New Grad PACU Nurse

Trauma Columnist · Oct 25, 2018

Moved to PACU nursing forum - good luck!

HeySis, BSN, RN · Oct 25, 2018

Congrats on your new job, I'm hoping this was a move that you were hoping for.

I love the PACU, The work, the environment, the patients and acuity and the people I work with, I hope it's the same for you.

AS for advice.

1. Make sure you get a full and proper orientation, as if you didn't have the three months of NICU experience.

2. Drians' Perianesthesia Nursing (book) is considered to be "the bees knees" when it comes to resources, A lot of certification questions are taken from it if you are ever wanting to get certified. Even before I was interested in certification, I used the book as a reference to study up on airway issues and anesthesia meds.

3. You can go to American Board of Perianesthesia Nursing Certification, Inc website and sign up for weekly email questions. They go back and forth between PACU and for Same Day Surgery questions each week, you get last weeks answer along with the reference of where to find it, with each new question. It is a free service and can keep you thinking.

4. Don't be afraid to ask questions, or ask for help. One benefit of PACU is it's open pit configuration, which means even when taking your own patients, there is normally someone within hailing distance to ask a question or get a second opinion.

5. Don't get so caught up in the charting that you forget the patient. We had one nurse try to cross train.. and she could not do both and her patient would be turning blue while she was standing right next to them charting. I great way not to get sucked into this as a new PACU nurse is to place the patient on your none dominant side.. you can type with one hand and keep the other hand on your patient. And yes I mean on them....before they have roused, if you place a hand on the shoulder or chest... you will be more intune if they start having breathing difficulties and I find will glance at them more often. I'm sure others have different tricks, but this one was taught to me, and I teach it forward.

6. Know your meds (both the anesthesia meds given in the OR, what they do, how long they last and which ones can be reversed and with what) and your narcotics, non-narcotic pain meds, anti-emetics, anti anxiety, beta-blockers and the meds used in a codes.

7. Frame of mind... PACU is not a place to cure drug seekers... the fact is someone who is opioid dependent will require more pain meds, not less, this is not rehab, our job is to safely control pain to the best of our abilities.. leave the judgements behind.

8. On that note, realize that those who use tobacco and/or antidepressants may require more pain management efforts as these drugs compete for opioid receptors so pain meds don't work as well for them.

9. On the other hand safety is first and there has been many times where I have told a patient "I know you are hurting, but right now it's a choice between pain relief and breathing and I always have to choose you breathing".

10. Transport your patient when ever possible, and give the family member s a small status update. They are hurting but you have given pain meds and they haven't peaked yet, or you had to wait for pain meds to wear off so they cold safely hold there own airway. PACU is a big mystery to most people.. and they don't like being out of the loop. If you tell them nothing and the patient goes back to their room complaining the family will think you did nothing.. so take credit for the things you did.

11. Makes sure to develop and good and professional relationship with your anesthesiologist and surgeons, it will make it so much easier to ask questions and get the things you need to do a good job.

12. And the same for your co-workers, be a apart of the team, help each other out, reciprocity os the name of the game here.

Good Luck and keep us up to date with how it's going or if you have specific questions.

recardo234 · Mar 14, 2019

On ‎10‎/‎25‎/‎2018 at 9:13 AM, HeySis said:
Congrats on your new job, I'm hoping this was a move that you were hoping for.
I love the PACU, The work, the environment, the patients and acuity and the people I work with, I hope it's the same for you.
AS for advice.
1. Make sure you get a full and proper orientation, as if you didn't have the three months of NICU experience.
2. Drians' Perianesthesia Nursing (book) is considered to be "the bees knees" when it comes to resources, A lot of certification questions are taken from it if you are ever wanting to get certified. Even before I was interested in certification, I used the book as a reference to study up on airway issues and anesthesia meds.
3. You can go to American Board of Perianesthesia Nursing Certification, Inc website and sign up for weekly email questions. They go back and forth between PACU and for Same Day Surgery questions each week, you get last weeks answer along with the reference of where to find it, with each new question. It is a free service and can keep you thinking.
4. Don't be afraid to ask questions, or ask for help. One benefit of PACU is it's open pit configuration, which means even when taking your own patients, there is normally someone within hailing distance to ask a question or get a second opinion.
5. Don't get so caught up in the charting that you forget the patient. We had one nurse try to cross train.. and she could not do both and her patient would be turning blue while she was standing right next to them charting. I great way not to get sucked into this as a new PACU nurse is to place the patient on your none dominant side.. you can type with one hand and keep the other hand on your patient. And yes I mean on them....before they have roused, if you place a hand on the shoulder or chest... you will be more intune if they start having breathing difficulties and I find will glance at them more often. I'm sure others have different tricks, but this one was taught to me, and I teach it forward.
6. Know your meds (both the anesthesia meds given in the OR, what they do, how long they last and which ones can be reversed and with what) and your narcotics, non-narcotic pain meds, anti-emetics, anti anxiety, beta-blockers and the meds used in a codes.
7. Frame of mind... PACU is not a place to cure drug seekers... the fact is someone who is opioid dependent will require more pain meds, not less, this is not rehab, our job is to safely control pain to the best of our abilities.. leave the judgements behind.
8. On that note, realize that those who use tobacco and/or antidepressants may require more pain management efforts as these drugs compete for opioid receptors so pain meds don't work as well for them.
9. On the other hand safety is first and there has been many times where I have told a patient "I know you are hurting, but right now it's a choice between pain relief and breathing and I always have to choose you breathing".
10. Transport your patient when ever possible, and give the family member s a small status update. They are hurting but you have given pain meds and they haven't peaked yet, or you had to wait for pain meds to wear off so they cold safely hold there own airway. PACU is a big mystery to most people.. and they don't like being out of the loop. If you tell them nothing and the patient goes back to their room complaining the family will think you did nothing.. so take credit for the things you did.
11. Makes sure to develop and good and professional relationship with your anesthesiologist and surgeons, it will make it so much easier to ask questions and get the things you need to do a good job.
12. And the same for your co-workers, be a apart of the team, help each other out, reciprocity os the name of the game here.
Good Luck and keep us up to date with how it's going or if you have specific questions.

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