Perioperative position advice

[Mickeylaw]

Hello, I am a Registered Nurse and I may be interviewing for a perioperative position at the closest Level 1 trauma and teaching hospital in my area. I have 1 year of critical care experience most of which is med-surg ICU and some neuro icu. I have a year of home health experience with trachs, pegs, chronic diseases, etc. I have a little experience in school nursing as well because I help out as a substitute nurse and have been assisting with health screenings in the school district I also teaching RN students during their school health clinicals. All of this is to aim for a healthy variety of knowledge because I would like to be a FNP eventually and possibly teach RN students after I gain experience as an FNP. I have one semester of my Masters degree in nursing, but left the program because I truly didn't feel like I was getting out of the program what I felt like I needed. I love to learn and that is why I have applied for a perioperative position. I feel like it is an ever-changing and updating area of nursing and one of the places that I could constantly get to continue using skills before I lose them. I do not know anyone who works preop, is a scrub nurse, circulator, or anyone who works in PACU. I thought I could get some seasoned advise from some folks on here. I am most interested in PACU within the perioperative division due to the acute/icu type work that it sounds like and feel that I may be most comfortable here. Are there any questions beyond the typical interview questions, staffing ratio, their nurse's hours, orientation length, and biggest challenge of the nurses in this division right now is? Just seeking some help because I think I would like to try this area and hopefully fall in love with it.

Thank you in advance.

Mickeylaw

[brownbook]

All I can think of is PACU nurses have to be on call. Ask about the on call scheduling, when will you as a new PACU nurse be expected to take call by yourself?

[Rose_Queen, BSN, MSN, RN]

What do you mean by "perioperative"? Perioperative is actually a pretty big umbrella, and what advice you may need can change based on the specific portion of periop.

[red2ret]

I would say the PACU sounds right up your alley! Go for it! I worked 27 years in OR and appreciate and respect a skilled PACU nurse. Usually the PACU takes call, so take that into account when you make your decision.

[Mickeylaw]

Thank you so much for your feedback, brownbook and red2ret!

[Mickeylaw]

What do you mean by "perioperative"? Perioperative is actually a pretty big umbrella, and what advice you may need can change based on the specific portion of periop.

The recruiter only said the hospital is starting a new "perioperative class." They like to orient for 6 months in acute care areas and I am assuming it will be similar for the "perioperative" hires simply due to the amount of learning that would have to be done to be adequate to be pulled to any of the "perioperative" areas.This hospital likes to cross train people for preop, scrub, circulating, and PACU nursing. I am asking (because "perioperative" is such a vast area of nursing) what would be some important specific questions to ask at the interview about any of those divisions of perioperative nursing since I don't know what I don't know.

[djmatte, ADN, MSN, RN, NP]

When peri-operative jobs are posted, by and large they refer to Pre-Op and PACU positions. Some smaller surgery centers though may require the ability to scrub in as well depending on the size and demands. But in those cases, it's rare that you are doing all three tasks at once. Given your ICU experience, that is the backbone of what most consider adequate to do well in PACU. But it isn't the be-all end-all as I spent the better part of the past 7 years excelling in pre-op/pacu fresh out of nursing school.

In regards for prepping you to be an FNP, I can categorically say that it will not. FNP is certainly focused on broader disease knowledge/management where PACU's primary focus is airway stabilization, pain management, and safely moving the patient on to the next point of care in a timely fashion. As someone who just passed his FNP boards, my choice in Perioperative services and pain management was probably among the least helpful paths I could have taken. Thankfully I had a strong study group to help pull me through school and pass my boards.

Every facility is different and has it's own issues in regards to your interview questions. Every PACU I have worked has had a 2 patients to 1 nurse ratio for non-critical patients and a 1-1 for what they consider "ICU level" patients. Though this can vary greatly. Call is important in any OR operation, but many places have a substantial staff pool to accommodate it. I think most places I worked 1 weekend day of call a month to 8 weeks.

Unit cohesiveness is an important thing that many people don't think to ask about. Periop is a team environment. While we are easily focused on our patients, you need a keen awareness of the OR schedule, the patient rotation, and how holding onto your patients impacts your fellow RNs. Knowing and accepting early on that this patient may not be "fixed" before they leave your care is an important thing to learn early on as their time in PACU should be for a minimal period. Another thing to ask about is how the patient's come out from surgery. Most places I've worked have some form of grid and assignment order. OR calls to a charge, charge gives an assignment, RN is notified, patient comes out. This flow can make or break a work environment. I worked with an RN once who was happy to be leaving our facility which she often drove up to 2 hours to when traffic was heavy to a PACU 10 min from her home. She was back less than a month later because their "system" involved the OR arriving with a patient and going into the first slot they saw open. At an equally busy facility, she said she'd gladly suck up a 2 hour commute. So absolutely verify they have a system in place.

[Mickeylaw]

Thank you so much. Very helpful!