PACU RN requirements

[smnurse]

Hi!

This is my first post.

I am interested in knowing the level of nursing experience your facility requires for RNs providing Phase I care of patients, particularly pediatric patients. Our PACU is combining with our Same-Day Surgery dept., so that Phase I/Phase II care will be delivered by the same nurse in the same location.

In our present PACU staff, we have always required our RNs to have a minimum of 2 years Critical Care experience. However, with the merge, we will now have nurses with no Critical Care background--and limited med/surg experience-- caring for patients in Phase I, including ICU overflow patients. Despite cross-training, several RNs have put patients in jeopardy. Thankfully, our regular PACU RNs were readily available to help correct what could have been disasterous situations.

We have shared our concerns with the managers from both areas, but they seem to feel that they can learn "on the job" with the help of clinical resources.

What do think about this? Any experience with this or a similar situation? If so, what did you institute to help the less experienced staff safely care for patients?

Thanks for your help!!!!

[mountaingrl]

Dear smnurse, about 3 years ago I too tried to combine the PACU and same day nursing staff. It seemed like the logical thing to do at the time. Here is what I learned from that experience. 1. PACU is truly a critical care area and needs nurses with those skills. 2. "Some" of my same day nurses are very good "level 2" PACU nurses, ie they take the less critical patients. 3. It is not worth the headaches if you try and force nurses into an area they are uncomfortable with.

I want all my nurse to love their jobs. I want them all to come into work every day with a positive attitude that enables them to give excellent patient care. I have told my nurses that cross training will be strictly voluntary from now on. However, those that choice not to cross train know that when their unit is slow they will be downstaffed, (an unfortunate reality in most hospitals ) For those that want to cross train, I make sure that their orientation is adequate and appropriate. Keep talking to your manager. Document when patient outcomes have suffered due to the staffing mix. Hard data is always a good thing! Good Luck!

[wendy60]

We are having similar issues in our PACU. We can not find qualified ICU nurses that want to apply for our open positions. Our manager feels that taking med-surg nurses and mentoring them will solve our issue. Our evening staff is very limited and it is difficult at best to provide adequate safe care for patients and 'mentor' those who do not have the skill set to function independently. There should be some type of extensive orientation and they need to work during times when there is adequate support staff to help them. Working on off shifts can become a dangerous situation. I don't have the answer but compromising patient safety is NOT the way!

[Hopecascade]

Two years of critical care experience are required, along with BLS, PALS, and ACLS. On the job training is a bit scary if you do not have critical care skills, ekg interpretation and a course certification with experience to back it up. How are they going to take care of A lines, IV drips, ICU level patients without being prepared? Good luck.

[debthern]

something we do is we assign 2 nurses to 3 bays which allows you to put a more experienced nurse with a less experienced one...

[NurseJR08]

Previously, our PACU only hired people with ICU experience. I was in the PACU in nursing school, so they already knew me and they hired me into the PACU as a new grad and put me through a residency program. So, no, I dont have ICU experience but i have a lot of really experienced people around me who have been great teachers and really supported me through the process. If there is something I haven't seen/done before then I always always always ask for help (patient safety over pretending like i know something that i dont). I have been really lucky to work in supportive group of nurses with a ton of experience. I love the PACU! Anyway, just another perspective.

[bioniclewoman]

Previously, our PACU only hired people with ICU experience. I was in the PACU in nursing school, so they already knew me and they hired me into the PACU as a new grad and put me through a residency program. So, no, I dont have ICU experience but i have a lot of really experienced people around me who have been great teachers and really supported me through the process. If there is something I haven't seen/done before then I always always always ask for help (patient safety over pretending like i know something that i dont). I have been really lucky to work in supportive group of nurses with a ton of experience. I love the PACU! Anyway, just another perspective.

It was nice reading your post. I just started nursing school and I have been working in a PACU for two years now. I would love to be hired when I graduate. I would say about a quarter of their nurses don't have ICU experience, they came from med/surg.

