PACU Call Coverage

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    I am faced with a recent delimma in our PACU. We live in an area with a lot of military where nurses come and go. Our volumes have dipped a little and a couple of RNs have left. We are down to only 8 RNs in the PACU to work 40 hour work weeks and cover "On Call" hours (M-F 11p to 8 a., Sat & Sun. 24hrs). We are essentially working over 100 hours a month "On Call" and everyone is exhausted. We strickly follow the ASPAN Standards with having 2 RNs "On Call', but are finding it very difficult to cover ourselves. We are also about to lose one additional RN out on FMLA so we are soon to have only 7 RNs. How are other PACU's meeting the Standard with minimal staff?
    Is anyone utilizing the ICU to recover?

    Open to see what the Pro's and Con's are on any suggestions.

    Thanks,
    Exhausted
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  3. 7 Comments so far...

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    We have one third shifter who is responsible for stocking and other things. She will also recover any non-peds and non-critical care patients with the OR nurse as standby. Level 2 trauma center, so we're staffed 24/7 and usually have a free nurse unless it's trauma circus time. One nurse on call if peds pt or critical care. If third shift is off/weekend, two nurses on call, first call comes in with OR nurse as backup and second on call comes in if peds/critical care. Perhaps looking to hire someone exclusively for third shift or at least for a later shift (3-11) would be an idea to look into?
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    Thanks for the feedback. We are also a level II center with 3 to 11 staff. I have been trying to get support from the OR RNs for some time now. I Will continue down that road. I think that will be our saving grace. The push back here with the OR is "what if a trauma comes in?". How do you guys handle that. I know here the OR team has to respond immediately and if we have a bad patient in the PACU that could create a huge issue. Who would stay with the PACU nurse or has that even been an issue for you?

    Thanks again,
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    Actually, the OR nurse isn't necessarily in PACU with the PACU nurse. She's at the OR desk about 10 feet from the open PACU door. Usually the PACU nurse is fine with being alone for the 30 minutes it takes to call in the call nurse (OR or PACU, if the trauma/emergency would come to PACU) if the OR nurse has to go do a trauma. Once the OR call nurse comes in, the third shift nurse is free again. Anything non-emergent waits until the OR call team arrives. It also usually doesn't take long at all to get a bed on third shift, so the PACU nurse isn't sitting for hours with one patient. Once they're awake enough to talk and eat ice chips, they're out.
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    Thank you....this is a great option for us here. I will try to push it up the chain.

    Thanks.
  8. 0
    Just wondering if Sweet Wild Rose has had any problems with using the OR as back up? Do they complain? We have same-day nurses up here on Saturday mornings and when I say oh okay you'll just be my second person in the room they look at me like I'm a crazy person. They go " We dont have ACLS" and I'm like "you're still a nurse".

    My boss told me it was okay to use OR as backup... plus there is CRNA and a multitude of other people. Whenever a surgery happens there are 4 OR nurses there just in case of traumas. How well does this fit with the whole ASPAN standards. Have you had any problems at all?

    Would like to know just so I can have the info so I'm less paranoid when I dont call on call person in for a healthy 20 y/o appendectomy.
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    We have one nurse on call 7p - 7a on weekdays (which overlaps our later shift people--we're officially staffed until 9:30 p and open at 6:30 a), one nurse 7a-7p Sat and Sun, and another nurse 7p-7a Sat and Sun. We recover patients in the ICU, so the ICU nurses are our 2nd nurse. We typically run one OR after hours, but sometimes they'll open a 2nd one, which can challenge the system, and when the ICU is full, we have to go back to the PACU and find a 2nd nurse.

    I really wish we could always recover in the PACU, but you raise some good points about the limitations and stresses it puts on your staff.
    emain86 likes this.
  10. 0
    Quote from wannabecnl
    We recover patients in the ICU, so the ICU nurses are our 2nd nurse. We typically run one OR after hours, but sometimes they'll open a 2nd one, which can challenge the system, and when the ICU is full, we have to go back to the PACU and find a 2nd nurse.

    I really wish we could always recover in the PACU, but you raise some good points about the limitations and stresses it puts on your staff.
    Wow this is really a good idea! Very inciteful. Using the OR as my secondary nurse isn't always the best because they are basically useless unless I'm calling for a code ( and even still they aren't always an ear shot away. ASPAN standards says 1 phase 1 PACU RN, + an RN at least within earshot).

    So basically I could look in my bedboard ( our bedding system) and see like oh T2 ( SICU) has 8 empty rooms. Lets just recover the patient up there and when OR calls to say where we putting the patient in room so and so?

    We actually have a nightshift nurse ( me and one other nurse nightshift) and we work Sun-Friday. Basically we work each others off days and we call in another nurse for patients. So basically since I'm up all night I pick up everyone's call so this could hurt my money haha but its really a great idea.

    Can you elaborate more on you do your drugs/what not? Do the Anesthesiologist every get mad if they have to walk over to the UNIT? Or maybe I could recover the patient over in SCVICU which is literally right across the hall. This is a good idea. Our drug stuff is funny and I'd have to work on how we'd do that. Overall I really like the idea of doing it that like that.

    Would really like to discuss this further.


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