New Pacu Nurse

enurslw · May 31, 2008

I know how you feel. I have been a nurse for 11 years and I started working in PACU 5 days ago. I like the challenge, but I have a lot to learn. I am currently trying to find a postanesthesia nursing book. No luck yet. Good luck to you!

nmred · May 31, 2008

Hello! I just joined the community. I've been a PACU nurse for 8 years and yes it can be very demanding and anxiety producing. As far as Peds patients go... same as adults... Airway, Breathing, Circulation, pain management... Kids will usually awaken with emergence delirium. Fentanyl works great. The dose ranges from 0.5mcg's to 1.5 mcg's /kg. The Circulator or Anesthesia provider should be giving you the weight during report. If not, make that your habit. With pedi pt's you ALWAYS want a weight. Anesthesia should be leaving you that order. I always go for 1mcg/kg. it's the fastest easiest to remember. And with a child that's screaming his head off, you want fast and easy.

Try and get the Parents in ASAP. It's OK for the parents to hold their child in their lap (depending on the size of the child). It's a great bonding time.

There are lots of other habits we can talk about. Remember above all else to trust your nursing instincts. They are your compass.

Pals, TNCC, ENPC are all great courses.

As far as Anesthesia books and info. Try ASPAN. If your not a member you might think about becoming one. They have great resources. Every state has a Chapter. Their web site is http://www.aspan.org or you can google it. They also offer info on certification as well. If your interested.

I learned anesthesia one on one with a provider. It was wonderful. How to intubate, extubate, complications, meds, the works. Anesthesia LOVE to talk about their profession. Tap into them.

It's long, but I hope it helps.

nmred · May 31, 2008

Check out ASPAN. They are a great resource

enurslw · Jun 1, 2008

Thanks so much for ALL the info. I will check out ASPAN. I think it will take me at least a good year to feel confident in the PACU. I have a great preceptor and my manager said she would not let me work alone until I was ready. We were busy last week no one had time to train me on the computer we use for our charting. I hope I make it!!

nmred · Jun 7, 2008

You'll do just fine. I remember I use to go home every night crying I was so overwhelmed. After about 6 months I was pretty comfortable with "minor" cases. By the end of a year I could recover any patient at our hospital.

Best of luck

yecart1 · Aug 19, 2008

I haven't visited here in a long time. I was bumped into a PACU position. I had approx. 1 year in Med-Surg, basicially part time with my LPN/RN License, then had 1 year of ACU experience.

I'm very overwhelmed. There's a lot to learn. I thought ACU had alot to learn, which it does. I didn't feel comfortable (really comfortable) until about 6-9 mos. Now I'm back to being the new one again and I'm not liking not knowing.

I realize I must give myself time to learn, but I'm not patient with myself.

I took the ACLS this past week and I probably should have waited. But it's over. I did well enough. I just need to put the pieces together. My brain is saturated. Between one full week in PACU, the next in with Anesthesia, then a 1/2 week in PACU, one night on call-on my birthday-not leaving work from 0730 to 2230, then taking ACLS after that, I'm a bit scattered/unnerved.

I'm taking call with others to get me use to it. I'm not sure I'll be ready to be on my own for a bit. I'm also afraid they will push me to be on my own with the on-call. I'm already planning on letting them know I'm not going to be ready for call by myself at least until Dec possibly Jan. I'm so GREEN. I'll get it. I'm hoping things click sooner rather than later.

A few good things are I'm 2nd in the Senority line up. Another good thing is you just do one job, unlike ACU where you switch from day to day doing different jobs. I loved the variety of ACU. I'm having a little 'rebellious' time...I didn't plan on leaving ACU for awhile and I'm a little ticked to be pushed into something I'm not quite sure I'm ready for. But it can only help me in the long run. I hope I like it.

I've read the You know you're a PACU nurse when and I laughed at all of them, because I've already experienced most of them. The loaft of bread was hilarious.

I'm so glad this message board is around. It seems like I'm not alone. Thank YOU.

Zoe's Mom · Aug 21, 2008

Tracey,

I am so sorry for you! If I understand correctly, this was a choice made for you, not by you. One question I have for you is: are you alone while on-call? I know right now you are shadowing, etc. but when you start taking call alone will you have another RN there with you? I've worked both ways! Remember, you always the right to decline responsibility for a patient if you do not feel capable of taking them. I have felt that way before, this is normal! What is upsetting to me most is that this was not your choice!

