Thinking about PACU

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    i applied for a couple of pacu positions, anxiously awaiting an interview. i had a question for you pacu nurses. how do enjoy (or not) the patient-nurse relationship in pacu? specifically, the length of time you care for a patient, the pt. turnover, etc. i come from peds oncology, where i see the same pts, day in and day out. it has it's ups and downs. more downs lately (feel like i don't want the attachment anymore). looking to hear your thoughts...
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    I floated to PACU from my critical care units. The pros are its fast turnover and stimulates your brain. You have surgeons and anesthesia providers close at hand for emergencies. You have a short intense relationship with your patients then you turn them over to another unit.

    One must like this fast pace with frequent turnover, it reminded me of ER in this respect...in and out all the time. PACU nurses generally work as a team, all getting the patient hooked up to monitors, etc when they roll in from OR.. If you're young and healthy and like a fast pace, stimulating intense environment it might be for you.

    Personally I didn't like pushing the beds and gurneys in a big rush...due to my age and found it hard on my arthritic neck and back, but I did like the critical care environment of practice.

    Go for it if you think it sounds like you might enjoy it.
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    Hope you get the position but what mattsmom said, it is fast paced. I like the pace personally, but at times you want to pull your hair out when you have a patient screaming in pain, one vomiting or having resp distress and the docs come up to you and ask you to fax something for them! Oh, and the secretary is pulled to surgical desk and the 5 lines are all ringing and its someones family member posing as a staff member to get info... I'm kidding though(sort of). It has NEVER been a boring day!
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    like any other specialty, pacu has its pluses and minuses. i agree with the pluses that others have cited. to me, the biggest down side of pacu is that some people come out of anesthesia very rough. yelling, screaming, saying inappropriate things, climbing over the side rails.....i can remember a very large post-crani that we had to practically sit on to keep him in bed, and he kept taunting his nurse. after some time, though (maybe 30 min?) he came out of it. another problem is when you have to hold patients while waiting on a bed. patients are uncomfortable (we keep ours on stretchers), family members are mad (can't visit due to confidentiality issues with the rest of the patients). finally, there were times when it was so hard to get the floor nurse to come in and accept the patient.

    transporting the patients irritates me at times, too. facilities all differ in their policies. i've worked in hospitals where patients are put on the bed coming off the or table, which meant they took up more room in pacu, and you had to have help to push the bed to the floor. in the facility where i currently work, they are on stretchers coming out of the or. i may be able to push the bed by myself, but then i have to transfer them to the bed when i get there, not always easy with a post op patient who hurts when they move. to me it is much kinder to do the transferring back in the or when they are still "out." they are being transferred to a stretcher, anyway....why not just put them on the bed then?

    i'd definatly ask in your interview about holding patients over, pacu visiting policies (and how well they are enforced), and how difficult it is to transfer the patient's care to another nurse once you get to their room. to me, those are the things that make pacu stressful (the stretcher thing might just be a little pet peeve of mine)
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    Quote from critterlover
    to me, the biggest down side of pacu is that some people come out of anesthesia very rough. yelling, screaming, saying inappropriate things, climbing over the side rails.....i can remember a very large post-crani that we had to practically sit on to keep him in bed, and he kept taunting his nurse. after some time, though (maybe 30 min?) he came out of it.
    this is something i never even thought about. thanks for the insight.
    another problem is when you have to hold patients while waiting on a bed. patients are uncomfortable (we keep ours on stretchers), family members are mad (can't visit due to confidentiality issues with the rest of the patients). finally, there were times when it was so hard to get the floor nurse to come in and accept the patient.... i've worked in hospitals where patients are put on the bed coming off the or table, which meant they took up more room in pacu, and you had to have help to push the bed to the floor. in the facility where i currently work, they are on stretchers coming out of the or. i may be able to push the bed by myself, but then i have to transfer them to the bed when i get there, not always easy with a post op patient who hurts when they move. to me it is much kinder to do the transferring back in the or when they are still "out." they are being transferred to a stretcher, anyway....why not just put them on the bed then?
    this is something i actually did think of, both the bed vs. stretcher, and the time to get the pt. to the floor. my med/surg days were spent on an ortho floor, so we dealth with a lot of post-ops, and the struggles between the nurses regarding accepting the pts. i remember how we tried as hard as we could to avoid taking those post ops back!! and how they would conveniently come back at 6:45, right before shift change, and the oncoming nurse would get stuck with the orders and other stuff :angryfire .

    i do appreciate your objective view of your job. that's what i was looking for.

