Any Texas PACU RNs here?

Specialties PACU

Published

Just a question---I was told by a TX colleague that your state nurse practice act does not mandate any specific RN to patient ratios, (as are mandated in CA.)

I understand this--CA is the only state right now with mandated RN to patient ratios---but, in every state I've worked in the past 10 years or so, ALL PACUs follow ASPAN guidelines for 2:1 nursing care in the immediate post-anesthesia recovery phase, for EVERY patient, post-op.

My colleague says that in TX, it is not unusual for one PACU RN to recover 1, 2, or even possibly 3 post-op patients simultaneously (depending on acuity, I guess.)

Is this, indeed, true---even in JCAHO accredited facilities? Don't most PACUs set P&P according to guideline recommended by ASPAN---even if there is no "written in stone" standard? Seems to me that's asking for trouble (not to mention making more work than necessary for one RN.)

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The PACU at my hospital follows strict ASPAN standards of 2:1. I don't know about the rest of Texas because this is the only PACU I've ever worked, but if every PACU nurse has 2 slots filled, the patient does not come out of the OR until a slot opens, period, no exceptions.

The OR can complain all they want, and they will at times, but strict 2:1 is followed here.

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The PACU at my hospital follows strict ASPAN standards of 2:1. I don't know about the rest of Texas because this is the only PACU I've ever worked, but if every PACU nurse has 2 slots filled, the patient does not come out of the OR until a slot opens, period, no exceptions.

The OR can complain all they want, and they will at times, but strict 2:1 is followed here.

2 RNs per patient, correct? Not 1 RN per 2 patients? Just want to make sure I am understanding you correctly.

Thanks for your response!

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2 RNs per patient, correct? Not 1 RN per 2 patients? Just want to make sure I am understanding you correctly.

Thanks for your response!

You wish. Pardon my late night dyslexia, I meant 1 RN per 2 patients.

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You wish. Pardon my late night dyslexia, I meant 1 RN per 2 patients.

But, don't ASPAN standards dictate 2 RNs to 1 patient, in the PACU immediately post-op? That's how I interpret them, from reading on their website at http://www.aspan.org

Here's an excerpt:

"Position

It is, therefore, the position of ASPAN that two licensed nurses, one of whom is a Registered Nurse competent in postanesthesia nursing, will be present in the Phase I Postanesthesia Care Unit whenever a patient is recovering from anesthesia.

Expected Outcomes

Perianesthesia nurses need to familiarize themselves with this position statement and inform and educate nursing peers, nurse managers, hospital administrators, and physicians.

Management needs to develop a multidisciplinary, collaborative plan to meet this standard for the patient recovering in Phase I PACU.

ASPAN, as the voice of perianesthesia nursing practice, must externalize this information by sharing this position with regulatory agencies and professional organizations that interface with the Postanesthesia Care Unit.

Approval of Statement

This statement was recommended by a vote of the ASPAN Board of Directors on January 10, 1998 in San Juan, Puerto Rico and approved by a vote of the ASPAN Representative Assembly on April 21, 1998 in Philadelphia, Pennsylvania."

I guess PACUs in TX (or anywhere) can get around the 2:1 (RN to patient ratio) by the ambiguous wording about 2 RNs being PRESENT in the PACU----not necessarily 2 RNs at the bedside of 1 patient.

Still, when you are on call, and there is only one patient, don't 2 of you get called in to recover that one patient?

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I don't work in PACU but I'll ask my fellow nurses in our PACU about their nurse-patient ratio.

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But, don't ASPAN standards dictate 2 RNs to 1 patient, in the PACU immediately post-op? That's how I interpret them, from reading on their website at www.aspan.org

Here's an excerpt:

"Position

It is, therefore, the position of ASPAN that two licensed nurses, one of whom is a Registered Nurse competent in postanesthesia nursing, will be present in the Phase I Postanesthesia Care Unit whenever a patient is recovering from anesthesia.

Expected Outcomes

Perianesthesia nurses need to familiarize themselves with this position statement and inform and educate nursing peers, nurse managers, hospital administrators, and physicians.

Management needs to develop a multidisciplinary, collaborative plan to meet this standard for the patient recovering in Phase I PACU.

ASPAN, as the voice of perianesthesia nursing practice, must externalize this information by sharing this position with regulatory agencies and professional organizations that interface with the Postanesthesia Care Unit.

Approval of Statement

This statement was recommended by a vote of the ASPAN Board of Directors on January 10, 1998 in San Juan, Puerto Rico and approved by a vote of the ASPAN Representative Assembly on April 21, 1998 in Philadelphia, Pennsylvania."

I guess PACUs in TX (or anywhere) can get around the 2:1 (RN to patient ratio) by the ambiguous wording about 2 RNs being PRESENT in the PACU----not necessarily 2 RNs at the bedside of 1 patient.

