HELP! New Grad hired in PACU OR

Specialties PACU


Hello all nurses!!

I just graduated from nursing school in April and I just got hired as a new grad in the OR!! I know that there is a big learning curve but I'm determined to work ten times harder to make sure I can keep up and be the best nurse I can be. The job position I got hired under is PreOP and PACU nursing. The hospital I'll be working at requires you to learn all the positions a nurse can work in the OR; PreOP, PACU, Scrub nurse, circulator, etc.

If anyone could please give me some advice, things to know such as common medications, procedures, and complications you see working as OR nurse I would appreciate it more than you. If you have any suggestions on books to read to better my education that is specific for the OR please let me know as well. I've tried reading a lot of forums on here. I see for the PACU it's a lot about airway and pain management. What kind of procedures do you do in your hospital to maintain and stabilize airway? What is your protocol for pain management and is it always controlled? For PreOP we do phone interviews before surgery a week in advance. Can you walk me through how you do your phone interview, how you make sure you don't miss anything?

Anything and everthing helps!!

Thank you so much in advance.


I started as a new grad in the OR and then transitioned over to pre-op/PACU. I've been working in perioperative services over three years and really love it. Don't let anybody tell you that you need floor experience or med-surg experience before starting in these areas. Will you have to work harder? Yes, but it's totally doable if you are willing to learn. The book I recommend for OR nursing is called Alexander's Care of the Patient in Surgery. For pre-op/PACU I recommend Drain's Perianesthesia Nursing. Most common medications in the OR that we use are local anesthestics (bupivicane/marcaine) and optiray (contrast agent). For both OR/pre-op/PACU I would be familiar with the drugs used for intubation: inhalation gases (ex: sevoflurane), paralytics - both short and long acting (succinylcholine and rocuronium for example), propofol, glycopyrrolate, neostigmine (this is just a list to get you started). In pre-op commonly given medications are: emend, pepcid, versed, scopolamine, antibiotics (ancef, clindamycin, vancomycin) and pain medications. Common drugs in PACU: opioids (fentanyl, dilaudid, percocet, norco, oxycontin, morphine etc), ketamine, benzodiazepines, demerol, zofran, reglan, benedryl. I would also brush up on common antihypertensive medications: think betablockers, and hydralazine for example. I would also be familiar with the reversal for opioids (narcan) and benzos (romazicon).

I know this is a long list.. try and remember that these are things you will learn on the job as well - no need to study them to death now, but may help to be familiar with some.

In PACU your main focus will be on airway management and pain control. No, pain is unfortunately not always controlled. In your orientation you will learn how to manage airways (chin lifts, oral airways, nasal airways, bagging a patient, preparing for re-intubation, etc).

You will do great! You have a lot to learn, but it is do-able - stay positive and take lots of notes! Remember, all physicians have a different way of doing things. Good luck!!!

Wow! Thank you so much for taking time out of your day to answer these questions for me. This is exactly what I needed and wanted to hear. I will definitely look into those two books and read up on those drugs. Thank you for your words of encouragement. I am definitely willing to learn and will always put my best foot forward! You are awesome.

Specializes in Urgent Care, Oncology.

I would suggest reaching out to your facility's nurse educator. Most places have one for their department. They'd be able to give you better information to study and policies to follow that are practiced by your facility.

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