pacurn60 803 Views
Joined: Aug 23, '11;
Posts: 9 (11% Liked)
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One of my CPAN (certified post anesthesia nurse) nurses got into CRNA school without ICU experience. He had worked in PACU for 4 years before he decided to go to CRNA school and they accepted his PACU experience as ICU experience but we work with critical patients. Hemodynamic monitoring- SVO2, a-line, PA, CVP etc.
ER to PACU is a great transition. I Left the ER 12 years ago and have been in PACU since then
We allow parents of peds. If we are holding for post op beds we usually let 1 or 2 family members at the most for 10-15 minutes. I do have to be a patient family advocate on this somewhat we have some surgeons who forget to talk to the family and invariably that patient gets the PACU nurse who is not proactive in updating the family by telephone then we have an irrate family that hasn't heard anything about their loved 1 for hours. Some of my nurses are awesome and based on patient acuity have called and talked to the waiting room within an hour of them arriving PACu and if they haven't they let me know and I will go update the family.
I agree with all the posts. Our OR must call and we tell them where to call. There have been times when they forgot to call and there have been no bays and we turn them right around back to the OR. ASPAN is awesome. THey have a clinical practice forum that you can ask questions and not have to join. I have worked at 2 PACU's 1 a very busy Level 1 trauma center and they still call report 10-15 minutes before the patient is coming out. I don't agree with a portable monitor and O2 at a desk for a fresh post op. You are setting yourself up for a possible bad event. I would move a patient that is nearing the end of their recovery to the desk and put the fresh post op in a bay.
Every PACU nurse I have hired was apprehensive at first but it has been there favorite job. Most PACU nurses never look back. Good luck.
As a charge nurse in PACU (previously ER) I foound that the best transition nurses to PACU were ER or ICU nurses. With that being said I have hired med-surg nurses with no ICU or ER experience. They have done well but they don't go on call for about 6 months and then when they are on call they are with a more seasoned PACU nurse. PACU is a great area to learn because it is a big open room and there is usually someone there quickly to help you. Also if you are uncomfortable with the way the anesthesiologist brought the patient out we demand the provider CRNA, MD to stay there until we are comfortable to care for the patient. We get very critical patients. Remember ask if you don't understand something don't assume. I love the PACU and you wil too
Interesting thread. As with adults kids act differently. We had 2- 4year old kids have Tymp and tubes both had same anesthesiologist and given same agents. 1 woke up and went home in an hour the other we had for 4 hours because he was wild and inconsolable by parents staff. In adults when we have a "wild" wake up our anesthesia routinely give them versed to go back to sleep and they usually wake up totally fine the 2nd time. We however didn't do that with the children in the same situation. Would be a good study.
We do CO2 monitoring on some of our extubated patients. Again our PCA's pumps monitor CO2. We ordered CO2 monitors for 4 of our bays but it is sometimes hard to know what patients will need CO2 monitoring. We put it on any patients suspected of CO2 retaining/ sleep apnea patients and any patient the nurse feels it is waranted. As the other writer wrote CO2 monitoring will be the next standard JCAHO , Medicare will be requiring. CO2
monitoring is the best monitor of a patients ventilation status. There is a great article in the JoPAN(Journal of peri anesthesia nursing) this month about Capnography and CO2 monitoring.
I have worked PACU for 12 years. I came from the ER which I truly loved but hated everyother weekend and working holidays. I then started floating to the PACU and finally took the step and never looked back. I have been a charge nurse in PACU for 9 years. The best PACU nurses either come from ICU or ER. PACU was kind of the best of both places. You have to use your critical skills to identify the problem and then move quickly. What I liked about the ER was the variety of patients you got from minor to critical. You can get easy recovery patients and then very difficult. Then you can get that simple D & C that starts bleeding heavily and needs to reutrn to surgery. What I did like about the schedule was you were ON Call about every 6th weekend and usually there was always a nurse who wanted to take your call for extra money. I have 1 nurse that went 9 months without a weekend because he kept giving his call away. Unsure how big your hospital is or if the PACU is a staffed 24/7 or if it is a Level 1 or 2 trauma center. The first Christmas I was on call at my PACU I didn't get called in until 11pm Christmas night for a post tonsillor bleed. Most of our surgeons don't want to work on Holiday's so they will only operate if it is a true emergency. I have 1 nurse that has been there 11 years and has never worked a Christmas because she too found someone to cover her call.There are times when call can be really bad too and you are recovering patients for 16-17 hours straight. I was fortunate in my unit that we always had in house candidates so we sort of knew their history. People I interviewed I wanted them to be upfront about their reason for coming to PACU and a lot of staff wanted to for family reasons because kids had weekend activities or were involved in their house of worship and missing 1 weekend every 6-8 weeks was better than missing everyother weekend. Also the fact of being home most holidays. Good luck on your interview. Most PACU's are very team oriented and you never are left alone because you may have the difficult patient but there are usually 3 or 4 staff that have easy patients and can break away to help you.
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