Babs0512 · Aug 23, 2008

If I were to decline taking a patient for ANY reason, I would be out of a job instantaneously! I can see myself getting called in at 0200 and them pulling in with a bowel resection on a T-tube and an art line (which we rarely see, maybe twice a year) and me saying, "I'm not comfortable taking this patient, I cannot recovery them." Boy would poopy hit the fan!

I'm uncomfortable with art lines. I haven't really worked with them since ICU some 10 years ago. We see them sooooo rarely in our PACU, that I never feel comfortable with them. So far I've been lucky, other nurses have been around and we trouble shoot together, but sooner or later I will be alone and have to do it. Gads, I hope the patient doesn't bleed to death while I'm trying to figure out the stopcock!

Also, while working in the ER, we saw codes a few times a week. I could run a code in my sleep. Now, although I'm ACLC and PALS certified, I haven't even seen a code in over 3 years, and boy do I get anxious with critical patients. I'm afraid I'll "forget" how to handle a code.

I would like to have "mega codes" at least montly to keep up our skills, can't get the boss to agree or find anyone willing to host the code.

yecart1 · Aug 25, 2008

Tracey,
I am so sorry for you! If I understand correctly, this was a choice made for you, not by you. One question I have for you is: are you alone while on-call? I know right now you are shadowing, etc. but when you start taking call alone will you have another RN there with you? I've worked both ways! Remember, you always the right to decline responsibility for a patient if you do not feel capable of taking them. I have felt that way before, this is normal! What is upsetting to me most is that this was not your choice!

Thanks for the advice Zoe's Mom. I guess I misrepresented the choice part. I was bumped and I had a 'choice' of going to Med-Surg-which I don't consider a choice, PACU, or ED-which I'm unqualified for). So my three 'choices' were PACU, Med-Surg, and Per-diem.

The gal that bumped me went to PACU and tried to come back to her job, which was within the 21 day period, only to find out her job was no longer available. Then she wanted to come back to Ambulatory Care and bumped me, with a lower hourly option. She was a 32-40, I was a 24-40. She is putting a grievance in with the union, but I doubt it will go anywhere, and also, even if she gets her job back I highly doubt they'll repost my job. I have one year from the time of displacement to get my job back IF they make it available. I get first choice.

I'm just overwhelmed. This weekend I was on call with another nurse and it went okay.

I'm so glad this board is around. I just need to bounce things off and make sure I'm not over reacting....Which can happen when I'm overtired and overwhelmed.

I think I've turned one corner and one of the gals that's been working there told me to not panic just realize that I'm learning and she said I"m going good. I guess I needed to hear that. It's just such a small unit compared with my old place. I'm slowly accepting it, but boy is it difficult to change when you really love your job and you're basically forced to change it.

Again, thanks so much for your words of encouragement and hope.

Tracey

Babs0512 · Aug 26, 2008

Tracey, being on call is tough! My last weekend on call I did 30 hours OT, 20 hours straight - it was exhausting! We take call by ourselves, so no one was there to relieve me. I don't find that particularly safe, but that's the way it is.

Don't let them push you into call until your ready. Stand your ground.

As far as feeling out of place. I worked 8 years in the ER, then came to PACU. Sure, I could read the monitors, and do assessments, but knowing all the anesthesia meds, various surgeries, new abbreviations, new policies, etc... I felt like a fish out of water too - and I had a ton of critical care experience. So, new nurse or seasoned, a new area of nursing can be unnerving, but you'll get it, hang in there.

Peace

yecart1 · Aug 26, 2008

Babs

Thank you so very much. I'm hanging. I'm an overachiever/hard on myself by nature. I'm learning and that is all that matters. Like one of the hospital persons said at orientation We(nurses) don't come to work to hurt anyone. We come to work to care and help.

I just need to get my perspective in the right frame of mind and know that orientation isn't forever, it's a short time, and I'll get it despite the challenge/people that seem like they are impatient with me will have to get over themselves. Everyone learns at a different pace and it's THEIR problem not mine. I'm doing the best I can.

I've got one more schedule for orientation and I believe I'll be good during regular work hours. My manager isn't going to push with the on-call, as I was told yesterday. I'm excited to get orientation over with and get back to a 3-4 day week. I NEED at least one day off during the week, ha ha, for getting my stuff at home done.

PS I got some much needed sleep....can you tell? *snerk*