Is the PACU floor a good start for a new RN grad?

[Mr.Mrs.RN]

Hi all, I am in an ADN program graduating this December. I tested out after my second semester last december for my lpn license and have been working in an assisted living ever since. I have been applying for residency positions and have an interview in the PACU tomorrow. I am really nervous. Just wanting to have an idea of what it's like so I know what to ask, etc.

[Rose_Queen, BSN, MSN, RN]

Honestly, I don't think it's a good place for a new grad. It can be a very fast paced environment- you usually have patients for maybe an hour before sending them on. You get one fresh post-op and as soon as they're settled you're getting a second. Many of the emergency situations and even non-emergent situations require one to be able to rely on nursing judgement, which comes from nursing experience. You need to have good assessment skills as well- and for pretty much every body system. The PACU in my facility is looking at only taking those with critical care experience and no longer accepting applicants with med-surg experience only.

[djmatte, ADN, MSN, RN, NP]

I started as a new grad and did half my RN Career there. I don’t believe experience is something you need so long as they train you. While the old adage is its where ICU nurses go to die, I find people who come from other units often don’t like the change and transition back. My first job was in periop at one of the biggest hospitals in Detroit. new grads there regularly started in Ed, icu, and pacu. The hospital had a critical care training course we all needed to take prior to starting.

The downside to starting there is it is a limited setting. Most patients will be the same process over and over. Skills and activities you may do on the floor you won’t do in pacu. You won’t gain the skills and nuance of managing a number of patients on a unit where you have to balance time and delegation in the same capacity. The job could make you feel pigeon holed in this capacity. Its easy to stay there. Hard to get out of.

But you can expand on the skills you learn there. I moved my job into pain management and helped start one hospitals acute pain service. During np school I was also able to use the dedicated patient time to hone much of my physical exam techniques we were learning. so even though I was limited in some aspects, I’m working now in primary care as an fnp despite starting in pacu.

[desert_MP, BSN, RN]

Experience-wise I started in the OR. Did 5 years. Switched to PACU...did a couple of years. Went to a surgery center, 8 months. Went to ICU for 18 months. Now I'm back in PACU.

It all depends on your facility. I work at a level 1 trauma center. The patients I see may be different compared to other hospitals. We take every patient aside from hearts which are direct recovered. Everything from days old children and older.

With that said- I was the "new grad" RN going into pacu after working in the OR. I say new grad because OR nursing is far different than any other kind of nursing. I was overwhelmed initially. Cranis, thoracotomies, triple As, vents, etc. I've seen a few new grads wash out of our department. I do not believe it has anything to do with poor precepting. It's just the skillset you obtain overtime from working at the bedside. More than anything else I've done- the ICU prepared me the best for pacu.

[RNninja]

That is a tough question to answer. I feel like with the right training a new grad could thrive in PACU. I came from multiple other areas before getting into PACU. I feel like the experience that I gained in the other areas of nursing really help me in the PACU setting.

I'm not sure the type of hospital or size that you are going into, but it is not uncommon for me to be alone at work, especially when I'm on call. Sure there are other RNs and Drs in the OR but if something happens I need to be able to act fast and be confident in my skills because it may take them awhile to get to me. I think that working in other high acuity settings have helped me with that.

[WookieeRN, BSN, MSN, RN]

I started as a new grad in the PACU at a large very busy Level 1 trauma center. I’ve never worked in any other specialty, nor as a CNA in the past either. I’ve seen new grads thrive and new grads crash and burn in the PACU setting. I don’t think it’s an awful place to start as a new nurse, you just need a really good preceptor and a decent length for your orientation.

[tamale29, MSN, RN, NP]

It'll be a rough start. You need to know how to respond in a critical care situation, without getting a lot of experience in it because it rarely happens. That being said its not easy to start anywhere. Ask a ton of questions, always admit to needing help, and when in doubt, dilauded. haha.

As far as interview questions. patient ratio. typical patient population. inpatient or outpatient. call requirement (thats a biggie)