Hopecascade

Nocturnal hypoxemia in subjects at high risk for OSA is associated with an increased potency of opioid analgesia. We follow ASPAN recommendations for OSA patients as best that we can. We do not have the protocol you mentioned. Is that from your Anesthsia dept.?

Uniform throughout the hospital. 50 cents more per hour with certification in your area. Union hospital 30+ years experience $43hr. East Coast pay, is usually higher than down South or Midwest in the USA. 10or 15% shift differentials for off shifts, evenings and nights. On call pay is 1 1/2 times hourly rate guaranteed four hours of pay even if you are only there one hour.

Hi Sometimes you have to move them out quickly. If they are a MAC case and meet the discharge criteria you can have them out in 30min. That is a transition for a critical care nurse! Your background will bode well for you and your patients. Airway is the first priority in the PACU. Brush up on Phase I and Phase II recovery and criterion for discharge. Review anesthetic agents, emergence delirium, hypothermia, neuromuscular blockade agents, etc. Good luck. I also recommend Drain's book A Critical Care Approach to Perianesthesia Nursing. It is through and comprehensive. Get to know your anesthesia providers and ask questions. Review ASA classes so you are aware the type of patient you are receiving just by the class. ☺️

I like the quick thinking and rapid responses you need. I like the turnover of patients. I dislike " holds " waiting for rooms. Some places call them boarders. I don't like when families expect to stay and pull up a chair for a good long chat. Families should just stay for 5 minutes or so, the patient is delirious for goodness sakes! I don't like having to mix pre-ops with post-ops late in the day/ evening when the SDS nurses have gone home. I like the highly technical critical skill level you need. I like comforting the patients. Good luck!

I think employers should offer more tuition reimbursement to RN's. RN-BSN programs are expensive. It is a bit of a racket Magnet hospitals now require BSN's. So we work hard and spend lots of money to the universities to get our BSN. I just started back to college. I have been avoiding it.

It sounds like your anesthesia providers are not providing opioids during their cases. Talk to your manager and the CRNA's.It might be your patient population, are they chronic pain patients? Trying to play catch up in the PACU is rough. I don't see IM Demerol used anymore. We use IV Demerol only for a one time dose for shivering/rigors. Some surgeons don't like blocks and use local sparingly. All of your patients should not be coming out of anesthesia writhing in pain. It sounds like you worked with a better group of anesthesia providers who managed pain much better in your old job. Good luck.

Thanks for your reply. I do maintain my own home and come home on weekends. This was my first time as a traveler. I am learning as I go along. I appreciate your input. I am still undecided about signing a new contract at the same facility. From your reply I should move along.

I have reassigned at the same hospital for a year,with a small 30 day break. I wish I asked for a bonus after each 13 week assignment. Also has anyone worked at one hospital with your agency wanting to tax your housing stipend? I have an upcoming contract and that is what they want to do. They said 30 day break does not count, it is considered consecutive. They want me to have a 13 week break or will tax my pay and housing stipend. I am undecided. I might look into another travel company.

I wish I could say, " you should have told the anesthesia provider and myself that you take percocets tens around the clock x2 years, if we had known we would have upped your dose of pain meds right away in PACU. No wonder you are writhing in pain! It truly hurts to Not share. If your allergies are to all pain medicines except Dilaudid how convenient for you? Seriously if your ABD hurts that bad why did you get a bag of cheetos from the snack machine on the way in to the ED?

This is in reply to the nasal airway in the mouth: I do use this and have seen it done. They are softer and it works with less irritation of the gag reflex. I have had one CRNA that does it and it works :). "Is my surgery all done? Did it go OK? What time is it? Can I have a drink? Can I eat? " This is asked in a Q 5 min LOOP I wish I could play back my same answers on a loop.

He Is supposed to be computer literate. But I only saw him use the pound key!

