Role of a PACU nurse?

  1. 0
    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. So, what is the role of a PACU nurse?

    I know it's patients coming from OR and they are pretty much recovering from anesthesia. I know great assessment skills is definitely needed- and pain management is a role. Versed is a PACU nurse's friend. I believe that the patient isn't in there for too long...from about 30 minutes up to a few hours? Ratio is 1:1 maybe 1:2 - I am not really sure that's why I want other nurse's voice in this. So, here's a few questions.

    1. What is the nurse patient ratio?
    2. How long are patients on the floor?
    3. Are there scheduled medications like home meds given or is it just pain management and Versed, if needed?
    4. Is PACU available in 12 hour shifts and night shifts - which is what I prefer.
    5. Is there much family present?
    6. Why do people say ICU is required? What for?
    7. Are tasks usually done - such as blood draws, IV starts, foley insertions, etc...?
    8. Are vented patients on PACU floors?
    9. Is there RT present?
    10. What is your typical day like? What is the actual role?

    Any input is very much appreciated. Thanks!
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  4. 27 Comments so far...

  5. 1
    Quote from itfeelsgr82savealife
    1. What is the nurse patient ratio?
    Typically, it is 2:1, unless one is a critical patient or peds at my facility. These patients are 1:1. However, at times when there are no beds available, one nurse may essentially be acting as a med/surg nurse and be responsible for several patients who no longer need the PACU environment but can't be transferred out.

    Quote from itfeelsgr82savealife
    2. How long are patients on the floor?
    This is variable, and depends on several reasons: patient's level of consciousness, availability of beds, pain level, meeting criteria for discharge from PACU. For most patients, the goal is about 1 hour.

    Quote from itfeelsgr82savealife
    3. Are there scheduled medications like home meds given or is it just pain management and Versed, if needed?
    Again, depends on how long the patient is there. The most common meds are analgesics and antiemetics, but pretty much any drug is fair game.

    Quote from itfeelsgr82savealife
    4. Is PACU available in 12 hour shifts and night shifts - which is what I prefer.
    This is facility dependent.

    Quote from itfeelsgr82savealife
    5. Is there much family present?
    Again, facility dependent. Many PACUs have a no visitor policy, although mine makes exceptions for patients being held for extensive times in PACU (2 visitor limit, and PACU must be fairly quiet- no codes, no critical patients, etc.).

    Quote from itfeelsgr82savealife
    6. Why do people say ICU is required? What for?
    You may be responsible for managing vents, invasive monitors, and drips. Not all places require ICU experience as they are willing to train, but it will be beneficial.

    Quote from itfeelsgr82savealife
    7. Are tasks usually done - such as blood draws, IV starts, foley insertions, etc...?
    Yes, if needed. Many surgeons order stat labs, chest x-rays, etc. to be done in PACU.

    Quote from itfeelsgr82savealife
    8. Are vented patients on PACU floors?
    Again, can vary from facility to facility. Mine tries to send patients who are expected to remain vented directly to the ICU. Sometimes they don't have beds available and the patient must go to PACU. Other patients are expected to only temporarily need a vent. Our policy is that if the patient is expected to be extubated within 2 hours, they go to PACU.

    Quote from itfeelsgr82savealife
    9. Is there RT present?
    Facility dependent. Our PACU nurses run their own vents and only call an RT for treatments.

    Quote from itfeelsgr82savealife
    10. What is your typical day like? What is the actual role?
    I'm an OR nurse, so I can't really answer this one for you.
    born2circulateRN likes this.
  6. 2
    The PACU is essentially a short stay ICU.
  7. 2
    Ratio is 1:1 initially, more once stable. Patients are in PACU until they are at nearly baseline status (minimum 30-45 minutes), then transfer to a room or are sent home. PACU usually deals with pain, anxiety, and antiemetic meds, but also antibiotics and other meds like anti-seizure meds, pressors, etc. PACU can be 8 hr or 12 hr, depends on your facility. There will most likely be "call shifts" for evenings and night shifts and weekends. Family presence in PACU; not usually. ICU experience is usually preferred but not absolutely necessary; depends on your facility. Why ICU? To deal with swan, ventric, arterial lines, cvp monitoring. To deal with vasopressors and vasodilators. To deal with respiratory distress and avoid reintubation if possible versus reintubation ASAP! Some tasks are done like Cxr and blood draws , but others are not done. Some patients are vented but the goal is recover them to near baseline and get them elsewhere. If you can't move them out, you get to stay overnight for them. RT presence, depends on your facility. Usually the anesthesiologist will extubate them in OR or PACU but will stay with patient for a short while after surgey. The sickest patients will bypass PACU and go straight to ICU. Your shift would be recover patient then transfer out then do again.
  8. 0
    Thanks everyone for the information; I really appreciate it! It's given me a much better view on this specialty. Anyone please feel free to add anything else.

    Thanks!
  9. 0
    Another question to anyone, do the patients come to PACU intubated or are they extubated in the OR? Thanks!
  10. 0
    Ignore the previous question.
  11. 0
    At my facility we do bring family in after the patient is awake and pain/nausea is under control.
  12. 0
    That's one of pros I like about PACU, USUALLY no family (per facility), which I prefer not to deal with. Well, hopefully that doesn't happen often. Thanks a lot!

    Also, to anyone, what's the pros and cons of PACU- in everyone's individual perspective of course? Thanks!
  13. 1
    I think for you to get an idea of what your pros and cons might be plus the role of a PACU nurse in your facility would be to ask for a shadow day. That way, you can see it firsthand rather than hear about it secondhand.
    wannabecnl likes this.


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