Back up PACU nurse on call

[kabrowni]

Looking to see what other PACU's do for on call... Currently our PACU has one nurse on call for 11p-7a weeknights and 1 nurse on call for the weekend. We will recover night/weekend cases in an ICU room to maintain the ASPAN standard of 2 nurses - this is 1 PACU RN and then the ICU RNs are available if we need help. If there is a quick case to follow, we would have to recover in the PACU so we could care for more than one pt at a time. When this occurs we have call upon the house supervisor to be with us if they're available or try to call down the list of RNs who aren't on call to see if someone could come in. Obviously other situations can arise that effect the standards, such as nurse/pt ratios with airway management and children, etc. In which we could use a backup nurse.

Staff is trying to implement a second nurse to be on call as a backup for when these situations arise. We are a 208 bed, level 2 trauma center in New England. I would love to hear from anyone that has any insight or thoughts on the subject as well as what you do in your PACU. Thanks!

[kabrowni]

57 people have viewed this... any input, please??

Thanks!!

[Ortho_RN]

During the week after 1130 we have a primary call person and a secondary call person.. But basically the secondary person will never be called unless things are just out of hand... Weekends its pretty much the same..

[jadespirro]

In the past we had 2 nurses on call 7 days a week from 1930 to 0700, but due to "Consultants" coming in, we no longer have call during the week, and only one PACU nurse on Sat. and Sun. call schedule from 0700 to 1930, OR circulator is expected to stay in the PACU for the recovery period, with the house supervisor as a back up if needed.

We are a physician owned hospital specializing in ortho and spinal. We have 10 OR's and only staff PACU till 1930, unfortunatly this situation leaves evening nurses to cover cases until they are done. So even though your shift ended at 1900, you are there until last case is done, this includes any "add ons" or "emergency" surgeries."

With that being said there is no "call bonus" being paid, thanks "Consultants." We used to get "call bonus" if we stayed 2 hours past the end of our shift, and didn't utilize the call person. Now there really is no insentive to stay and us evening nurses are about fed up. We fought to get our shift diffs back, after they too were taken from us, "consultants" again.

If the hospital had an evening emergency, and OR and PACU staff had already left, the case would be transfered out or scheduled for the morning, depending on the acuity.

We have stayed as late as 0100 recovering cases, although this was rare, recovering patients till 2100 is not.

I am curious how other PACU's run...

How is staffing during the day and evening?

Does your PACU have ancillary staff?

Do PACU nurses take over pre-op patients, when pre-op nurses shift ends?

Do you have to break ASPAN standards with staffing to do ancillary job (going to lab for blood, transporting patients, delivering specimens to lab, etc.)?

Does your OR schedule often change (Dr. starts hours early or late)?

These are just some of my questions...I know I have many more.

[nmred]

I've only worked in 2 PACU's requiring call. The first was a small hospital, ~ 60 bed including the ER. We were left alone. The Policy was "If you asked the Circulator to stay, they stayed". Lots of luck with that one. They complained so much I had rather be alone.

:angryfire :angryfire :angryfire

Where I currently work we have to nurses on call at all times. You call them if you need them. I work with anesthesia provider. If they wish for me to stay in the PACU with the patient we work something out.

Now we have a nurse who only takes call Monday - Thursday. If she needs assistance she calls in the call 2 person. So far that's working out well.

I believe it's a never ending battle.

[nickola]

I did call for 10+ yrs at a Level II trauma hospital in New England too. We had one PACU RN on call. In the event that a patient was in PACU & a 2nd came in, anesthesia would hang out. They also stayed until the patient (if there was just one) was out of Phase 1 recovery, even if there was a 2nd case. The OR team (RN circ & tech) was very good about checking on us to make sure we were OK b/f they left. Most of our middle of the night cases were not quick, mostly traumas, except for C/S & those patients came in pretty awake. ASPAN standards are '2 RNs in the room while a patient is in 1st phase recovery' & we never violated that. In rare instances the MDA would have another anesthesia provider as back-up to start the next case, & it was up to the circulator to call for back-up OR team &/or PACU. However, we rarely had 2 unstable patients at the same time. We all worked very well together, and the OR was in close proximity to PACU too. The worst part was waiting for the floor to send someone to help transport patients.

[nmred]

We have two nurses on call every day. The problem with that is the nurses complain every time you call them in. They want us to recover in ICU. The problem with that is care is compromised because the recovery room nurse is in a different surrounding with equipment she's unfamiliar with. Bottom line is management needs to be more aggressive with patient care and standards.

Peace

[Siss]

I work in a 13 bed PACU (appx. 400 bed hosp.). We have two PACU nurses come out on call anytime a patient is in PACU. This has forced to have more staff, which has been a good thing, but we do take a lot of call. We all like having two nurses. It feels more secure in the middle of the night after the OR crew has left and it is dark down the hall in the OR suite.

[All4Seasons]

For at least ten years here there are always two RNs on call - our call is 2300 to 0700 7 days a week. We do wait list surgeries on Sat and Sun and the floor nurses frequently have to come get their pt either with a colleague or with a porter, as we cannot leave PACU with the pt, leaving only one nurse with the remaining pts still in the unit.

