Role of a PACU nurse?

dah doh, BSN, RN · Jan 21, 2013

Pro: rapid turnover of patients, no families until close to discharge Cons: superbusy when multiple patients come out of surgery at the same time, middle of the night call Your opinion may be different, that's my hubby's opinion listed above (he's does PACU).

Roseyposey · Jan 25, 2013

Versed 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!

born2circulateRN · Jan 25, 2013

Thanks 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!

meandragonbrett · Jan 25, 2013

On 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.

dah doh, BSN, RN · Jan 25, 2013

Depends 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.

GHGoonette, BSN, RN · Jan 25, 2013

Another question to anyone, do the patients come to PACU intubated or are they extubated in the OR? Thanks!

This 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....

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.

born2circulateRN · Jan 26, 2013

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!

http://www.osha.gov/dts/osta/anestheticgases/index.html

GHGoonette, BSN, RN · Jan 26, 2013

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

Only if the scavenging system is not functioning properly. This is part of the normal function of all anaesthetic machines, unless they're museum pieces!

dmh2007 · Jan 26, 2013

I 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.

born2circulateRN · Jan 26, 2013

@GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?

Editorial Team / Admin · Jan 26, 2013

@GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?

Typically, 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.

born2circulateRN · Jan 26, 2013

Well 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.

https://www.theinvisiblerisk.org/index.php