PACU NURSING

Someone else asked about a day in the life of PACU earlier today so I'll copy and paste my answer to that here.

In the PACU the long orientation period is a must, when you're on-call your "second RN" is most likely an OR circulator and has no idea how to do what we do... so while you have an extra pair of hands (to jaw thrust an airway open) it's your judgment and call on the care the patient receives. (I know some larger hospitals are not staffed this way, but from talking on this board it seems to be a consensus that most PACU's are doing on call like this)

I have only worked in one PACU, so I can only tell you my experinces.

I stand almost my entire shift. We do 1:1 patient care and I go around the stretcher to place leads, do my assessment and such, but a majority of my time is spent standing at the head of the bed, protecting/monitoring the airway, heart rate/rhythm, and blood pressure and charting.

I monitor airways, sometimes inserting OPA or Nasal airways. I remove OPA. LMA. and ET tubes regularly. (Some Facilities don't allow the patients into PACU until the ET tube has been extubated... depends on your places policy)

I check dressings, drains, catheters (rarely place one), urine output, IV's, intake.

On spine patients, neuromuscular checks

On ortho patients, musculoskeletal checks including doing CRT, pulses, sensation, temperature, color and ROM on effected extremity.

I deal with a lot of pain and post op nausea, so I titrate meds based on parameters in the orders, pt LOC, VS and nursing judgement.

I apply ice, elevate, irrigate catheters (TURP), deal with emergence delirium and other behavioral issues at times. Some people get weepy when waking up, most of them have itchy faces they'd scratch right off if they could. I warm people and cool people. Makes sure post op X-rays are completed, second does of antibiotics, hang blood products, call RT to come give racemic epi or albuterol or apply a C-PAP. Call doctors that haven't put in orders for the floor. Score Aldrete's and when the patient is ready, call and give report, either back to the surgical center if they are going home or to the surgical unit if they are staying.

My patients come to me with little to no warning. If I've had time to associate the monitor and check orders before they are getting wheeled through the door, I'm ahead of the game.

I receive report at bedside from the anesthesiologist, while doing my primary assessment. Report is verbal, you learn how to hook up monitors, be assessing airway and bleeding while listening to report. That was one of the hardest things for me to catch onto. And when I'm tired, its still a struggle. Luckily, I know my doc's well enough I'm not shy to ask "Did you already tell me if the patient got blocked?" or whatever else I need to know.

When the OR's are turning over quickly things move fast. Then all of a sudden every OR has a long case and you sit twiddling your thumbs (or going to use the restroom, catching something to eat).

I take call at least once a week and have to be able to be there and ready for a patient within 30 mins. Most of the time though, I get the call the same time the OR crew is called in, so I have more time then that.

The last thing I can think of to give you the flavor of my unit is the schedule. It changes all the time, not the day I work, but the times I go in. I could be scheduled at 9am all week and some days go in earlier or get pushed back to later and not actually start at 9am all week. I could be scheduled to leave at 5pm, but if surgeries are not done, and no OR has closed, I'm there until 7pm. Or visa versa, could be scheduled to 7pm and all the surgeries are done for the day and leave at 2pm. My family knows I'll get home 20 minutes after I call you and tell you I'm on my way. But other then call, I have the weekends and holidays home (we take call two holidays per year). And when I'm home I don't have to think or worry about work.

I love what I do! I love the unit, the challenges, the routine, the pace, even the crazy schedule and taking call (call helps to make up cut hours somewhere else in the week) I also love the team I work with... which is one of the most important things for me no matter where I work, my co-workers can make or break any experience.

I just realized I wrote a book. Sorry for that. I do love PACU, though, I think I could be happy in a variety of units depending on my co-workers.