PACU vs. Prep and Recovery

Hoozdo, ADN · Nov 18, 2010

Maybe that is a typo and prep is REALLY pre-op.

GHGoonette, BSN, RN · Nov 18, 2010

Yes hoozdo, I think so. Never heard of a recovery room having a prep area attached to it.

OP, where I work recovery/PACU staff are responsible for controlling the pre-op area; they take turns running it. Unlike some larger facilities, we do not have a phase 2 recovery area. I presume somewhere in here is the crux of your question; are you perhaps referring to phase 2 recovery as opposed to phase 1?

If you are interested in moving to OR, and if recovery can spare you, I would ask the unit manager if you can be assigned to one of the senior circulating nurses to assist her with theater preparation and setup. Get your foot in the door and some experience under your belt.

GHGoonette, BSN, RN · Nov 18, 2010

heyRN said:
Hi. Could someone please tell me the difference between working in a PACU position vs. working in Prep and Recovery? I understand prep would be before the surgery, however I am not understanding what the difference would be between PACU and Recovery.
I am highly interested in working somewhere within the surgery setting, however I don't have experience in that area...I am finding that most hospitals want someone with experience for OR and PACU. Would working in Prep and Recovery be a better way into the surgery setting for someone with no OR or PACU experience? I appreciate any input on this topic. ? Thanks in advance!

Ah, sorry, didn't read your post properly. You might find the larger hospitals with the phase 2 I mentioned would be prepared to take you on. You'd be responsible for monitoring patients of lower acuity prior to transfer to the ward. That way you can get experience in the recovery setting without being exposed to intubated, poorly reversed patients, which is very risky for a newbie. Get the feel of the department, and assist the RNs in phase one wherever possible.

Likewise if they're looking for someone to work specifically in pre-op. There your main requirements would be ensuring that patients have been correctly prepared for theater, sending for the patient, ID, consent, knowledge of medico-legal hazards, premedication and side effects etc.

I've read in this forum that preference in the USA is given to nurses with ICU experience, so you might find yourself hamstrung without that. But good luck anyway.

All4Seasons · Nov 19, 2010

Oops...see below...

All4Seasons · Nov 19, 2010

Hi,

Here are the different perioperative stages,which are similar in all hospitals. Perioperative meaning the entire process of having a (usually) surgical procedure to walking out the door to home, or out to a postoperative nursing unit. In our centre it goes like this:

Pre Admission Clinic - this is where some pts begin the process,a week or more before their surgery,usually those with more complicated medical histories (e.g. diabetes,chronic renal failure,coronary artery disease,etc - who are worked up before their surgical date: lab work,pulmonary function studies,ECGs, CXRs,etc.

Pre Op - those mentioned above and all other cases check in here the morning of surgery and v.s.are taken,npo is confirmed, a ride home is clarified (or the case will be cancelled),and patients change into gowns and booties,etc. Any preop medications ordered are given here.

IntraOp - pt is having their procedure or surgery in theatre, cared for by Anesthesia and Nursing staff (mostly anesthesia)

Phase 1 or PACU (Post Anesthetic Care Unit), some hospitals call it PARR Post Anesthetic Recovery Room. You arrive here immediately after your time in the OR. This is a critical care area - a patient's airway,vital signs,pain and nausea management, and fluid status are the primary focus here. Complications postoperatively are not uncommon - Laryngospasm, cardias dysrhythmias,bleeding; because all anesthetics - general or spinal, sedatives, analgesics, and nerve blocks have the potential to affect vital signs (usually a depressive effect).patients are carefully monitored to assure safe and comfortable recovery. Xrays to confirm placement (hip,pacemaker,etc)and that no damage was caused (e.g.pneumothorax). The APS - Acute Pain Service ,if consulted,see patients here - often Patient Controlled Analgesic or a Continuous Nerve Block are initiated here.

When a patient's nurse has decided, based on set criteria, that the pt is dischargeable from PACU, she/he will call report to the receiving floor nurse, ICU,or IMCU nurse, and send the patient to a floor/Unit bed. Or,if the patient is a day patient they go onto Phase 2....

Recovery Phase 2 (in my hospital it's called PRL (Post Recovery Lounge) - is where the patient goes when the PACU nurses have made sure that the patient ; has reached an optimum level of consciousness and comfort, and has stable vital signs which must be within 20 % of their preop readings (Aldrete Score). It is usually in this area where pts receive another set of vs,a snack,and preop teaching (verbal and brochure) is given. Appointment for followup visit with surgeon is arranged.

If you think you might be interested in pursuing a career somewhere in the PeriOperative process, I'd look for permission to shadow a nurse in each of these areas. They differ vastly.

The training needed is very area - specific; to my knowledge, an OR course is necessary to work in the OR theatres.Several months long here. To work in PACU,you would require an ICU course or experience, or a PACU course (3 months long here) or previous experience. As far as Phase 2 is concerned,to my knowledge there is no specific course;you are educated via a preceptor (an experienced RN) - on-the-job training,if you will. Nurses who need lighter duties e.g. back injury are sent there (here) - no previous perioperative experience needed. This may not be the case everywhere, however.

If you find something which interests you as you shadow,then look into getting the specialized education needed - that you can't do without.

