ICU to PACU

[dmarie1075]

Hello everyone. I have been an ICU nurse for 6.5 years. For the last year I have been feeling the need for change, and am interested in PACU nursing. I have an interview at a surgical hospital next week for a PACU position. The hospital specializes in orthopedic surgeries. I would like to hear from other nurses about the transition from ICU to PACU nursing. I am afraid that if I leave the ICU, I will miss it. I am somewhat of an adrenaline junkie. I imagine there are not a lot of exciting crashing patients in a low level surgical hospital, although all PACU patients are considered unstable during recovery. I went into the ICU as a graduate nurse so it is the only area that I have experience with. I understand that the PACU is a nice transition for "ICU burnout."

Any feedback would be greatly appreciated.

Thank you

[poppy07]

I'm also in a position in ICU where I want to really learn. I never received a good orientation, and would like to go somewhere else that offers a supportive learning environment and exposes me to more (especially surgically-related). The hospital I work for has an awesome position open (good hours and schedule), and I'm wondering if ~6 mos. into working ICU is to soon to transfer to PACU. I really love ICU and want to experience same stuff, but learn more.

[kellybecker09]

I recently transfered to a PACU position from the ICU and I really miss the ICU. I was wondereing if you ever transfered to PACU and what you think of it?

[GHGoonette, BSN, RN]

Can't really comment on whether you'd miss ICU, as I went straight into PACU and received my orientation there. It varies from being breakneck hectic to quiet backwater. You assess staffing according to the number of lists, whether they run concurrently, whether they are quick in-and-out operations etc. Orthopedic surgery tends to be slower-moving, depending on the surgeon and the type of surgery performed. Much depends also on whether they are predominantly pre-scheduled or emergency cases.

The bigger PACUs, those in hospitals with a Level 1 trauma center, will be busier and more exciting than those in smaller facilities dealing mainly with scheduled surgery. The biggest difference is that scheduled patients have been prepared pre-operatively, and underlying conditions have been addressed. Emergency, life-or-death situations, and anything can happen.

[Glageman]

Hiya,

I worked in a 45 bed ICU for about 24 years. I needed a change. I transferred to PACU. I have been there now 7 years. For the first 6 months, I hated it. I did not know the docs, the routines, the anesthesiologists' preferences or the reversal meds. Now, I love it. I am learning lap procedures, coilings, non-invasive heart valves surgeries, hand re-attachments, flap surgeries, and more. We are doing total nephrectomies that have three small stab sites - that is awesome. I think that I felt like the "new" nurse when I first started. I had not felt that way in a long time. Now, I am learning without feeling totally stupid. I still care for the multiple traumas, the Whipple procedures, the ruptured aortas, and the craniotomies. An added bonus, I see the patients improve in minutes not days or weeks.

[suanna]

I made a simular move 8 weeks ago. After 25years in a CV Surgical ICU I moved to PACU. I couldn't be happier with the change. You don't say why you are feeling "a need for a change". I miss the patients on 5 pressors, a pacemaker, IABP, Vent, CRRT that I got to drag back from the tunnel of light by thier Swan Ganz, and every now and then see them live to spend another Christmas with thier grandchildren. I miss the doc I worked with for over 20 years saying " thank God you are on tonight, this one is a real train wreck."

In PACU I'm no longer "the Decider" (to quote GWB). I'm way lower on the pecking order with the Anesthesiologist, surgeon, and resident staff making most of the calls.

I don't miss being the "Primary Nurse" to the 130kg combative patient on the vent with C.Diff, MRSA, ARDS, and a family that just don't understand why they can't sleep in the patients room with thier 4 children and the drunk brother. I don't miss having this patient EVERY NIGHT for weeks on end. I don't miss having 1/3 of my patients discharged to a nursing home or heavenly home. I don't miss 80% of the new staff taking a job in the high acuity unit just so they can put it on an application to CRNA school in a year and start thier "real career".

Think hard about what you need in a job- but for me changing jobs was the right move. If you are an "adrenaline junkie" I'm afraid an Ortho PACU is going to put you into an abrupt withdrawl.