Considering PACU job after postpartum maternal/newborn

[boquiabierta]

I'm looking for some general thoughts. I've been a nurse about three years and all of that time has been spent in postpartum maternal/newborn nursing. Not high risk maternity or NICU; my patient populations have always been relatively healthy and I've dealt with few emergencies or acute situations. A few hemorrhages, some babies in mild respiratory distress, no codes or anything even really close.

I just moved and am considering a pediatric inpatient PACU job. I'm worried about my ability to go from pretty low acuity to much higher acuity. I know you can't learn until you learn. But I am honestly concerned that I won't have the instincts to handle airway emergencies and everything else. Obviously I would go through orientation and not be on my own for a while. But I'm worried that the unit, which doesn't hire new grads, thinks I'm more equipped than I feel I am. Not sure if this is rational or imposter syndrome. I want to develop my acute care skills and I don't really have any reason to think I can't do it, except that, well, I'm worried I can't.

Any thoughts/reassurance/advice?

[brownbook]

Did you already get hired? Just wasn't 100% sure from your post. If so you obviously have some smarts and or display enough common sense, maturity, etc., for them to hire you.

Were you required to have NRP to work maternal newborn? Not that you'd need those specific skills. I am sure you will take PALS, and even ACLS can't hurt, before, or as part of orientation.

Get a written plan of their orientation program. How thorough their orientation program is, how long it lasts, how long you will work with a preceptor, will there be classroom time, etc. If orientation appears good I say take the job with the hope, assumption, that it is a well run unit, that you will get good support from co-workers etc.

A student showing up for the first day of chemistry is not impostering a chemist. You are not impostering an experienced pediatric PACU nurse. You are new. Don't "imposter" a more experienced nurse than you are. Ask every dumb stupid question that comes up during orientation and even the first few weeks on the job.

[boquiabierta]

Thanks for the reply. No, I haven't been hired, but the interview seemed to go pretty well and one of the interviewers hinted that I should be hearing from them (in a positive way). Yes, I had to be NRP certified in my old job but I never had to actually resuscitate a baby. This new job will require PALS and possibly ACLS. They said orientation is around 10 weeks, sometimes more or less depending. I did get the sense that it's a pretty well run unit with lots of teamwork and support staff, and you're always 1-1 with your patient. Not sure if that's standard PACU practice.

[brownbook]

Great, inspite of my no dumb questions during orientation comment.... I except to see you here, or the PICU specialty section asking for shall we call it clarification questions :).

[HeySis, BSN, RN]

I agree not an "imposter", but new to PACU. Great thing about PACU training is that it's an open room (all the ones I have seen are, may have curtains.. but still pretty open) and even after your orientation is over you'll have other team members literally within eyesight to ask questions of.

When I first started PACU I had three months orientation... and even then I didn't see everything there is to see, some things happen so rarely (I have thankfully still never seen MH in our PACU). But when I came across something new I could just raise my voice a notch to ask a question, if the patient was stable I could take a step over to the next bay and still keep my patient in eyesight, or another nurse could come to me and do the same with her patient. My team was (and still is) a great resource for when the "well, I've never seen that before" comes up.

[SBJustBreathe, ASN, RN]

Wondering how things are going for you. Did you get the PACU job? I also am considering trying to apply for PACU. I have 2 years mother baby and 1 year home health. Nervous that I don't have critical care experience moving over.

[boquiabierta]

I was offered the job and accepted! Not starting until the second week of January, so we'll see :)

[boquiabierta]

Follow up question: any suggestions as to what I should study or read up on to prepare for working in the PACU?

[djmatte, ADN, MSN, RN, NP]

ASPAN (American Society of PeriAnesthesia Nurses) information is a good place to start. Also Pain Assessment and Pharmacologic Management by Pasero and McCaffery is exceptionally detailed, but has lots of great info. I used that book in my transition to Acute Pain, but is valid for PACU as well.