Eek! What is PACU nursing? And do they really want to interview me?

Editorial Team / Admin · Nov 14, 2011

2) Can anyone give me some kind of picture of what day surgery and PACU are like? Day-to-day working conditions? What does a PACU look like? I've only been in an OR once, during clinicals, for a C-section, and have never seen a PACU. I'd like to have something relevant to say for the interview!
I know I sound kind of like a bumbling idiot; I want to go to days, and to more critical care; I just don't want to kill anyone or fall flat on my face or lose my license while doing it!

A PACU nurse is responsible for recovering patients from anesthesia. It could be general, MAC, epidural/spinal, etc. Typically you would care for these patients for about an hour, until they either go to their hospital room (if they're awake enough and stable, bed is available- we've held patients in PACU for an entire shift because there weren't any beds available) or are ready to go to the post-op/discharge area. Lots of pain management, monitoring vitals, dealing with side effects of anesthesia (N&V along with others, but that's the most common), handling emergencies (airways on patients who are unable to maintain their own, the occasional code), sometimes invasive line monitoring.

Some days can be pretty crazy, depending on the schedule. Other days, particularly around the holidays (Black Friday is the next one for us) there may be a limited number of surgeries and you could have a low census day off. Some days there may be all quick cases, and the patients are coming out of the OR non-stop. Other days they may all be long, involved cases where they trickle out or all come at the same time needing a higher level of care. The typical ratio is 2:1, although where I work it's 1:1 if the patient is ICU/step-down, comes out on a "wake-up" vent, or is a pediatric patient.

Most PACUs are set up as cubicles divided by curtains (not closed 100% of the time), with the exception of the isolation rooms. If the unit has good teamwork, there's always someone to help you with getting the patient hooked up to monitors while you're getting report. With the open set up, people can also see that you may be in trouble/have your back, etc.

A PACU/day surgery nurse may be one of three options: only PACU; pre/post/PACU, where you rotate between getting patients ready for surgery, recovering them, and discharging them; or cross training to do some combination of PACU/OR or pre/post/PACU/OR. Whoever interviews you would be able to answer that question, or it may be that they haven't determined which combination of units the person hired will work in until they see who they hire. Good luck!

allthesmallthings · Nov 15, 2011

You spent some time on that answer! Thank you, poetnyouknowit.

GHGoonette, BSN, RN · Nov 15, 2011

If I understand correctly, the position is PACU in a Day Surgery unit; if I'm right, then your first step is to find out what kind of operations are performed. Day surgery usually consists of short procedures, light anaesthetic. Patients are discharged the same day, and you wouldn't need the intensive skills that would otherwise be needed. You would have to get to know the drugs that are predominantly used, and to recognize signs and symptoms of overdose and allergic reactions.

A big question is whether the patients are brought to PACU with artificial airways. I wouldn't leave a new recruit to deal with an intubated patient without experienced supervision, so I'd say you need to find out a little more about the unit. Is it possible that you can contact the unit directly and speak to the manager there?

allthesmallthings · Nov 15, 2011

If I understand correctly, the position is PACU in a Day Surgery unit; if I'm right, then your first step is to find out what kind of operations are performed. Day surgery usually consists of short procedures, light anaesthetic. Patients are discharged the same day, and you wouldn't need the intensive skills that would otherwise be needed. You would have to get to know the drugs that are predominantly used, and to recognize signs and symptoms of overdose and allergic reactions.
A big question is whether the patients are brought to PACU with artificial airways. I wouldn't leave a new recruit to deal with an intubated patient without experienced supervision, so I'd say you need to find out a little more about the unit. Is it possible that you can contact the unit directly and speak to the manager there?

Job description seems to indicate both light and heavier anesthesia - says Day Surgery, but also states cases are neuro, ortho, vascular, and general. You're right, I need this info; I may just wait until the interview in a couple of days and ask then. Some of the best interview advice I've ever gotten was to remember that the interview goes both ways - I'm there to ask them questions, too, and find out if the job is right for me, not just the other way around.

GHGoonette, BSN, RN · Nov 15, 2011

Well, in all of those specialties you do have surgical procedures after which the patient is discharged, but it's highly unlikely you'd get critically ill patients requiring ICU post-op. Even in ortho and neuro, you get cases where only conscious sedation is required. You'll know more after the interview; good luck!

allthesmallthings · Nov 15, 2011

Well, in all of those specialties you do have surgical procedures after which the patient is discharged, but it's highly unlikely you'd get critically ill patients requiring ICU post-op. Even in ortho and neuro, you get cases where only conscious sedation is required. You'll know more after the interview; good luck!

Thank you. :)

Melissa Ladd · Nov 18, 2011

This was great information. I just accepted a PACU position after 6 years of being a step down nurse. I am excited and intimidated all at the same time!