Role of a PACU nurse? - page 2
I am very interested in becoming a PACU nurse in a level 2 trauma hospital. I am relatively new nurse with medsurg/critical care experience and I want to try something different - something that... Read More
Jan 24, '13 by RoseyposeyVersed is a PACU nurse's friend. - Actually, I very rarely give Versed in the PACU
1. What is the nurse patient ratio? Depends on the day and patient. Airway in place is 1:1; otherwise it is usually 2:1
2. How long are patients on the floor? 30 minutes to several hours
3. Are there scheduled medications like home meds given or is it just pain management and Versed, if needed? There are meds other than pain meds (Have given Versed probably three times in the past year) Give tons of anti-emetics, anti-hypertensives, blood/volume expanders, ephedrine, glyco, insulin. No PO meds at all. We are here for airway, cv stability, and pain control, not to manage chronic problems.
4. Is PACU available in 12 hour shifts and night shifts - which is what I prefer. We have 8, 10, or 12
5. Is there much family present? Nada, unless we call them in specifically - eg. a child with special needs. My PACU is too busy to have accessory people running around. I came from an ASC that allowed family, and it usually created more problems and did little for the well-being of the patient.
6. Why do people say ICU is required? What for? I personally did not have ICU, but did have prior PACU experience.
7. Are tasks usually done - such as blood draws, IV starts, foley insertions, etc...? Yes. Phlebotomy draws blood, unless it is from a PICC or central line. IV starts are usually because we lost a line or need to give blood. Almost nobody gets a Foley anymore, but we do insert them sometimes.
8. Are vented patients on PACU floors? Yes.
9. Is there RT present? We are supposed to call them; however, they only come if they feel like it...therefore, I save myself time and handle things myself.
10. What is your typical day like? What is the actual role? My actual day is very busy. We usually run 10 operating rooms with 4-5 nurses, and lately the house has been full, which means a lot of holds. It can be a crazy, stressful circus of an environment. My coworkers all bicker like a dysfunctional family, but when push comes to shove, we all hold each other up and dig in to get the work done and take great care of our patients (who won't remember us anyway).
And there is call, which stinks.
Any input is very much appreciated. Thanks![/QUOTE]Last edit by Roseyposey on Jan 24, '13 : Reason: spelling.
Jan 24, '13 by born2circulateRNThanks a lot for the input...to everyone.
Also, I understand on call is in PACU. How is that done actually? Do you sign up for slots or is it random? Is it counted as overtime? Is on call just like a normal shift -because I've read that in OR the on call can be per case as opposed to an entire 8 or 12 hour shift. Also, is on call mandatory even if you have to commute a long distance? I'm not sure how it works. Thanks everyone!
Jan 24, '13 by meandragonbrettOn call is generally mandatory. You are on call for a scheduled block of time. If you're needed to come in and recover a patient during that block of time you have to go in and recover them, get them to their unit, and then you leave and go back home. The call back is generally paid at 1.5x and many facilities are a 2 hour of pay guarantee....meaning you get 3 hours of your regular pay when called in.
Jan 25, '13 by dah dohDepends on your facility, but call shifts are mandatory for full time and part time staff; per diem not mandatory for us. If you don't want a lot of call, you can usually find someone to take it for you...usually the per diems. It would be best if you lived within a 30 minute drive of your workplace; depends on your unit's policy.
Jan 25, '13 by GHGoonetteQuote from itfeelsgr82savealifeThis may be dependent on various factors; it may be the facility's policy that patients must be extubated and stable before the anaesthesia provider may hand over to the PACU RN. This may be feasible in a small clinic/hospital where only elective or at least non-emergency surgery is performed. However, where you have significant numbers of emergency cases - which usually depends on the facility's trauma level - the PACU must be able to take intubated patients. A life may depend on fast turnaround. you will need to learn how to ventilate patients, my preference being a valved ventilation bag, so I can regulate the oxygen flow. Then, of course, you get those anaesthesia providers who've forgotten to turn off the Remifentanyl infusion until the operation's finished and the dressing's been applied and are in a hurry to finish their lists....Another question to anyone, do the patients come to PACU intubated or are they extubated in the OR? Thanks!
Normally patients on continuous ventilation are taken straight to ICU by anaesthesia, but I have had patients held over in PACU until ICU was ready to receive them. It's extremely rare, but it can happen.
Jan 25, '13 by born2circulateRNHas anyone, which I'm sure you have, heard of WAG (waste anesthetic gases) that's caused by anesthesia during and after surgery that can affect healthcare workers or any personnel within the environment (OR, PACU, etc...)? Is there anything implemented by your hospital that has reduced the risk of WAG? What is your policy or protocol? Thanks!
Jan 26, '13 by GHGoonetteQuote from itfeelsgr82savealifeOnly if the scavenging system is not functioning properly. This is part of the normal function of all anaesthetic machines, unless they're museum pieces!Has anyone, which I'm sure you have, heard of WAG (waste anesthetic gases) that's caused by anesthesia during and after surgery that can affect healthcare workers or any personnel within the environment (OR, PACU, etc...)? Is there anything implemented by your hospital that has reduced the risk of WAG? What is your policy or protocol? Thanks!
Anesthetic Gases: Guidelines for Workplace Exposures
Jan 26, '13 by dmh2007I suspect every facility has different call rules. At mine call is mandatory, but because we have a couple of overnight people it is weekends we have to take call. Ours is rotated. I am currently on the Sunday rotation, so I am on call one Sunday per month. Call is either 16 or 24 hours on Saturdays and Sundays. We are also scheduled a Saturday 8 hour shift once every 2 months. We pick the Sunday unless you are bottom of the list, in which case you get stuck with whatever is left. We can trade our call days. We have 1 hour to get to the hospital when we are called in.
Jan 26, '13 by born2circulateRN@GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?
Jan 26, '13 by Rose_Queen, MSN, RN GuideQuote from itfeelsgr82savealifeTypically, inhalational anesthetics are only used by a CRNA or MD. In PACU, they are usually on either propofol drips or another IV anesthetic/sedative; therefore, there is no waste gas to be concerned with.@GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?
Jan 26, '13 by born2circulateRNWell I mean after the patients come from the OR - anesthesia is still within their system from the surgery, right? When they are transferred to the PACU, they are still able to exhale anesthesia into the environment for healthcare personnel to inhale while recovering from the anesthesia. I was just wondering if anything is implemented within hospitals to reduce the risk.
Jan 27, '13 by GHGoonetteQuote from itfeelsgr82savealifeThe newer volatile agents are very quickly metabolized so you don't get that "smell" when the patients exhale any more. The older generation gases were said to have an affect on staff in PACU, which I suppose was possible, and I admit, I used to get that sleepy feeling, usually early afternoon, and we used to make jokes about sleeping with our patients But then, at the time we had truly ancient anaesthetic machines which were replaced a few years later, and the issue of getting sleepy on duty became a thing of the past. In fact, I'd forgotten about that until this thread reminded me!@GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?
Feb 2, '13 by SueC56The anesthesia machines actually measure the amount of anesthetic gas exhaled by the patient. They are usually pretty much at zero gas before they leave OR. That's one way that the anesthesiologist knows they are safe to be extubated.
We actually wore testing badges once or twice to measure for residual gases in PACU. I assume they didn't show much because we have n't done it since and nobody said anything about the results.