I never answered your post back. I was actually on call last night and have some insights to consider if you want to recover pts outside the PACU.
1. You asked about meds; yes, I still do the med orders and administrations the same way as in the PACU. Only change is that the ICU doesn't stock all the same meds as we do, so I may have to call the pharmacy to tube up the meds I need.
2. I don't know about looking at the census and going from there to select a recovery area unless you have pre-determined buy-in and a little infrastructure in all the areas. We always use the ICU; we keep a recovery cart there with "everything" we need, and then we restock the ICU stuff we have to borrow if it isn't on the cart. The cart can be moved from one ICU room to another, but I wouldn't want to be moving it all over the hospital every night. The ICU tells the house supervisor if they need that ICU bed, and we might be bumped back to PACU.
3. Even more subtle is the dynamic between the PACU on-call nurse and the "host" nurses wherever you recover; you're going to have to ask these people for help every so often (for example, I had a nurse watch my rather fresh post-op for a minute because I needed to get something that was out of view of his room), and you need to know that they are qualified to help with the kind of stuff you do. I know ASPAN standard says RN and doesn't get into details about ACLS, etc., but I am more comfortable with backup that is experienced in critical care. That's what I love in the ICU; their nurses have much of the same training as we do (and more), and they also recover their vented patients after surgery so they know what to do with a post-op. Some of the nurses are more helpful than others. I'll just leave it at that; my experience has been about 90% positive and 10% positively ridiculous. I think that's true no matter where you are, but when they are your only backup, it's nice if they aren't put out at having to help.
4. I haven't had a problem with my anesthesia or OR staff. They know where we are, they are responsive to pages (especially the on-call anesthesiologist, who usually stays at the hospital and isn't rushing off to another case like during the day), and they know we are kind of marooned. Call is the one time we are allowed to carry and use personal cell phones; I just page the docs and have them call my cell, and I can always call the switchboard or direct-dial departments PRN.
5. Pedi is a whole different thing. If you do a lot of pedi, consider setting up a cart for pedi in your PICU if you have one, in addition to a regular cart for the unit. We are brainstorming this right now; I've recovered kids, but they were old enough that I could safely work in the adult ICU with them and have help. If it were an infant or toddler, I'd much rather be in the PICU with pedi nurses as backup.
6. Finally, I miss my support staff when I'm not in the PACU. It's like taking away everything familiar except the monitor sometimes! We're physically distant from other nurses (within earshot, certainly, but nothing like our packed-like-sardines PACU bays), the unit secretary in the unit has usually gone home, and we don't have our LNAs, on whom we rely heavily for transport, emptying drains, removing A-lines, the works. I could borrow an LNA from the ICU for an emergency task, but at night the LNAs are very busy and I don't like to give them non-ICU work to do. At night we also don't have transport, so we have to beg, borrow, and steal staff from around the building to help!
These are just some thoughts. I don't know if one system is better than another; this is just how we do it. My preference would be 2 on-call nurses recovering in the PACU, but that's not the way it is for us right now. Good luck!