Help, I have questions about recovery room specialities! please!

[bengland]

Hello all! A little about me first: I'm a 4 year nurse who has worked ER, CCU, SICU, MICU, NeuroICU, and Ortho-Neuro PACU. The Ortho-Neuro PACU has all acuities, some come out on vents, a pressor, and blood administration is pretty common. I do what's known as Phase One PACU nursing.

Ok onto the second thing. I'm considering taking travel job for money and a life change (I need one so badly). The job is in an outpatient surgery center where they do plastic surgeries (face lifts, boob lifts, body lifts, noses, eyes, etc)...ENT/sinus surgeries...some eye surgeries. The patients go home the same day and are healthy, and the manager said never a ventilator or blood administration, that the PACU that Im used to is way more intense than her PACU. And I would be doing phase one AND two of recovery right there in my bay of the PACU.

My question is...

1. Do you think I would have no problem doing the job considering I've never done plastics or the like?

2. Considering my background and that I'm currently in a higher acuity PACU now, would this new job be something I'd have little problem catching onto quickly?

Opinions and tips appreciated! I want the job, but I've never been exposed to those types of surgeries, so they make me nervous. I've talked to some nurses I work with and they say I should go for it bc if I can do the PACU work I'm doing now, I could totally do the stuff the new job requires me to do.

Tips for recovering plastic surgeries/eyes?

I sure this seems long winded, I just want to be confident that it is do-able and not doubt myself so much. I tend to over think! Any help I'd appreciate.

[Rose_Queen, BSN, MSN, RN]

Welcome to AN! You may want to head over to the PACU nursing forum- this forum is for nurses dealing with addiction and recovery.

[sirI, MSN, APRN, NP]

Welcome to allnurses.com

Thread moved to PACU forum.

[brownbook]

My first thought is you may over think your patients medical/nursing needs.

The patients are healthy, often come out of surgery awake, talking, etc. You connect them to pulse ox and BP cuff (we never hook up telemetry), why even listen to lung sounds if they're talking to you in normal complete sentences?

You look at their dressing, ask if they're in pain, give them juice, coffee, crackers, get their family/friend ride home, go over discharge instructions and they can be out the door within the hour.

The more procedures they do the more money they make. It can be like an assembly line, get them in and out quickly. Keeping up with the paper work may be the hardest hurdle.

[Smauf]

I've recovered all sorts of plastics patients in the outpatient setting, and from the types you've listed the ones that give me the most trouble are the ENT/sinus patients simply because of airway management. Most of them have obstructive airways to begin with, (which usually is why they are having surgery) add a bunch of swelling, bleeding, anesthesia & narcotics and it makes for difficulty keeping their 02 sats up. NC's don't work very well with them, but some places have face tents which I think work great. But obviously they can't go home until you wean them off the oxygen, which the more pain medicine you give the longer it usually takes. I usually apply ice right away to help reduce swelling and bleeding (and it helps a little with pain). I try to shy away from narcotics if I can. Some anesthesiologists will let you give Ofirmev 1,000 mg (IV tylenol), or tramadol but in an outpatient setting you might be limited to how many drugs are on formulary in the pharmacy. I would avoid giving toradol though since it will increase the risk for bleeding.

Anways based off your experience I think you'll be fine. I worked ICU for several years, then worked PACU at the hospital before I went to an outpatient surgery center. One thing to keep in mind though in the outpatient setting is that the patients are either going to go home or you will have to transfer them to the hospital. There's nobody coming in to relieve you for your shift, and there's no other department to ship the patient to. I have had shifts where I came in at 6:30am and didn't leave until 9pm until the last patient left. Those are extremely rare but they do happen. Normally I'm out by 5 or 6pm, and on slow days before 3pm. Occasionally anesthesia will give the okay on a patient that they think is an ASA III, but is actually an ASA IV, and it is a nightmare getting them recovered because they have breathing issues, morbid obesity, htn, chronic pain, heart problems, kidney problems etc. Those are the types of patients that are supposed to be done in the hospital, and it can be very difficult to recover them in outpatient because they have to be ready to go home and take care of themselves before you can discharge them.

Hope this information helps. Good luck whatever you decide!

[whichone'spink, BSN, RN]

I think you'll be okay. And the phase 2 stuff is easy peasy, just make sure they can eat, urinate and their dressings are okay. Oh, and of course, go over discharge instructions in detail.