ER to PACU

Mavrick, BSN, RN · May 13, 2015

PACU can be very enjoyable when things go well. A lot of the going well of things is directly dependent on predicting and preventing disasters. A simple chin lift, elevate HOB, oral suction, 500ml fluid bolus or slamming 100mcg of Fentanyl can avert said disaster. But there are also plenty of times to therapeutically do nothing. For example, I like to let folks wake up to the ambient room noise not shake, rattle and roll 'em just to get an airway out then watch 'em loll back into unconsciousness and need another airway. (Classic Anesthesiologist technique)

So, I guess I'm saying you do need some experience in the progression of events. My PACU doesn't recover any conscious sedation just general anesthesia and vents usually go straight to ICU but we get our fair share of spinals, blocks, wound drains, art lines and tubes you probably don't see in an ER setting.

Maybe I'm taking my ICU experience for granted because when you're familiar with something it doesn't cause all that much stress vs. learning a lot new stuff on the fly being quite stressful.

And incidentally slamming 100mcg of Fentanyl can also cause a disaster!

Lev, MSN, RN, NP · May 18, 2015

So we do get art lines in my ER. Many of the ICU admits get them and we tend to board. I worked on a surgical floor for a year prior to ER so I'm familiar with the general GI surgeries and also Ortho. I have experience with the wound vacs from med surg too (work on urology/GI/oncology floor prn) and from rehab floor I worked on. Thanks for your answer. I guess every PACU is a little different...

Mavrick, BSN, RN · May 20, 2015

You fo sho on that one.

I've worked PACU's where we also doubled as Pre-Op, Endoscopy, Cath Lab, IR, Phase II and ICU boarding.

Collor · May 29, 2015

I worked med-surg for a few years, then ER for 10 years before going to PACU. I will say, PACU has its good days and bad days. When you get disaster patients, one after the other, it can certainly become exhausting. The ER can be just as exhausting at times, having said that, not everyone that comes through the door is urgent. I feel like EVERY patient you receive in PACU, is urgent, even if for the first 15 minutes or so.

One comment that I hear other PACU nurses make is that ER nurses transition pretty easily to PACU (due to its fast pace, high turnover patient load). We have ex-ICU nurses also working there and they are a wealth of knowledge when it comes to PCA's, Epidurals, CVP lines, etc.

If you really want to work in PACU, I do not think you would need ICU experience to be successful.

djmatte, ADN, MSN, RN, NP · May 30, 2015

I have been a periop RN for five years and started there out the gate. If you are a new RN there is a learning curve, but not one that can't be overcome. I have had many colleagues that came from both ICU and ER and I usually feel the ER RNs are better equipped for the quick transition of patients out the gate. Their assessment skills tend to be geared toward quickly diagnosing the level of care a patient will need and ensuring the patient gets to that area efficiently and safely. Not to say ICU RNs aren't able to...but I have met my fair share that bring the ICU focus of fixing the patient and hanging onto patients for longer periods. PACU is a completely different bird than ICU and ER, but both of those locations bring skills and experience that benefit PACU. I will say hang out where you are if you aren't feeling burned out on it...because I know a LOT of PACU RNs who never leave. But if your PACU is the type that doesn't require ICU experience (many are moving that direction) and it is your long-term goal, I say go for it as soon as they are willing to have you. The unit will round out your experience, but your ER experience IMO will serve you best.