

I think PACU nursing offers the best of all worlds. You really get to use ALL of your nursing skills, you really do not have to deal with families too often (a blessing in MY opinion), you get to interact with awake/talking patients and then you will get a vented/sedated pt. next, you also get to transfer the difficult/abusive patients! Thats a beautiful thing in MY book!

Anyways that the crux of PACU nursing.

gentle_ben_RN, ASN · Dec 29, 2006

I've never worked ER before but my wife has been in the ER for over a year now. She and I are often talking/venting about our days at work. The one thing that I can honestly say that we are both frusturated about is bed availability. Holding patients in the PACU is not a good thing (especially when you have the put the OR on hold because the PACU is full) So that is one similarity between PACU and ER, waiting on beds. I work in a pretty large hospital so I am not involved in pre-op at all, only PACU. Therefore, I do not get the opportunity to start as many IV's as you would in ER. That is one skill that I miss (I don't want to lose my touch). Otherwise, I don't think it would be difficult for you to make the transition. We do use a whole other kind of "anesthesia drugs" that you may not be use to in the ER. But they are easy to learn. Good luck.