    this is not directed at you, critter: i'm not looking for a 'break' or an easy way out. i'm looking for a change, a different, prferably more controlled environment, where i can build critical care skills. no specialty, in my opinion (or at least anything i would be interested in) is going to be cake. nothing in nursing is these days. so i believe it goes without saying that "pacu is tough". every job has its minuses, so i think it's best to ask these things in advance, as these are things you may not get on the interview.
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    The strethcer thing is also my pet peeve, but I can see OR's point of view in that it takes more of their time and effort to move a bed back there. HOWEVER, if I were allowed to make a policy based on the PATIENTS welfare and comfort, I would have every INPATIENT on a bed.Period. Thats me though.
    I think you will enjoy PACU, I know I do.MEd surg seems much harder to me by the way.
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    every job has its minuses, so i think it's best to ask these things in advance, as these are things you may not get on the interview


    i'm actually not currently working in pacu, but giving serious consideration to going back. i left my last job due to coworker issues....which brings me to another point: you must find a place where the nurses work well together. i know this sounds like a "no-brainer," as it is important everywhere. but on a floor, and to a limited extent in the icu, you can function fairly independently. not the case in pacu. the turnover rate is just too high. the line of "my patient" versus "your patient" is very blurry. i may admit, but 40 minutes later you may discharge because i 'm tied up. you need to be able to trust each other. similar to the er, but the turnover is even faster and the lines blurrier. and its great when you and your coworkers work well as a cohesive unit.

    one other thing that i would ask in your interview is about the relationship the pacu nurses have with anesthesia/surgeons. in general, they all get along well with mutual respect. but it would be horrible to work somewhere if that wasn't the case....you have to work too closely together to not get along.

    i think you will like pacu, as long as you find a good place to work with good coworkers. good luck!
  10. 0
    Quote from critterlover
    you must find a place where the nurses work well together. i know this sounds like a "no-brainer," as it is important everywhere....
    i think you will like pacu, as long as you find a good place to work with good coworkers. good luck!
    wouldn't that be heaven?? nurses working together. you've been very helpful. really given me food for thought.
  11. 0
    I have been an ER RN for almost 20yrs and am totally burned out. I have put in a transfer request for PACU hoping that will be what I am looking for. As a nurse for the past 30yrs, I can go down the list of areas I know I don't want. I've worked MICU/SICU and hated it. I did home health for 2 yrs and didnt' care for it. I have always loved the ER and that's the painful thing. But it's not like it used to be what with all the governmental regulations, pt's rights, low staffing grids, high stress, etc. I have decided it is time to let it go. I've never worked PACU but a friend who left ICU to go there absolutely loves it. This is a small hospital (128 beds) and major traumas get transferred out, we don't do neuro surg., no heart/lung surg. So, I really hope it turns out for the best as I can't think of another place to try. I would also love to hear more from nurses who know about PACU.
  12. 0
    As a former ER nurse who also HATED Med Surg ICU (did my year and ran!!), I now work in PACU in the same hospital where I worked ER for the majority of my 25 + years as a nurse.
    I have found it to be a very wonderful change yet with many of the same challenges. I love the rapid turn over and the different patients everyday-although as we are aa Trauma Center, we do get many patients several times during their recovery.

    PACU's have advance warning of the number of patients they should have as there are very few surgeries that are not at least an hour from induction to arrival to us. Of course, there is still the unknown of how many of the patients will have airway problems, extended PACU stays and complications that no one anticipates. It is more predictable than ER but still with enough of the unknown factored in to keep you stimulated and you need to be competent and capable of caring for patients of all ages which your background has prepared you for.

    PACU's are very much as intense as ER's and a wonderful place to easily tansition to (but be prepared for the first patient you try to extubate vs ensuring that this does not occur because I was intimidated with the idea of removing the airway support vs doing everything I could to maintain it!)!


    Quote from wayover20
    I have been an ER RN for almost 20yrs and am totally burned out. I have put in a transfer request for PACU hoping that will be what I am looking for. As a nurse for the past 30yrs, I can go down the list of areas I know I don't want. I've worked MICU/SICU and hated it. I did home health for 2 yrs and didnt' care for it. I have always loved the ER and that's the painful thing. But it's not like it used to be what with all the governmental regulations, pt's rights, low staffing grids, high stress, etc. I have decided it is time to let it go. I've never worked PACU but a friend who left ICU to go there absolutely loves it. This is a small hospital (128 beds) and major traumas get transferred out, we don't do neuro surg., no heart/lung surg. So, I really hope it turns out for the best as I can't think of another place to try. I would also love to hear more from nurses who know about PACU.


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