Role of a PACU nurse? - page 3

by born2circulateRN

15,870 Unique Views | 27 Comments

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 isn't so much of floor nursing.... Read More

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    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.
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    @GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?
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    Quote from itfeelsgr82savealife
    @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.
    GHGoonette likes this.
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    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.
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    Quote from itfeelsgr82savealife
    @GHGoonette, but aren't the scavenger systems only connected to the anesthesia machines in the OR? What about the PACU?
    The 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!
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    The 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.
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    Call is going to vary alot from one hospital to another. One hospital in our system has one PACU nurse on call on weeknights and a couple on weekend days (scheduled cases) and one or two on weekend nights. We get minimal trauma cases, they go to one of the two large hospitals.

    My hospital is small (3 OR/3 PACU beds), we only have 3 PACU nurses. When I started, OR still did their own call case recoveries. After a while, they put PACU nurses on call on weekends only. We each take the whole weekend. OR still does their own weeknight recoveries. OR Nurses have to live within 30 min of the hospital. PACU nurses don't have a specific distance because usually we have plenty of time if know about the case before it starts.

    As far as how call is assigned, I could let the manager make up the call schedule, but I draft it myself, so we can talk about it before we give it to the manager. She likes not having to make up the schedule.

    We get paid a small amount for being on call, then get paid time and a half for cases, min two hours paid.
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    It's so interesting to see the variation in how different facilities implement the PACU. Here's my weigh-in: I have never given Versed unless I was assisting with a pre-op procedure; if a post-op patient needs anxiolysis, we use Ativan. I give mostly IV pain meds, anti-emetics, and the occasional BP medicine; I also set up PCAs for the floor and occasionally run piggy-back IV meds with their maintenance fluid from the OR. We do give vasoactive meds as needed, but for most of my patients, the focus is on waking up, breathing, and pain control.

    We routinely have pedi patients' parents come in, but adult pts' families only come in for special needs, extended stays, or other special circumstances. I am a new grad just out of PACU orientation, but most of the nurses in my unit came from med-surg, cardiac telemetry, or ICU. There isn't one path to the PACU (or I would have taken it!). I can say it is easier to learn PACU if you have some experience with nursing in general; just today I had to ask a really stupid question because it was something I had never done before!

    As far as call, I'm not on call yet, but we choose to either rotate on weekends or on weeknights (not sure how many per month). I'm thinking of going with weekends, because I can't imagine working overnight and then coming in the next morning for a regular shift. Every hospital is different. I'm not looking forward to call at all. I know of some units that are staffed 24/7, but that's at the really huge hospitals with ORs running all day and night.

    We've had very few intubated patients come out to our PACU while I've been there, though it does happen; the usual practice is to either extubate in the OR or leave them on the vent and send them to the ICU. Respiratory comes to do breathing treatments, and we see a fair number of X-rays and lab draws in a typical shift. Routine meds are not normally given, often because the patients have been NPO or received meds before surgery. We do finger sticks for all diabetic patients and medicate according to orders, but again, because they have been NPO, we have a higher glucose threshold before we treat than the floors do, because it is very easy to tank their sugar if they aren't eating yet.

    What do I love about PACU? I love the variety, I love the surgical "flavor" of the unit in general (started out wanting to be an OR nurse but changed my mind during school), and I love the very close focus on one or two patients at a time. One tough thing was realizing that if, say, an orthopedic surgical patient came in with a crappy heart rhythm, they're probably going home with it; we didn't fix that in the OR! Especially as a student and a newbie, I want to understand all of it, and it is a process to learn what to focus on and what to let go. I ask a lot of questions, and I have cultivated a good relationship with most of the anesthesia staff, because they are my go-to people for most of what goes wrong with my patients.

    At least in my unit, the relationship between physicians (especially anesthesia staff, but surgeons, too, to some extent) and nurses is more collaborative and collegial than elsewhere I've seen. The docs rely on us for a large amount of oversight, and they respect our autonomy. They are always around, too, so it forces the relationship to be more in the open than on floors where the doctors flit in and out and hardly interact with the nurses at all.

    I hope this helps. I totally agree about shadowing; I have vowed to never take a job without shadowing first, because that's the only way I can say, "This is for me" vs. "This is SO not what I want to be doing." Good luck!
    TomGuy likes this.