From bedside to outpatient surgery center (pre/post op RN), do you like it?

brownbook · Feb 2, 2017

Is this a free standing ambulatory surgery center? Or outpatient surgery connected to an acute care hospital?

I have worked both, the one connected to an acute care hospital we had to cover, be on call, for PACU after hours for OR emergencies.

Both are open Mon to Fri, no holidays, no weekends, (except if you have to do emergency on call coverage).

They are fast paced because the more surgeries they can schedule each day, the more money they make.

Remember the patients have seen their primary care doctor, their surgeon, and a pre-op RN has reviewed their chart and spoken to them on the phone for a quick screen of their health, meds, previous surgeries, allergies, when to be NPO, who will drive them home, etc. Hopefully one of these three medical/nursing professionals has has "caught" patients who are not candidates for out patient surgery. Even an "iffy" patient may come in for a quick short out patient procedure with anesthesiologists pre-approval.

It is becoming more common for anesthesia to call their patients the night before and review their health history. Anesthesiologists are the ones putting these patients "to sleep" and hopefully waking them up in good condition! They are going to be the most concerned with their patients health. An anesthesiologist can and will cancel a surgery over a surgeons objections.

My point is few, if any, seriously ill patients come to out patient surgery. If they have serious medical issues they are done in an in-patient hospital. So you don't do, have time for, a head to toe assessment in a pre-op patient. If they have a cardiac history, rather than listening to heart sounds your time would be better spend checking their chart for a recent EKG or stress test results for the anesthesiologists to review.

Pre-op the checklist is king. How may hours NPO? Is there consent signed, both the surgeon's and anesthesiologist's? Who is their ride home,do we have their phone number? There are a lot of important questions, but the check list covers them all. Just be thorough. If an answer is vague, (I had a little water when I woke up), you have to be like a detective questioning a suspect. When did you wake up, how much did you drink, was it just water., etc. then let anesthesia know.

Some pre-op centers the anesthesiologists start IV's. If you will start IV's you may be confident in them with your 7 years experience. If not you will quickly become efficient. Some surgeons or anesthesiologists prefer a certain gauge or location for IV's so you will just need to ask co-workers.

Recovery is also fast paced. Where I work many surgeries are done with a little propofol and versed. The patients come out awake. They don't need hours in PACU. Use common sense and your gut feeling. If they come out of OR talking to their anesthesiologists, are on room air, O2 sats 98%, you don't have to listen to their lungs. If their vitals are good, they are awake, eating, pain under control, their ride is ready, they can go home within an hour, (or less for minor procedures.).

I love it. I love the hours. I love having a patient an hour or so then they are gone. I love teaching a pre-op what to expect, and in post-op, after care instructions.

My transition was a little hard simply because I had been in administration for 5 years, and was awful at IV's. but it all worked out.

justcuriousrn1 · Feb 3, 2017

Thanks brownbook for your insights! It is very much appreciated!

naptimeRN · Feb 4, 2017

Hi, justcuriousrn. I have been an RN for around 4.5 years. Started on a med/surg floor (still work there per diem). I worked for a couple of years in an outpatient urology surgical clinic and now work in the PACU of a free standing outpatient orthopedic surgery center. The hospital is the highest paying, especially when figuring differentials, holiday pay, overtime, etc. my hospital was unionized so we also get decent raises. The PACU job is okay pay. I figure it's worth the cut in pay for me for no weekends, no holidays, no nights, and no call.

I do pre and post and enjoy both. The patients need to be cleared to come so they are ambulatory and relatively healthy. It's fast paced and lots of running and being on your feet. I find it way less stressful than the hospital. I have patients for a max of two hours and then send them on their way. I like that it involves assessment and lots of patient teaching. I find that outpatient nursing (at least in the jobs I've had) does get a bit more monotonous than hospital nursing. That can be looked at as good and bad.

Unfortunately it's not managed well where I work and it's high staff turnover due to that which makes it hard because we are extremely busy. Still, I always get a lunch break, which certainly can not be said when working at the hospital. My biggest gripe is that the schedule comes out only one week before and there is little flexibility (we aren't granted requests off like at the hospital). I am part time and this makes it nearly impossible to plan for childcare or for my life. Definitely look into how they do scheduling wherever you Interview and make sure it will work with your home life needs. Outpatient surgery centers not affiliated with hospitals will all vary in how they are managed and run, so that can certainly make a difference.

All areas of nursing have their pros and cons, but generally I really enjoy outpatient surgery. I definitely prefer it over floor nursing.

justcuriousrn1 · Feb 4, 2017

Thanks for the heads up naptimeRN. I'll have to look into the scheduling esp for the kids!

HeySis, BSN, RN · Feb 21, 2017

During my orientation I spent time in that area and we work closely with them, so it's not where I work but this is what I know.

Our pre/post op RN's work Mon-Fri and do not take call, they do all pre-op, even for patients that will be staying after surgery. The patients then come to PACU for phase 1 recovery and then back to the post-op for phase 2 and discharge home. There are some procedures (cataracts comes to mind) that use MAC sedation that will skip phase 1 and go directly back to the pre/post op area nurses.

1. everyone takes turns doing phone assessments for pre-op the day before a patent comes in, usually assigned once every two weeks.

2. everyone takes turns doing follow-up calls the day after the out patient goes home

3. lots of IV starts

4. lots of crying kids on days when the ENT's are scheduled.

5. lots of post-op teaching and different surgeons want different teaching for the same surgery, so they really get to know who wants what (how long to keep dressings on, what to call about, when to see them again).

There are nurses there that worked the floor and ER, and they say it took some time getting use to not doing head-to-toes. But the work-life balance is great.

meaghann3 · Mar 23, 2017

I was an RN on inpatient ortho/neuro. I left my job because I was offered a full time position at an outpatient orthopedic surgery center- I also do pre/post! I LOVE MY JOB! It was the best decision I made in my entire life. I was worried about the hours (you never know what hours you work until the day before, but it's always within reason- 0600-1800). I love that it is no weekends or holidays, but you still maintain your critical thinking and nursing skills. You will get really good at starting IVs! If IVs aren't you thing, our docs are super nice about doing it if we can't get it. But, you will become a pro in no time. I always get my lunch break, and I really love taking care of my patients through the whole continuum of their stay at the ASC. I also call my patients the next day to see how they are doing. The main thing to consider is how busy the surgery center is. We are slow in Jan-May... meaning I am only working about 30 hours a week. But in December I was working 50 hours a week and getting over time. So, make sure you ask if you are guaranteed a certain amount of hours if there are no cases that day, or if there are opportunities to float to other ASCs. If you have a family to support and they give a lot of unpaid days off due to being slow, you may not want to take the job unfortunately.

ShayRN0217 · Nov 17, 2017

I was recently offered a position in pre-op/phase 2 at my hospital. I was in Med-Surg, but decided to make the move. I still work MedSurg prn, but really enjoy the pre/post op position. We have a choice to do 3-12's and a 4, 4-10's, 5-8's, or 2-12's and 2-8's. It gets busy (a different kind of busy than in Med-Surg). However, I find it to be less stressful. We are off on weekends and holidays unless it is our week to be oncall. Two nurses split the holiday on-call to 6 hours a piece. I am so happy that I took a leap of faith and joined the pre-op/post team.