I wouldn't work under any other policy...it's too dangerous and the status of a pt can change so rapidly,as you all know...

[All4Seasons]

In the past we had 2 nurses on call 7 days a week from 1930 to 0700, but due to "Consultants" coming in, we no longer have call during the week, and only one PACU nurse on Sat. and Sun. call schedule from 0700 to 1930, OR circulator is expected to stay in the PACU for the recovery period, with the house supervisor as a back up if needed.

We are a physician owned hospital specializing in ortho and spinal. We have 10 OR's and only staff PACU till 1930, unfortunatly this situation leaves evening nurses to cover cases until they are done. So even though your shift ended at 1900, you are there until last case is done, this includes any "add ons" or "emergency" surgeries."

With that being said there is no "call bonus" being paid, thanks "Consultants." We used to get "call bonus" if we stayed 2 hours past the end of our shift, and didn't utilize the call person. Now there really is no insentive to stay and us evening nurses are about fed up. We fought to get our shift diffs back, after they too were taken from us, "consultants" again.

If the hospital had an evening emergency, and OR and PACU staff had already left, the case would be transfered out or scheduled for the morning, depending on the acuity.

We have stayed as late as 0100 recovering cases, although this was rare, recovering patients till 2100 is not.

I am curious how other PACU's run...

How is staffing during the day and evening?

Does your PACU have ancillary staff?

Do PACU nurses take over pre-op patients, when pre-op nurses shift ends?

Do you have to break ASPAN standards with staffing to do ancillary job (going to lab for blood, transporting patients, delivering specimens to lab, etc.)?

Does your OR schedule often change (Dr. starts hours early or late)?

These are just some of my questions...I know I have many more.

I am curious how other PACU's run...

How is staffing during the day and evening?

We have a 23 bed PACU (but 3 are being used as a block rm and 3 aren't open -not enough staff) - so 17 beds.) We try to have 10-12 RNs on + charge (who isn't to have an assignment,but does help -depending on the nurse!). If the unit had no pts through the night,the unit is opened at 0700 by 2 RNs. 1 more comes in @0800,2@0900, 3or4 @ 1000,sometimes 1@1100, 2 @ 1200 -and then 3 @ 1500.

Does your PACU have ancillary staff?

We try to have 2 nursing attendants (they are trained in CPR,etc) on 0900 -1700 and one 1300-2100 -helping him is porter from the main portering dept who's been assigned to us for the evening. Attendants can take some stable pts back to the floors,porters can't unless they're with an RN or Nursing attendant. We also have hard working ward clerks on Mon to Fri 0830-1630 and 1630-2100. No clerks on w/e s.

Do PACU nurses take over pre-op patients, when pre-op nurses shift ends?

That's a BIG gripe here amongst the nurses - Post Recovery Lounge gets to close up at 1800 Mon,Tues,Thurs Fri ( we HAVE to give report by 1730 or we'll hear about it big time!). On Weds they close at 1900 (report by 1830) -after these times,we do it all -the teaching, phoning for rides,etc. They are NEVER in on the w/e s -we do all their work and sometimes it's crazy busy - we do wait list sx on Sat/Sun and it can be extremely busy - there are alot of in patients who've been cancelled all week plus we get our share of ICU cases when they're full.

Do you have to break ASPAN standards with staffing to do ancillary job (going to lab for blood, transporting patients, delivering specimens to lab, etc.)?

Nope,never happens - nursing attendants,the ward clerk or porters do it.

Does your OR schedule often change (Dr. starts hours early or late)?

Recently six Anesthetists were hired from Germany to fill positions. They came, I understand, on the stipulation that the ORs were to begin and end sooner in the day,so now,most rooms are to start at 0700 and end at 1500 -used to be 1700. There are waitlist rms which go beyond this time though.

On the w/e s the rooms usually start at 0800 and 0900 -this varies though,especially if a surgeon or anesthetist has been on call the night before and had to be in late.

[Babs0512]

We have one 1st call RN for PACU weekdays. The second call goes home around 1900. We cannot call her back in.

On weekends, we have a 1st call and a 2nd call - however, the 2nd call cannot take 1st call. So, they are of no help if 1st call is sick, or was in an MVA on the way to the hospital. They are only used to assist 1st call.

It is also frowned upon to actually call them in. Lots of gossip if you actually do, and then the 2nd call argues about taking 2nd call when your 1st call. It's a really ridicules and dangerous situation.

We once had a nurse who was on first call, had to stay with a patient in pacu overnight because the floors had no rooms. She worked 23 hours straight. She called our boss at home and was told she could try calling others in, she called the supervisor and was told "You can't leave and abandon your patient, deal with it". I came in a 0700 and took over for her, I would have come in earlier if notified.

It's a sucky place to work. We work every 6th weekend on call. My last weekend I worked 30 hours. 20 straight hours without sleep. No one cares, it's expected you "suck it up". It's not safe.