Still, when you are on call, and there is only one patient, don't 2 of you get called in to recover that one patient?

Yes but that is because 2 RN's need to be in the PACU whenever it is open. If it is a level one trauma center then at least 2 RN's need to be covering the PACU 24 hours because it can never close.

I highly doubt any hospital staffs 2 RN's to recover one patient but if there is such a hospital please let me know so I can send my resume.

We all jump in and help whenever someone rolls through but technically each patient belongs to one nurse and each nurse max's out at 2 patients.

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Specializes in O.R., ED, M/S.

The hospital I work at now has one RN and a CNA on call for after hours, but the regular shifts, 7-3 and 3-11 have an all RN staff. The other hospital that I go to has an all RN call team, no CNAs. A hospital I worked at a few years ago had an all RN PACU. Mike

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Yes but that is because 2 RN's need to be in the PACU whenever it is open. If it is a level one trauma center then at least 2 RN's need to be covering the PACU 24 hours because it can never close.

I highly doubt any hospital staffs 2 RN's to recover one patient but if there is such a hospital please let me know so I can send my resume.

We all jump in and help whenever someone rolls through but technically each patient belongs to one nurse and each nurse max's out at 2 patients.

Since 1990, when I moved to Oregon from CA, I noticed that there were always 2 RNs to 1 patient (at the bedside) in every PACU at every Oregon hospital I was staff or registry at---all shifts, and on call. At the time, I thought that was strange, as in CA there was always only 1 RN in the PACU per patient--even on call, we always only called one RN in.

Now that do travel nursing, usually in San Francisco, I see the same thing---2 RNs to 1 patient in PACU---of course, CA has a MANDATED minimum RN to patient ratio, so the RN to patient ratio is always 2:1 in PACU all over CA (except for those hospitals that choose to ignore the law, and they do exist.) Now, whether they actually are present at the bedside (that is, 2 per patient) at every moment I don't know, but I know that whenever I have taken a patient to PACU immediately post-op, there are 2 RNs in the space designated for that patient, and both start tending to the patient. I don't know how long they stay.

How long does "Phase 1 Recovery" last? I guess that's how long they must stay.

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Since 1990, when I moved to Oregon from CA, I noticed that there were always 2 RNs to 1 patient (at the bedside) in every PACU at every Oregon hospital I was staff or registry at---all shifts, and on call. At the time, I thought that was strange, as in CA there was always only 1 RN in the PACU per patient--even on call, we always only called one RN in.

Now that do travel nursing, usually in San Francisco, I see the same thing---2 RNs to 1 patient in PACU---of course, CA has a MANDATED minimum RN to patient ratio, so the RN to patient ratio is always 2:1 in PACU all over CA (except for those hospitals that choose to ignore the law, and they do exist.) Now, whether they actually are present at the bedside (that is, 2 per patient) at every moment I don't know, but I know that whenever I have taken a patient to PACU immediately post-op, there are 2 RNs in the space designated for that patient, and both start tending to the patient. I don't know how long they stay.

How long does "Phase 1 Recovery" last? I guess that's how long they must stay.

Ask the nurses who is actually taking the patient next time you roll them out. I'm curious because when we get patients from OR, 99% of the time the OR staff is going to see at least 2 nurses in the slot hooking them up to monitors and getting them settled.

But that doesn't mean that 2 nurses are actually assigned to the patient. After everything is set up,(IV, PCA, A-line, monitor, etc.)then there is really only one nurse actually assigned to the patient.

If that's not the case out west, then maybe I need to move.

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Ask the nurses who is actually taking the patient next time you roll them out. I'm curious because when we get patients from OR, 99% of the time the OR staff is going to see at least 2 nurses in the slot hooking them up to monitors and getting them settled.

But that doesn't mean that 2 nurses are actually assigned to the patient. After everything is set up,(IV, PCA, A-line, monitor, etc.)then there is really only one nurse actually assigned to the patient.

If that's not the case out west, then maybe I need to move.

Yeah, I guess you are right---I just checked the CNA website for the mandated RN to patient ratios in PACU, and it is 1 RN to 2 patients---just like where you live.

If you want to read more about AB 394 (remember, this is minimum RN to patient ratios---LVNs cannot be included in the minimum staffing ratios) check out the CNA website detailing the minimum RN to patient ratios in other areas of the hospital at:

http://www.calnurse.org/files.calnurse.org/assets/finratrn7103.pdf

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I don't work in PACU but I'll ask my fellow nurses in our PACU about their nurse-patient ratio.

Ok, I asked the PACU nurses where I work (teaching hospital in Dallas) about their nurse-paient ratios. I was told their ratio is one RN to 2 patients, regardless of whether the patient has been in PACU for one minute or whether they're fixing to leave PACU. When patients are taken to PACU there are two RNs to hook up to monitors and settle the patient, but once that's done it's back to 1 RN for 2 patients.

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