New Pacu Nurse

[WYRN1]

Read with interest many of the postings from fellow PACU nurses. I am fairly new to this area of nursing but I do have to say that one I can't believe that some of you only received a few weeks of an orientation I was oriented with a preceptor for 4mths. Also I do not think this is an area that a new grad would do well in. I had Critical Care and ACLS background from years ago and years of nursing experience yet somedays I still feel wether I am prepared for this enviroment were the patient is most unstable and anything can happen. I sometimes feel I need to know much more. Its good that I am surrounded by nurse colleagues that are understanding and supportive with there many years of PACU experience, and I hope for me too it will become second nature. My manager told me when I hired in that it would be about a year or so before I would feel really comfortable with my abilities and I believe she may be right every day I get just a little more confident but I am also continually learning. I especially have anxiety with the pediatric cases since I had never worked in a pediatric setting except for in nursing school. They are quite scary, and a bit of a challenge. Any advice you seasoned PACU nurses can give me would be gratefullly accepted.

[pie123]

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.

I agree about the Mega Codes. I cannot understand why this doesn't happen more often. Even in a critical care area. Everyone says a code is a team effort, but what if you're in CT scan, and it's just you. There is no time to wait for someone else to get there and run the code. I don't understand why it's such a big deal to do mock codes at least once a month.

[mimi55]

I am a fairly new PACU nurse altho I have been a nurse for many years working in OR and psych I know weird combo. Anyway my manager came up to me yesterday and wanted to know what my problem was? She says I am taking to long to chart (computer). Now it hasn't affected me taking pts. or affected my pt. care. I work PRN it doesn't affect my hours. I work just like a full time person ie taking call, coming in on day off when she asks me and coming in early when she calls and says we are in a crunch can you come now? In other words I am very flexible. I have worked here since Jan. 2008. She knew when she hired me I had about 1 year of out pt. pacu experience and long past ICU/CCU experience. I had about 2 wks. orientation. This is a new computer program for me and I was out during the summer for 6 wks. due to and unexpected urgent surgery myself. So I have worked there about 6-1/2 mo. I have just gone back to work about 3 wks. now. I am thinking about getting a different job. It is extremely stressful with mostly ICU type pts. I think I have held my own there and she wants to complain about my slow charting oh and I don't keep the pts. until I finish charting I send them on to the unit or floor when they are recovered and finish the chart to take to floor later. This isn't with every pt. either. Anyway I feel hurt the way she approached me and worded it "something is wrong here and I don't get it I don't know why YOU can't get it." She was frowning and almost accusitory. May be I am getting paranoid or to sensitive in my old age. She wants me to think about what I am going to do about this and get back with her on Thursday. I told her a computer lab would be nice so I could practice I probably am over charting. Whew thanks for letting me vent. That place is stressful enough without getting called in to her office about my slow charting.

[PACU'er]

Well, I wonder how things are going, it's been a month since your last post. We also introduced computer charting and EMAR to our unit. It was quite a transition, and I am fluent with it. However, it does take more time to chart than with paper charting which management needs to realize it. This is even more true when you have an ICU patient, because there is obviously more care that occurs, and more charting in different screens.

I hope all is well with you.

[Babs0512]

All is well with me, I just haven't hand anything interested to post.

God Bless

[mimi55]

I'm still hanging in there. Nothing came of the slow charting complaint it hasn't been mentioned since, so I haven't brought it up either. I have noticed that I wasn't the only one so maybe she decided she had too many nurses that were slow charters to complain about. I am not comfortable there but I am learning so much and most of the nurses are good to work with. We work with 2 nurses all the time. Last Friday the nurse I was working with took off for about 15 min. just said I'll be right back knowing we had one pt. left in surgery, in the meantime OR brought the pt. in he was not sating well throwing couplets and triplets right and left and b/p was in the toilet. I already had a pt. he was stable thank god but, I told the OR nurse to stay with me until the other nurse showed up as I had no idea where she was or when she would be back. Anesthesia had stepped out for some reason any way I didn't want to be alone and have the pt. crash if I could help it. Everything turned out ok in the long run but when I talked to the nurse about being gone so long she blamed the OR thier fault for not calling report and giving a heads up and me for taking things so serious. Then she proceded to make fun of me when the oncall nurse called to see if she needed to come in.:argue: I know I am a perfectionist and take myself to seriously at times but....BTW this nurse is new to PACU too so maybe she just doesn't realize the importance of back up. She came from a med-surg floor no ICU/CCU experience. Oh well such is life in nursing.

[Babs0512]

Regardless of where she came from, she should know the importance of back up - esp in ICU. Perhaps you should reminder of ASPAN - leave it out for her to read as part of her orientation.

[mimi55]

Thanks Babs :wink2: Thats a good idea about leaving ASPAN out for her to read. We don't have much of an orientation at this facility I know I had to find the Policy and Procedure book and read it as it was not part of the orientation I received. Maybe she had the same orientation?