New PACU NURSE

wannabecnl · Feb 6, 2014

First, congrats and welcome! I love PACU and am happy to take a quick stab at a few of your questions.

First of all, in PACU it's not ABC; it's airway, airway, airway. And then airway. Then breathing, circulation, and pain. After you medicate for pain, it's back to airway and breathing again! In phase I recovery, I have seen patients come out of the OR wide awake on room air, and I've had people schnockered for 40 minutes with an oral airway and/or needing constant jaw support to breathe. You have to know how to KNOW they are breathing (it's not just the pulse ox number--is the mask fogging? Do you hear bilateral breath sounds? Chest rise?), what to do if they aren't, and where you keep all the stuff like ambu bags and oral/nasal airways.

Malignant hyperthermia is pretty rare, but you need to be aware of its existence. Family hx of MH is something that anesthesia documents in preop, so if you're doing preop, you may be in on that conversation. This drives the anesthetics used in the OR and is something you must know in postop. There are some good CEs out there on MH, which I would encourage you to study rather than getting into a discussion here. Know where the MH cart is and where to find ice machines, cooling blankets, etc. Learn about dantrolene!

I have no idea if PACU is a good precursor to ED. Did you try to get an ED job? There's a steep learning curve in PACU, and I'm not sure how much will be relevant if you move on.

As far as style, there is no one style. You'll have patients that require a little extra TLC--a D&C after a pregnancy loss, for example. And then you'll have patients who just want you to leave them alone so they can sleep, and you have to be firm, crank up the head of the bed, and ship 'em off to the floor or to phase II when they are actually ready, not just when they want to go. Efficiency is key; see the next paragraph for what you're trying to accomplish.

Having worked in LTC, I imagine your time management is probably pretty good, and PACU is yet another area of nursing with its own flow. Your goal for everyone who rolls through the door is the same: awake, breathing and satting well (on or off O2 depending on baseline and where they are going--home or the floor), oriented, pain under control to the best of your ability (i.e., most of the time you can't get them to a 0/10), and everything stable, then out of there. I'm still working on my flow after 14 months, but I'm getting better.

Make sure you get a good orientation with a strong preceptor. You want to take a cross-section of patients; the "easy" ones are important because it's a chance to learn the documentation and that PACU flow, but the hard ones are crucial because that's how you're going to transition into acute care. You don't want your first crashing postop when you're on call by yourself!

Ask questions. Ask for help. Offer to help your coworkers to get an idea of how they do things (and to help them out, because in PACU, we have to rely on each other). Get to know the docs (anesthesiologists and CRNAs will likely be writing your orders) and ask them questions, too. And be confident but not cocky with your patients; you are likely the first face they will see when they wake up, and even if they don't remember you after they go, they need to trust you when they are scared, bleary, and in pain.

Finally, visit the website for ASPAN, the American Society of Perianesthesia Nurses Home. Read their position statements and guidelines. Even better, join ASPAN and get involved in your local component; the educational offerings are relevant, and the journal is well-written. Get a copy of the Core Curriculum for Perianesthesia Nursing and look up cases as they come up.

It's a lot of stuff, I know. PACU is my passion, and I hope this is a good career change for you!

aramis2121 · Feb 6, 2014

Thank you for such a well thought out response! The points you brought up and answered are fantastic. I'm very excited to start on this path. I just had surgery recently and I really thought about the Pacu nurses and their jobs pre and post. I tried to put myself in their place. My new manager explained to me that post surgery patients need some TLC and more babying than what I'm used to at my LTC. This will be a change for me. But I've always been fair and caring to all my patients no matter what so I'm no worried about that too much. I'll look into the Aspan like you recommended. That seems like a great source of knowledge and I want to make sure I can impress from day one!