The OR course is focused on becoming a scrub and/or circulating nurse. There, largely,it is the anesthetist,anesthetic resident,and anesthetic tech who have hands on care of the patient That is completely different from a PACU course - PACU being very much a hands-on area,where the emphasis is intense observation and advanced intervention needed to safely care for potentially unstable patients who,for a time,cannot protect their airways - we do that for them. In depth knowledge of all sorts of anesthetics,narcotics,sedatives,nerve blocks and their potential side effects are learned.

I would suggest shadowing a nurse - no commitment,no outlay of $$ and you could get the 'nitty gritty' (the good and the bad) from someone at the front lines. All the best! ?

heyRN · Nov 22, 2010

Thank you soooo much All4Seasons and GHGoonette for your responses. They were very helpful! :yeah:

blandis · Dec 13, 2010

I am peri-op. We have pre-op holding, PACU and then phase 2. Someone else on here described them well. Make sure you have ACLS, PALS and a critical care course under your belt before you apply. I like working in pre-op holding the best because the patients are "with it". You get to help patients and their families deal with their pre-procedure worries. I find it the most fufilling because you are most likely the only nurse they will remember in the end. They are too out of it to remember any other peri-op nurse. You also have TONS of interaction with the doctors and CRNA's this way. They don't show up to PACU much and never to phase 2.

blandis · Dec 13, 2010

All4Seasons said:
Hi,
Here are the different perioperative stages,which are similar in all hospitals. Perioperative meaning the entire process of having a (usually) surgical procedure to walking out the door to home, or out to a postoperative nursing unit. In our centre it goes like this:
- Pre Admission Clinic - this is where some pts begin the process,a week or more before their surgery,usually those with more complicated medical histories (e.g. diabetes,chronic renal failure,coronary artery disease,etc - who are worked up before their surgical date: lab work,pulmonary function studies,ECGs, CXRs,etc.
- Pre Op - those mentioned above and all other cases check in here the morning of surgery and v.s.are taken,npo is confirmed, a ride home is clarified (or the case will be cancelled),and patients change into gowns and booties,etc. Any preop medications ordered are given here.
-IntraOp - pt is having their procedure or surgery in theatre, cared for by Anesthesia and Nursing staff (mostly anesthesia)
-Phase 1 or PACU (Post Anesthetic Care Unit), some hospitals call it PARR Post Anesthetic Recovery Room. You arrive here immediately after your time in the OR. This is a critical care area - a patient's airway,vital signs,pain and nausea management, and fluid status are the primary focus here. Complications postoperatively are not uncommon - Laryngospasm, cardias dysrhythmias,bleeding; because all anesthetics - general or spinal, sedatives, analgesics, and nerve blocks have the potential to affect vital signs (usually a depressive effect).patients are carefully monitored to assure safe and comfortable recovery. Xrays to confirm placement (hip,pacemaker,etc)and that no damage was caused (e.g.pneumothorax). The APS - Acute Pain Service ,if consulted,see patients here - often Patient Controlled Analgesic or a Continuous Nerve Block are initiated here.
When a patient's nurse has decided, based on set criteria, that the pt is dischargeable from PACU, she/he will call report to the receiving floor nurse, ICU,or IMCU nurse, and send the patient to a floor/Unit bed. Or,if the patient is a day patient they go onto Phase 2....
-Recovery Phase 2 (in my hospital it's called PRL (Post Recovery Lounge) - is where the patient goes when the PACU nurses have made sure that the patient ; has reached an optimum level of consciousness and comfort, and has stable vital signs which must be within 20 % of their preop readings (Aldrete Score). It is usually in this area where pts receive another set of vs,a snack,and preop teaching (verbal and brochure) is given. Appointment for followup visit with surgeon is arranged.
If you think you might be interested in pursuing a career somewhere in the PeriOperative process, I'd look for permission to shadow a nurse in each of these areas. They differ vastly.
The training needed is very area - specific; to my knowledge, an OR course is necessary to work in the OR theatres.Several months long here. To work in PACU,you would require an ICU course or experience, or a PACU course (3 months long here) or previous experience. As far as Phase 2 is concerned,to my knowledge there is no specific course;you are educated via a preceptor (an experienced RN) - on-the-job training,if you will. Nurses who need lighter duties e.g. back injury are sent there (here) - no previous perioperative experience needed. This may not be the case everywhere, however.
If you find something which interests you as you shadow,then look into getting the specialized education needed - that you can't do without.
The OR course is focused on becoming a scrub and/or circulating nurse. There, largely,it is the anesthetist,anesthetic resident,and anesthetic tech who have hands on care of the patient That is completely different from a PACU course - PACU being very much a hands-on area,where the emphasis is intense observation and advanced intervention needed to safely care for potentially unstable patients who,for a time,cannot protect their airways - we do that for them. In depth knowledge of all sorts of anesthetics,narcotics,sedatives,nerve blocks and their potential side effects are learned.
I would suggest shadowing a nurse - no commitment,no outlay of $$ and you could get the 'nitty gritty' (the good and the bad) from someone at the front lines. All the best! ?

Fantastic info!

NVCW · Apr 17, 2011

I rotate between pre-op, pacu, and phase II. I enjoy pacu the most and work there most of the time, but a week in pre-op or phase II offers a nice change of pace, as there are much fewer critical situations than in pacu.

anita_li17 · Apr 23, 2011

The hospital where I'm at now (as a student) combined the PACU and Recovery area because of lack of resources!!

DutchRN09 · Jun 11, 2011

I work in pre op and phase 2, mostly phase 2, and just recently started cross training to PACU. It is defenitly way more stressful and fast, but I really like it. It heps that the staff is great