[PACU'er]

I came from a Med/Surg background (not ICU) and have worked in PACU for 2 years. In fact, we have many nurses that have the same background. Those who weren't capable enough, were weeded out. We have so many excellent PACU nurses in our unit, I am sometimes amazed. They are on top of their game.

We are also a busy PACU in a large Phoenix hospital. We have all kinds of patients day and night, including ICU, peds, etc. I have never seen a nurse respond inappropriately to any situation. The Med/Surg background nurses have proven to be as capable as the ICU background nurses.

ICU experience is awesome, but a nurse with a Med/Surg background can be just as efficient, have excellent critical thinking and be able to respond to emergent (or otherwise) situations. I think the key is preparation. Just my thought.

Thanks.:redbeathe

[HC RN]

We have the same issue in our unit. We have nurses in the PACU without critical care experience and when it comes to a heavy vented patients these nurses are bypassed. This places additional burdens on the experienced staff. Does anyone know about MRSA and pregnancy. I am 8 months pregnant in the pacu and when we get an isolation patient the charge nurse loves to give me the patients. One time she called an additional nurse in to help us, I had a post op patient already, the additional nurse did not after being there 10 minutes circulating we were notified that an isolation pation with MRSA was coming into the unit. The charge nurse told me that I was was going to take the isolation pt. I told her that I should not have the isolation pt b/c I have a patient and the nurse who came in didn't not have a patient should. She told me that pregnancy is no reason not to take an isolation patient. We take turns in our unit taking patients from the OR to evenly spread the patient load. It was my turn and smiled at me and told me that I was getting the next patient and that the patient was MRSA isolation. Well the next patient that came out was not isolation so I took that patient and she ended up with the the busy hip revision MRSA patient who lost a lot of blood. She came up to me and then told me well I guess you lucked out this time. She deserved that.

[NurseJR08]

no problem, i am not the usual PACU nurse, but i love it. (almost) everyone has been so supportive. Another idea for if you want to work in a PACU when you graduate is to take ACLS and PALS if you haven't already.

[PostOpPrincess, BSN, RN]

I find that those without critical care experience have a "harder" time and are less adept at managing a high-level care patient.

They are slower (not dumber, mind you, just slower in a sense that things are not second nature).

I prefer working with someone who has a lot of experience because I know I do not have to "babysit"; although I do not mind being supportive to my colleagues, after a while I get tired of doing "everything" and thinking of "everything." Generally, I don't mind.

I understand that is the part of the environment we are in now as we have very few nurses even where I work with an extensive critical background, compared to 10 years ago when everyone who worked there was ONLY from ICU.

[NurseJR08]

I find that those without critical care experience have a "harder" time and are less adept at managing a high-level care patient.

They are slower (not dumber, mind you, just slower in a sense that things are not second nature).

I prefer working with someone who has a lot of experience because I know I do not have to "babysit"; although I do not mind being supportive to my colleagues, after a while I get tired of doing "everything" and thinking of "everything." Generally, I don't mind.

I understand that is the part of the environment we are in now as we have very few nurses even where I work with an extensive critical background, compared to 10 years ago when everyone who worked there was ONLY from ICU.

While I do agree that icu experience IS important and can be helpful for PACU nursing, about half of the nurses in our PACU dont have icu experience, myself included. I do not have to be "babysat" by anyone. I am more comfortable taking the critical/icu patients than some of the nurses who have been there for years and years. This was a huge struggle I faced when I entered PACU as a new grad. There are a lot of "this is the way things have been for years..." Well, things in nursing are changing. Nurses are needed everywhere. Many places are now offering residencies to train new grads or even experienced nurses new to an area. I think more nurses need to accept that nobody knows everything and we can all teach each other something. Maybe the perspective should change...if you have icu experience, help people learn, dont look at it as "babysitting". I love it when our more experienced nurses teach me things, it helps me become a better nurse. Be willing to teach and share your experience, but dont put others in a position lower than yourself, we are all nurses, you might even learn something from someone else.

"