PACU Call Coverage

Editorial Team / Admin · Jul 23, 2012

We have one third shifter who is responsible for stocking and other things. She will also recover any non-peds and non-critical care patients with the OR nurse as standby. Level 2 trauma center, so we're staffed 24/7 and usually have a free nurse unless it's trauma circus time. One nurse on call if peds pt or critical care. If third shift is off/weekend, two nurses on call, first call comes in with OR nurse as backup and second on call comes in if peds/critical care. Perhaps looking to hire someone exclusively for third shift or at least for a later shift (3-11) would be an idea to look into?

1PACURN · Jul 23, 2012

Thanks for the feedback. We are also a level II center with 3 to 11 staff. I have been trying to get support from the OR RNs for some time now. I Will continue down that road. I think that will be our saving grace. The push back here with the OR is "what if a trauma comes in?". How do you guys handle that. I know here the OR team has to respond immediately and if we have a bad patient in the PACU that could create a huge issue. Who would stay with the PACU nurse or has that even been an issue for you?

Thanks again,

Editorial Team / Admin · Jul 23, 2012

Actually, the OR nurse isn't necessarily in PACU with the PACU nurse. She's at the OR desk about 10 feet from the open PACU door. Usually the PACU nurse is fine with being alone for the 30 minutes it takes to call in the call nurse (OR or PACU, if the trauma/emergency would come to PACU) if the OR nurse has to go do a trauma. Once the OR call nurse comes in, the third shift nurse is free again. Anything non-emergent waits until the OR call team arrives. It also usually doesn't take long at all to get a bed on third shift, so the PACU nurse isn't sitting for hours with one patient. Once they're awake enough to talk and eat ice chips, they're out.

1PACURN · Jul 23, 2012

Thank you....this is a great option for us here. I will try to push it up the chain.

Thanks.

emain86 · Nov 4, 2013

Just wondering if Sweet Wild Rose has had any problems with using the OR as back up? Do they complain? We have same-day nurses up here on Saturday mornings and when I say oh okay you'll just be my second person in the room they look at me like I'm a crazy person. They go " We dont have ACLS" and I'm like "you're still a nurse".

My boss told me it was okay to use OR as backup... plus there is CRNA and a multitude of other people. Whenever a surgery happens there are 4 OR nurses there just in case of traumas. How well does this fit with the whole ASPAN standards. Have you had any problems at all?

Would like to know just so I can have the info so I'm less paranoid when I dont call on call person in for a healthy 20 y/o appendectomy.

wannabecnl · Jan 16, 2014

We have one nurse on call 7p - 7a on weekdays (which overlaps our later shift people--we're officially staffed until 9:30 p and open at 6:30 a), one nurse 7a-7p Sat and Sun, and another nurse 7p-7a Sat and Sun. We recover patients in the ICU, so the ICU nurses are our 2nd nurse. We typically run one OR after hours, but sometimes they'll open a 2nd one, which can challenge the system, and when the ICU is full, we have to go back to the PACU and find a 2nd nurse.

I really wish we could always recover in the PACU, but you raise some good points about the limitations and stresses it puts on your staff.

emain86 · Jan 20, 2014

We recover patients in the ICU, so the ICU nurses are our 2nd nurse. We typically run one OR after hours, but sometimes they'll open a 2nd one, which can challenge the system, and when the ICU is full, we have to go back to the PACU and find a 2nd nurse.
I really wish we could always recover in the PACU, but you raise some good points about the limitations and stresses it puts on your staff.

Wow this is really a good idea! Very inciteful. Using the OR as my secondary nurse isn't always the best because they are basically useless unless I'm calling for a code ( and even still they aren't always an ear shot away. ASPAN standards says 1 phase 1 PACU RN, + an RN at least within earshot).

So basically I could look in my bedboard ( our bedding system) and see like oh T2 ( SICU) has 8 empty rooms. Lets just recover the patient up there and when OR calls to say where we putting the patient in room so and so?

