Medsurg to outpatient PACU?

Specialties PACU

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I am a new grad coming up on my 1 year of a busy Medsurg unit and am exploring my options moving forward. I have recently been offered a position at a same day surgery center for Preop/PACU.  It is 4/10s, more pay, no holidays, and only occasional Saturday so much more appealing than my hospital schedule. I am really excited about the opportunity but also nervous that I do not have critical care experience. I am comfortable with my nursing skills used in Medsurg and have become very good at time management. However, my floor unfortunately did not have telemetry. I have recently taken an 8 hour tele class, and am planning to get my ACLS in the next couple weeks per the job requirements. I will also get my PALS within first few months of hire. It is a 2 week orientation at new job. Does this seem adequate time for orientation? Is it bad idea to go into PACU with the experience I have? I know outpatient is quite different than inpatient pacu, but I want to make sure I am not getting in over my head and making safe choices for my license and patients! Any input on the day to day and what I can expect is also appreciated!

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2 week orientation is crazy.  

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I've worked inpatient and outpatient PACU in various settings ranging from surgery centers to level one trauma and peds. I think you'll be fine. One of the great things about PACU is that it's a highly team oriented environment, unlike what you've probably experienced on the floor. In PACU, if there is ever an assignment or type of case you're uncomfortable with, there are always nurses available to help. I know this, because I too was a medsurg nurse with a year of experience when I made the transfer to an inpatient PACU and I do not regret it!

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On 7/23/2022 at 9:44 AM, MakeItRain said:

I've worked inpatient and outpatient PACU in various settings ranging from surgery centers to level one trauma and peds. I think you'll be fine. One of the great things about PACU is that it's a highly team oriented environment, unlike what you've probably experienced on the floor. In PACU, if there is ever an assignment or type of case you're uncomfortable with, there are always nurses available to help. I know this, because I too was a medsurg nurse with a year of experience when I made the transfer to an inpatient PACU and I do not regret it!

With a 2 week orientation?  I’m going to disagree with you 100%.  Managing airways is a large part of what we do.  I’m glad you had a supportive environment but not all are that way and with only 2 weeks of orientation it’s scary.

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Specializes in PACU, pre/postoperative, ortho.
16 hours ago, LovingLife123 said:

With a 2 week orientation?  I’m going to disagree with you 100%.  Managing airways is a large part of what we do.  I’m glad you had a supportive environment but not all are that way and with only 2 weeks of orientation it’s scary.

Absolutely!  Recovering an outpatient is no different than recovering an inpatient when it comes to anesthesia. You may not be seeing more critical patients but your initial priority will always be airway & breathing. It takes time to become confident with managing airways & feeling comfortable doing that jaw thrust, removing/inserting orals, recognizing & treating laryngospasms, inadequate reversals...Just thinking about all the outpt peds cases with only 2 weeks training (& part of that sounds like it will be pre-op training).  ? My rural facility is 3 months; does not require prior critical experience.

OP, did you take the job? Curious how things are going?

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16 hours ago, LovingLife123 said:

With a 2 week orientation?  I’m going to disagree with you 100%.  Managing airways is a large part of what we do.  I’m glad you had a supportive environment but not all are that way and with only 2 weeks of orientation it’s scary.

I've travelled all across the western half of the US for PACU and the vast majority are the way I describe. Also, the OP is talking about an ambulatory surgery center which means 99% of their patients will be MAC. In many inpatient facilities MAC patients don't even stop in the recovery, instead they go straight back to their rooms after 10 or 15 minutes of monitoring prior to leaving the OR. In which case, the OP has probably cared for many of these patients I described already. 

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47 minutes ago, RainMom said:

Absolutely!  Recovering an outpatient is no different than recovering an inpatient when it comes to anesthesia. You may not be seeing more critical patients but your initial priority will always be airway & breathing. It takes time to become confident with managing airways & feeling comfortable doing that jaw thrust, removing/inserting orals, recognizing & treating laryngospasms, inadequate reversals...Just thinking about all the outpt peds cases with only 2 weeks training (& part of that sounds like it will be pre-op training).  ? My rural facility is 3 months; does not require prior critical experience.

OP, did you take the job? Curious how things are going?

While there is technically no distinction between the actual or potential needs of an outpatient vs inpatient postoperative patient, there is however a huge difference between anesthesia techniques. For example, you wouldn't need to worry about residual or reoccurrence of paralysis in a patient post MAC, because the patient never received any paralyzing agents, nor would you be expecting a laryngospasm if the patient was never intubated (unless of course they were post-bronchoscopy) which is why there is a distinction between phase one and two care. The vast majority of outpatient ambulatory centers use MAC and/or regional anesthetics with occasional general requiring phase one level of care. Yes two weeks is a very short orientation, but given that the OP will likely be recovering low acuity patients and doing mostly pre-op/phase II, this could be a very good opportunity for them to break into what I believe to be one of the best fields of nursing there is. 

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Specializes in PACU, pre/postoperative, ortho.
27 minutes ago, MakeItRain said:

While there is technically no distinction between the actual or potential needs of an outpatient vs inpatient postoperative patient, there is however a huge difference between anesthesia techniques. For example, you wouldn't need to worry about residual or reoccurrence of paralysis in a patient post MAC, because the patient never received any paralyzing agents, nor would you be expecting a laryngospasm if the patient was never intubated (unless of course they were post-bronchoscopy) which is why there is a distinction between phase one and two care. The vast majority of outpatient ambulatory centers use MAC and/or regional anesthetics with occasional general requiring phase one level of care. Yes two weeks is a very short orientation, but given that the OP will likely be recovering low acuity patients and doing mostly pre-op/phase II, this could be a very good opportunity for them to break into what I believe to be one of the best fields of nursing there is. 

True re: MAC but it will truly depend on the facility. Our local free standing surgical center does outpt TKR & my understanding is there is a push for doing more of these types of procedures as outpt. They also do a lot of urology & plastic surgery, much of which also requires general anesthesia; it may not just be a bunch of scopes & cataracts. Hopefully OP gives an update how things turned out.

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On 7/31/2022 at 11:39 AM, MakeItRain said:

I've travelled all across the western half of the US for PACU and the vast majority are the way I describe. Also, the OP is talking about an ambulatory surgery center which means 99% of their patients will be MAC. In many inpatient facilities MAC patients don't even stop in the recovery, instead they go straight back to their rooms after 10 or 15 minutes of monitoring prior to leaving the OR. In which case, the OP has probably cared for many of these patients I described already. 

I guess we will have to agree to disagree.  You still need to be proficient at maintaining an airway and 2 weeks orientation is awful short for that.  

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