PACU interview.

I have an interview Monday for a PACU position. I have nine years icu experience. Five years of that as a travel nurse and before icu worked surgery. I am burnt out on icu and am looking for a change and would like to stay home for awhile. Anyway, what should I look for in a pacu position, what questions should I ask? Also, what is the best thing and the worst thing about pacu nursing. Thank you in advance for your responses.

Ask:

1. What are your staffing ratios? Are they strictly adhered to or are there times when nurses are expected to take on more than 2 patients each? What happens when every nurse has 2 patients each and the OR is calling to come out with another patient?

2. Is there call involved and if so how much? If you are applying at a level one trauma center there typically should not be any call as PACU is required to be open and staffed 24 hours. Other levels may close and put nurses on call for weekends and off hours.

3. How are PACU nurses scheduled? Self-scheduling or not? 8, 10, or 12 hour shifts? (My PACU has all 3 shifts available). Are the nurses rotated for taking less desirable shifts like nights or weekends or will I be expected to take them more often as the new guy?

4. What is your visitation policy? Believe it or not, some PACU's actually allow visitors even if it is an open room for visitors to see everything including someone waking up from anesthesia kicking off their covers exposing themselves and all. Not to mention the confidentiality issues with them standing right there hearing report.

5. Does this PACU recover pediatric patients? What about PICU patients?

6. Where do the ICU patients go after surgery? What happens if there is a code on the floor and the ICU's are full? Do they come to PACU? Is this PACU expected to take ICU patients from the ER to decompress it as well?

This question is most important because you mentioned being burned out in ICU. I went to PACU from ICU for a change of pace and found it most disheartening to find out that we are used as an ICU dumping ground and frankly I'm getting quite sick of it as the years go on.

The pro's for me are the varied shifts and being able to go home if it slows down and I want to leave. Back in ICU it was 7-7 and you stayed until your relief arrived at 7. I love actually recovering patients and sending them on their way. There is something about having the same patients for 12 hours that I don't like and if they are particularly difficult patients for one reason or another, I used to go home dreading having the same two patients the next day for yet another 12 hours. I love the "Get 'em in and get 'em out" fast pace about PACU. Oh, another pro is no floating to other units!! If you are not needed as the PACU slows down for the day, you can go home instead of getting sent to some other unit. This may not be the case in all PACU positions.

The con's.....well like I said, I'm tired of being used as an ICU dumping ground and being used as a quick fix for ICU staffing problems. My hospital has open ICU beds every day while ICU patients sit and sit in the ER and PACU because they can't keep enough nurses to actually staff those open ICU beds.

I charge often so I often get caught in the crossfire of competing for open PACU slots. Anesthesia and surgery complain that their patients are getting put on hold to come out when I have no physical space and/or nurse to care for their patients....often because those slots get taken by getting ICU dumps from the ER or we recovered the ICU patient after surgery and they have no ICU bed to go to. Then the administrator is calling me to tell me that there is a code on the floor and the ICU's are all full so they have to come to PACU. Again, more slots being taken that the OR can't use for their patients.

My advice is to find a non-level one trauma center that does not use the PACU as an ICU dumping ground if you truely want to get away from ICU because I still spend a lot of days caring for ICU patients with no place to go rather than actually recovering patients from surgery which is what a PACU is for in the first place.

Don't mean to be too negative but I want to be realistic and tell you what you might be getting into depending on the hospital you work for. When I interviewed for my PACU position, it was presented to me that I "might possibly" get an ICU overflow patient "on occasion" when a major staffing crisis occurs or we get some unexpected influx of ICU patients. Well that has been pretty much every day for the past couple of years.

Thank you for your reply it is very helpful.