I am sorry this happened to you. I don't know what group 1 & 2 are. Do you want to leave or fight to stay? Think what recourse you could have to deal with her. Document what happened, take it to HR. File your own grievance and calmly proceed. Your story and others are what is chilling about nursing. It will take stamina to take a stand with this manager. She is not an entity unto herself, upper management has the ultimate power. Employees do have rights. Nurses have rights too. The patient is NOT always right. Your record should speak for your integrity, too. Sometimes dealing with a difficult toxic manager is not worth the struggle. There are professional managers with sound judgement and integrity out there. I wish you all the best.

Never Fear Dr. WonderDog is here!

I saw his stupid pet tricks last night. I laughed more than the patient did!

Two dermatone levels from initial assessment. They are all ready in a bed and are transferred to the floor. If they are SDS they must be able to stand to get into a wheelchair. They must void in SDS. I hope this helps

We wear hospital issued scrubs and scrub hats.

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.

We have ten hour shifts in our PACU along with 12's and a few eights. We alternate start times that way we overlap for the busiest flow. Usually 2 start at 7, two start at 8, two start at 9, three start at 10 and two at 11. It works well.

We have a flat screen TV in the OR holding area for all the patients. It gives them a distraction while waiting for OR. I read that gameboys, handheld video games for school age children pre-op caused relaxation and they required less versed pre-op. I have not read any studies for Phase I recovery for video presentation. Pain management is of importance too. If the videos work with that fine, but just distracting them from the pain will not relieve it. If it works you most likely should continue to use it. I would be careful of the noise level if they are in emergence delirium. Good luck.

We use dermatone levels to document levels of sensation. I hope this helps.

You should transition well. ED nursing is a solid background for PACU, theart lines, ventrich's and other things will come with experience. Learning the pain management and types of surgeries will be new. I had ED experience and transitioned well. I work with four othe ED nurses that have been in our PACU for a few years. They love it. You get gratitude instead of attitude. Good for you. Enjoy it.

Our PACU allows 2 visitors after two hours of recovery or sooner at the nurses discretion. It is supposed to be a quick 15 minute visit. Of course children are allowed their parents almost as soon as they arrive. We provide a chair at the bedside. Space is tight and we try to maintain privacy with the curtains as best as we can. Some folks abuse it and there is a steady stream of visitors. They bring their coffee, cell phones, etc. You try to politely tell them no food or drink, no cell phones, no cameras. If the surgery was extremely long we try to let the family visit sooner. We have a delay for room assignments so our PACU allows visitors or management is trying for a family centered care facility. If the patient becomes a boarder you try to accomodate the family again later for another visit. When new patients roll out of the OR we try to ask the visiting families to leave so we can get report and provide as much privacy as possible. If the patient will be going back to SDS no visitors, they can see their family when they go to PHase II. Patients that are waiting for rooms eat hot meals right next to a PHase I recovering patients. We also have portable TV's for them. It can be noisy and bothersome. Most families are understanding and follow any guidelines we give them. A few annoying surgeons always tell the families they can come in in a "few minutes" when they know the policy is two hours. I have been in this PACU for a few years with this policy it is okay but I liked it better without the families. I think initially the patient needs quiet and to recover. They are not really up for a visit.

Do your SICU patients get recovered directly in the SICU or do they go to PACU first? I would be happy to hear what others facilities do. We do not have a SICU where I work, we have a TRauma Intensive Care Unit and they usually go back to TICU for recovery. Lately they come to the PACU and are downgraded post anesthesia. Or we "hold" them in PACU until a bed opens in TICU, sometimes for days. Our open hearts go to ICU post-anesthesia not to CCU. CCU doesn't get surgical cases for some unknown reason.

If you apply online a Human Resources Rep. will email you back and set up an interview. I did it almost 2 years ago and got quick results. I accepted a job there. It has its pros and cons. Mostly pros... Good luck

Hi Do any other hospitals that are Level One Trauma Centers require TNCC or ATLS certifications for PACU nurses? We handle overflow Trauma Intensive Care Patients more and more frequently in our PACU. I would love to hear your feedback. Thanks.