Brand new world! Nicu to Pacu!

brownbook · Feb 2, 2014

I can't figure out if your surgery center is hospital based and patients will be having "major" spinal and cardiac surgeries then admitted to the hospital, or an ambulatory center for "minor" procedures and they will go home the same day? It makes a big difference.

I assume these are patients who will be admitted to a hospital, but I hate to assume things.

cassidyhodgkins · Feb 3, 2014

These will mostly be minor surgeries with the patient going home the same day.

brownbook · Feb 3, 2014

Okay.....the bottom line is the patients are pre-screened by (usually) their primary care physician, screened by their surgeon, screened by the anesthesiologist. So you are going to have basically healthy patients who can tolerate the surgery well enough to go home afterwards.

Honestly the bottom line in these surgery centers is to get the patient in and out quickly. You may not, will not, be doing head to toe assessments. You may rarely listen to lung or heart sounds, very limited assessments.

In my old job a nurse did pre-op assessments with the patient actually coming into the facility. We took vitals, drew labs, did EKG'S, sent them to x-ray. In my current job the nurse's pre-op assessment is only a phone call "assessment." We complete a health history check list with the patient over the phone. It can be done with a family member, (which is highlighted on the chart so the information is confirmed with the patient the day of surgery.)

A typical day is you have the whole day's surgery schedule. Patients arrive 1 - 2 hours prior, check in, you bring them back, change to gowns, witness their consent to operate, when did they last eat and drink., start IV's (some places anesthesia does this,), check the surgeons orders, were antibiotics ordered, does this surgeon like the patient shaved, do they need SCD'S. You check the chart so anesthesia can assess the patient, anesthesia may want an EKG, and labs, (which were hopefully ordered by the surgeon or PCP and already done and in the chart). But a young healthy person for a minor procedure might not need either.

You must have a list of their current medications they are taking.

They must have a history and physical less than 30 days old.

PACU may have a fast pace. As I said these people are already deemed healthy enough to tolerate the surgery. They are connected to a monitor for BP's and pulse ox, seldom get their cardiac leads put on. You won't be doing a full assessment. They may be ready to go out the door 1/2 hour after arrival to PACU. They may get a snack, family or the ride home is brought back, discharge instructions are gone over and signed. They get a wheelchair ride to the drivers car. You may call in their pain prescription to their pharmacy.

Meds in pre-op are mainly antibiotics. Meds in PACU are pain meds, anti-emetics. Of course there are occasionally others but I am trying to keep this short.

In my current job we don't do call. We are closed evenings, weekends, and holidays. We are able to keep patients overnight but ideally the surgeon has given us a heads up several days before and we have a few nurses available for that shift.

If for some reason you do need an on-call staff, at my old job it was assigned by the charge nurse. Honestly I paid little attention to it. As crazy as it sounds every time the on call list came out my co-workers would beg me to give them my shift, they loved the extra money....I HATED being on call. But when I was we just had our phones always on and had to be available, less than 30 minutes away.