We actually have a nightshift nurse ( me and one other nurse nightshift) and we work Sun-Friday. Basically we work each others off days and we call in another nurse for patients. So basically since I'm up all night I pick up everyone's call so this could hurt my money haha but its really a great idea.

Can you elaborate more on you do your drugs/what not? Do the Anesthesiologist every get mad if they have to walk over to the UNIT? Or maybe I could recover the patient over in SCVICU which is literally right across the hall. This is a good idea. Our drug stuff is funny and I'd have to work on how we'd do that. Overall I really like the idea of doing it that like that.

Would really like to discuss this further.

wannabecnl · Jun 5, 2014

I never answered your post back. I was actually on call last night and have some insights to consider if you want to recover pts outside the PACU.

1. You asked about meds; yes, I still do the med orders and administrations the same way as in the PACU. Only change is that the ICU doesn't stock all the same meds as we do, so I may have to call the pharmacy to tube up the meds I need.

2. I don't know about looking at the census and going from there to select a recovery area unless you have pre-determined buy-in and a little infrastructure in all the areas. We always use the ICU; we keep a recovery cart there with "everything" we need, and then we restock the ICU stuff we have to borrow if it isn't on the cart. The cart can be moved from one ICU room to another, but I wouldn't want to be moving it all over the hospital every night. The ICU tells the house supervisor if they need that ICU bed, and we might be bumped back to PACU.

3. Even more subtle is the dynamic between the PACU on-call nurse and the "host" nurses wherever you recover; you're going to have to ask these people for help every so often (for example, I had a nurse watch my rather fresh post-op for a minute because I needed to get something that was out of view of his room), and you need to know that they are qualified to help with the kind of stuff you do. I know ASPAN standard says RN and doesn't get into details about ACLS, etc., but I am more comfortable with backup that is experienced in critical care. That's what I love in the ICU; their nurses have much of the same training as we do (and more), and they also recover their vented patients after surgery so they know what to do with a post-op. Some of the nurses are more helpful than others. I'll just leave it at that; my experience has been about 90% positive and 10% positively ridiculous. I think that's true no matter where you are, but when they are your only backup, it's nice if they aren't put out at having to help.

4. I haven't had a problem with my anesthesia or OR staff. They know where we are, they are responsive to pages (especially the on-call anesthesiologist, who usually stays at the hospital and isn't rushing off to another case like during the day), and they know we are kind of marooned. Call is the one time we are allowed to carry and use personal cell phones; I just page the docs and have them call my cell, and I can always call the switchboard or direct-dial departments PRN.

5. Pedi is a whole different thing. If you do a lot of pedi, consider setting up a cart for pedi in your PICU if you have one, in addition to a regular cart for the unit. We are brainstorming this right now; I've recovered kids, but they were old enough that I could safely work in the adult ICU with them and have help. If it were an infant or toddler, I'd much rather be in the PICU with pedi nurses as backup.

6. Finally, I miss my support staff when I'm not in the PACU. It's like taking away everything familiar except the monitor sometimes! We're physically distant from other nurses (within earshot, certainly, but nothing like our packed-like-sardines PACU bays), the unit secretary in the unit has usually gone home, and we don't have our LNAs, on whom we rely heavily for transport, emptying drains, removing A-lines, the works. I could borrow an LNA from the ICU for an emergency task, but at night the LNAs are very busy and I don't like to give them non-ICU work to do. At night we also don't have transport, so we have to beg, borrow, and steal staff from around the building to help!

These are just some thoughts. I don't know if one system is better than another; this is just how we do it. My preference would be 2 on-call nurses recovering in the PACU, but that's not the way it is for us right now. Good luck!

emain86 · Jun 6, 2014

I work nights so I hate calling people in the middle of the night just to recover a simple patient. On top of that it would literally save thousands of dollars doing it that way. Like thousands. My manager on the other hand wants nothing to do with any change. We don't say what would jesus do we say WW ( insert name) do.

Thanks for the response though. I'm over it. Actually about to head over to the travel nurse forums and was totally gonna find out about travel nursing in PACU . That really would be a fabulous way to recover patients and save thousands of dollars a year.literally thousands.