New Grad in Outpatient Surgery

NYCRN16 · Jun 18, 2008

Hi all,
I graduated in May and take my boards in July. I was offered a job in an outpatient surgery center doing pre-op with my interim permit and then move to PACU after I get my license. I read some threads about new grads in the PACU, but the majority seem to be inpt PACU. Any advice on what to expect in outpt PACU? My first day at work is July 7. I have a 6 page clinical skills checklist to go through, and it's intimidating!!! Intubations -(do we intubate?) induction agents, neuro block agents, respiratory drugs,cardiac drugs... I'm trying to find journal articles or other postings on what to expect - but I'm not having the best of luck. I want to be as prepared as I can before going in. Any advice? Scared and excited!!Thanks!!!

I had to laugh when I read your post because I know I was there when I was new. I am also starting an outpatient surgery job in a few months, but I am not a new grad, I have 5 years of ER experience. Even though I am not so new, I still remember being overwhelmed when I started my first job as a new grad. I just wanted to try to ease your anxiety and little.

The skills checklist that a job gives you is very overwhelming, they list every single thing on there even if you will never see it. That list is really meant for nurses who have experience in a particular area, they know that you are a new grad so they aren't expecting you to know much since they will train you. When I look at an ER checklist I still dont know 100% of the things on the list, and its probably just now in the past year or two that I can say that I know most of the stuff on the list, and certainly not all.

To answer some of your questions, you will not be intubating patients, doing neuro blocks, that type of stuff is done by the doctors. I have obviously never intubated any patient, but I am familiar with the drugs used for induction and how to monitor the patient after intubation. Some of the drugs you may want to look up include paralytics like succinylcholine, and other anesthetics like propofol, versed, and pain meds like fentanyl and morphine. Know the side effects of these meds and the general duration (versed lasts a lot longer than propofol for example). Also be familiar with any reversal agents like narcan and romazicon.

They are asking you about these things on the skills checklist because they want you to know how to care for patients who had these things done. For example, if you have a patient that is in recovery who was intubated during surgery, you will recieve the patient extubated when they arrive in your area. You are responsible for monitoring this patient for signs of hypoxia and that they are breathing well and oxygen saturations are good. Patients that recieved general anesthesia or moderate sedation are at risk for respiratory depression, and they want you to know this and recognize the signs of a patient having a reaction to the meds or who are in trouble otherwise.

Fortunatly, the patients who are in outpatient surgery are generally healthy, but there are people out there who will have a bad reaction to anesthesia, and that is not always predictable. As long as you don't get too comfortable and assume that everyone will be just fine, you will do great.

Just keep in mind that outpatient surgery is not a great place to do procedures and be exposed to different disease processes, so if that is what you are looking foward to, this may not be the place for you. Just a thought to keep in mind. The beauty of nursing is that you can switch specialties when you like. Give this a year, and if you find its not for you than you can always go elsewhere.

Good luck with your new job, keep in touch and let me know how things are going!