PaKuRN

When a vented patient from ICU goes to OR for trach, where does the patient go afterwards? Directly returns to ICU?, if so does a PACU RN go to ICU with patient? Does patient go to PACU then return to ICU? If possible, let me know the size/type of hospital and PACU unit size. Thanks in advance to any and all who take time out to answer. :)

Well this is a new concept for me, this PACU RNs holding and pre-anesthesia assessment. On off hours the hospital I used to work in had the OR RN call for patient when Anesthesia got there, the OR RN does not read monitors or start IV and does not give meds, other then handing them to Anesthesia. He/She however does the appropriate Nursing assessment and check list and get report from floor RN. PACU is called in one hour before case ends for recovery. Now, where I work holding RNs are part of PACU, but do not work weekends or off hours. We have PACU phase I staff on Saturday day shift, so they pre-op. On off hours my Nurse manager does not want PACU to be called in to pre-op, sit around for case to end and then recover. Too much call pay to lay out, so on off hours, OR has the pre -op responsiblity, but Anesthesia is there to do IV, pre-med, and monitor. I don't think OR RNs need to have the IV skills, or monitor skills. I certainly can not do their job with out years of training, they are a different specialty. But pre-op Nursing paper work is responsiblity of all RNs, and getting a comprehensive report from unit is also an RN responsiblity, we as PACU get the patient next and who knows if that floor nurse has gone home, so I need an accurate, pertinent report , that is where OR RNs need tobe compentant on, in addition to their OR skills.

Visitation in the PACU had been a sore spot for the PACU's I have worked in. The guidelines are parents only when child is awake, airway out. We absoultly do not want children or infants, who knows what, if any immunizations are up to date, and what they may carry into the room. Ok, I said guidelines, not craved in stone, so we may have parents and grandma, but we do want only 2 at bedside at a time, it is better for all. The young child rule of 16 and older is strictly followed. We still have issues with adult patient and visitors. But thats another post. The best way to achieve this is to have a short information pamphlet with the PACU visitation policy. If mommy brings the baby sibling she can not see patient in room, she needs to have a friend with her to help her out. I think it has to be address before the procedure, but in the perfect world it should be told to parent in the MD office before case is book. In emergent cases, we can find someone to watch baby for 5 mins outside door, but who wants that responsiblity, maybe pastoral care?? Of course you need a policy on everything these days and since you are in a pediatric hospital I would think a policy is already in place, bump it up the chain of commend.

Yes, ASPAN standards are a great reference for this. I do believe that it states one RN experienced in Pre Anesthesia assessment must admit the patient into the holding area. You can not jepordize your license for poor turn over times, that issue is bigger then you and ALL ORs deal with that, there is more in play then waiting on a patient. I suggest that Anesthesia take the responsiblity of monitoring the patiet pre-op while room is being opened. Or have supervisor stay with patient until you are ready to accept. I believe if a patient has an incident in holding you will be responsible, and I doubt the hospital will be behind you, they will claim you as negligent. You must go up the chain of command for resolution to this. Good Luck

give yourself a bit more time, 12 days of orientation does not make you "ready"for PACU, I do feel some critical care background is a must for PACU, but that doesn't mean you can't be a competent RN. The PACU nurses should be a team in accepting a new patient into unit, but once patient is settled one nurse usually takes over. Hopefully you are not shying away, your fellow RNs know your new, but have expectations that you will be there for the opportunities to continue to learn. If you really have an interest in the this field of nursing, which I consider the best area to work as a nurse, then keep going... nursing jobs don't get any better then PACU. You made a big change, and it will take time, but it is doable if you really want it. EKG monitoring can be confusing, but plenty of books, cheat sheets out there for review. We all know NSR, so if it is different, ask... that is how you learn. If you want it you'll have to work for it, but the personal rewards will outweight this "PACU frustration" you now feel. Good luck.

I am on a nursing commitee and we are discussing the blood transfusion policy in our hospital. At this time our tubing for blood tansfusion is free flow, no controllers to regulate rate of flow, just the ball on tubing. The only machine I have seen for blood transfusions are the blood warmers. Does anyone have any insight on the use of IV controllers for blood transfusions?, Or know of any research articles on this particular subject, as I am on the Nurse Practice Consul, and we are basing our findings on Nurse Research. Also, when transferring a patient from one unit to another, does an RN have to be present when blood products are hanging? Our policy is vague, but it is the practice of our hospital to always have an RN present. thanks for any input.

Yearly, my hospital will increase all salaries based on a "cost of living" raise and with that a "merit' raise is added based on yearly evaluation and longevity. New grads do not start out making more then the experienced RN. I would suggest you speak with your supervisor (nurse manager) about that. I think that at your year anniversary, a significant raise is in order to increase your rate to above entry level, If you do not get satisfaction from her/him, then go to human resourses.

add: That's two RN's on call for each 12hr shift. We only have call on the weekends. We are staffed with two Night RN's and if one is out, then there is a call shift of 11p - 7a posted for anyone to sign up for. Weekend call is mandatory.

Call pay for our PACU is $75.00 for 12 hr shift, which comes to $6.25 per hour, That is just to be on call. If called in, minimum of 4 hrs time and a half is paid. If you work 2 hrs, you get paid for 4 hrs (time and 1/2). If you work more then four hours, you get that amt. at time and 1/2. Sine this IS overtime, it should be time and 1/2.

We have 12hr shifts, with only two eight hour RN, both partime, working 12 to 8. This covers our busy times, and we are actually able to get a lunch, off the unit. We have one RN in at 7a, then 2 at 8a, 2 at 9a, 1 at 10a, and occasionally 1 at 11a. This covers the unit well. At 7p, there are two 12 hr night RN's in. I love the 12hrs, it is hard when your doing two in a row, but I love my days off.....

Well, this was a tough sell for the OR nurses, who now have to get report from the unit RN, and then have to give the PACU RN report. We used to get report from anesthesia.(and OR nurses did not get involved in any report) PACU RN's also had a bit of struggle with this process, we relied on Anesthesia for report. But, with some standard forms on a single piece of paper, (not part of the chart), the RN in OR gets the basic info, anesthesia adds to it upon arrival to PACU, and then we put it all together. There are some OR RN's that have a strain in their voice as they give report, i guess feeling like a fish out of water, but we worked it out... This is called a "hands off" report, and we must document in our chart that "report was received from ... RN", and "report given to ...,RN" on discharge, using the nurses first and last name. When mock rounds are made in preperation for the JOINT, we are asked this information and where it is charted. So, it has become an important part of the continous legal paper work.We had no choice but to "buy" it. We were told that this is what the JOINT looks at for continuity of care and we had to do it. It has been over a year now, and it is the norm, report is expected PRIOR to patient coming into the PACU. No report,,, then don't bring the patient in here. It gives accountability to each professional, it's a good practice. Go for it!

Well... PACU and OR nursing are quite different. "Intense" six month training should include time on ICU, Vents and drips (and peds if your hospital does pedi cases). These things, among others are learned by doing... not text books. We recently had a med-surg RN orient to PACU and we tried to expose her to as much as possible, but the unit was too busy and fast paced and at the end of orientation she was not ready to work independently, she requested a transfer. Sooo, as an experienced PACU nurse, I suggest critical care training. I like to work with nurses who have a background in ICU/ER nursing. I feel PACU nursing is the best RN hospital job. If you have this oppurtunity in the begining of your nursing career, your very lucky. So GRAB IT, and take this intense training, learn and do as much as you can

Thanks... I really like the comments on PAKU nursing, I am laughing already... Looking forward to the interesting topics and sharing the unique experiences of PACU nursing.