All my PACU RNs

I have worked in ICU and PACU. What I like about ICU is that you get an in depth total picture of your patient. Labs, history, LOC, etc. In PACU you'll probably never lay eyes on your patient until they roll out of the OR unconscious. The only history you'll get is what the OR team tells you because you just shipped off your last patient and the slot was immediately filled. Since you still have a patient you haven't had time to look anything up on the patient you are currently getting. Sometimes some very important things are left out of the history you get from the OR staff. In PACU you usually only have your patients an hour or so, you have very little contact with family, and there is usually less charting. On the other hand, you have about an hour to get your patient awake, charting done, pain under control, and any other things that need to be done, all while managing another patient as well. Also, patients will not remember you, so if you are the kind of person who likes acknowledgement, forget it.

I worked in ICU for over 27 years and then went to PACU. It was a wonderful place to work until a year or so ago when the "climate" began to change. Now we often have patients for many hours as they wait for a bed to open up on the one surgical floor we have. We also have liberal visiting which should mean a brief visit in pacu, but often turns into families gathering at the beds and sitting in chairs when pts are delayed. We also get many ICU patients that stay for days in the pacu because there are no ICU beds available, and that means having "on call" nurses work around the clock to care for them. Be sure to check out how the pacu you are interested in working in functions, since not all are alike. We also should only have 2 patients at a time, but often have 3 in quick succession due to the OR schedule and the number of pacu nurses on duty. It can get quite chaotic, especially since a patient's condition can change very quickly as they emerge from anesthesia.

Love: 2:1 ratio, rapid turnover, no night shift, making pain go away, high acuity of some patients, working so close with anesthesia, recovering many types of patients and procedures. (some are really amazing!)

hate: boarding ICU patients, long delays for beds, weekend calls, cranky surgeons, patients can crump super quick and sometimes you can't hand off your other patient... They basically get ignored while you're saving the life of the pt next door!

Wow , Thanks a lot for the good info !

I like the quick thinking and rapid responses you need. I like the turnover of patients. I dislike " holds " waiting for rooms. Some places call them boarders. I don't like when families expect to stay and pull up a chair for a good long chat. Families should just stay for 5 minutes or so, the patient is delirious for goodness sakes! I don't like having to mix pre-ops with post-ops late in the day/ evening when the SDS nurses have gone home. I like the highly technical critical skill level you need. I like comforting the patients. Good luck!

I won't be repetitive. I love that they sleep, (sometimes), family are usually not present. By the time they feel awake enough to ask for drinks and crackers and start telling you their life story, they are ready to go to their room or home. They actually NEED the narcotics, (I came from the ER to PACU). I like the autonomy of nursing decisions because our group of anesthesiologists are wonderful and appreciative of what we do. Ok so I've outed myself as only 'slightly' burned out, but I've been a nurse a long time.

Love: Varying acuity, ages, and surgeries. Relative autonomy (docs will often ask me what I think, though usually if I've bothered to call the surgeon, it's because I want to know what he/she thinks!). I love the one-on-one attention I can pay to the patient, and I like being the person they see smiling at them when they wake up.

Hate: Call. I freaking hate call. I hate discharging patients home after hours; if I wanted to do that, I'd work in phase II. Parents of pedi patients who ask a million questions (I'd be the same way, but it's hard being on the other side of the bed from them!) drive me insane. Another tricky bit is that you don't get to do the same thing very often, so new skills take a very long time to become comfortable. I have had to jump in and do the new stuff very purposefully so that I had enough exposure to get comfortable.

Right now I'm training in medical stepdown . Where I am I have the chance to be expose and learn many new skills. Would love to concentrate in critical care . I've been a nurse for 18 months . On the unit I am I feel like I know nothing because everything is so new to me . I'm excited and motivated to learn and learn !!!! I want to be a PACU nurse one day . I really appreciate all your feedback and keep it coming please !!!!

PACU loves- quick turn around, fits my personality so its a win for me. Pt care is focused on a few main goals, and because things from other areas like call lights, family meetings and such don't really occur you can really focus on the patient and their care. LOVE having anesthesia available, but I have been blessed with good anesthesia groups, you need help, call and BANG there are several right there to handle the situation. Great relationships with anesthesia (depending on the group) because you are working closely with them quite a bit. Really makes caring for the patient a lot easier, they know and trust you and vice versa- and that's good for the patient too. Getting to have the critical care element ( I tend to take the sicker cases) but again with a good quick turn around. And not to be mean, but quite frankly, doors that aren't labeled for the general public and that lock. The environment in the PACU, I think, gives you more control and autonomy than almost anywhere else.

Issues:

Hospital full? Good luck you just became the holding tank, and ER will get beds before you. That means for hours, or overnight you are holding people in an environment NOT designed for anything but short stays. Often no pt bathroom, no TVs, no privacy, family cant stay, etc...... I hate being the holding tank, because the patients and families are often upset, and its justifiable and often there is no solution.

Surgical residents that have no clue. They don't know but there are the "oncall", so hope you know what you are doing well enough to make up for them

Visitation that isn't appropriate. This is a big deal right now because managers feel like it might help satisfaction and are really pushy about it now, but I follow the standard. With the normal adult patient you get a phone update after I make sure everything is ok, and a visist at 2 hrs if they are still there. The PACU has no privacy for others, and is NOT the waiting room. The pt is recovering and doesn't need to entertain visitors. The patient says they are feeling ok til grammy asks them 70 times if there are "really sure" they aren't nauseated, then suddenly they have been convinced they are. Pts don't recall PACU most of the time, but families do. My mom was in horrible pain in PACU, and knowing she would not recall it I opted to NOT visit. She wouldn't remember, but I would Always remember seeing her that way, wouldn't have helped either of us. MRDD, children, and such do require ONE caregiver at bedside for obvious reasons which I fully support. I also always give that 2 hour visit. Its short, come see she is okay, say hi, and head back out. I have had too many visitors with front row seats to another patients reintubation, and its NOT appropriate.

Peoples attitude that if you worked ICU you are the same as a PACU person, and its the same. It ISNT I have worked both, and PACU and anesthesia have a number of very important differences.