PACUed

According to AHA the infant (1 year or less) should be placed on a firm, flat surface to perform compressions, but when they talk about activating the emergency response system the AHA states: "If you are alone, after 5 cycles of CPR activate the EMS and then return to the infant to provide CPR, if you are alone and witness the sudden collapse of an infant, you should activate the EMS and the return to the infant to provide CPR. If the infant is small and not injured, you should carry the infant to the telephone so that you can either continue CPR or resume CPR more quickly after the call.

As the other posts stated they can be somewhat of a chalenge with pain control post op as many neck and back patients have been on po pain meds for quite a while. As far as bad outcomes we do not see this as a rule with our patients. Most are very stable. For post-op care airway is always a factor but especially for those patients like these where the surgical site is so close to the airway. For our post op assessment of course you do a full body assessment but extrememty muscle strengths and sensation are important to assess on these patients due to the close proximity of the surgical site to the nerves and spinal cord. you should be assessing their hand grasp strength, leg strength, and dorsi flexion and extension. One of the things you would want to know from the circulator during report is what type of deficits they had pre-op such as weakness, numbness, pain, and or tingling and what extremeties were involved. The other thing to remember is that the patient's symptoms may not be relieved right after surgery due to swelling from the procedure. For those patients that wake up and complain that they still have whatever symptoms they had pre-op it is important to reassure the patient that it may take a while to see results and that this is normal. Hope this helps a little.

We are going live with Cerner computer documentation in a couple of weeks. We currently chart our assessments every 30 min. When we go live with the computer documentation some staff are saying that they are only going to chart their initial assessment and only go back to chart any changes that may occur. How are other PACUs that use computer documentation charting their assessments?

Although not quite that bad I worked at a hospital that had the same mind set "it's the way we have always done it". It is amazing what you will get used to. It took a long time of hating my job and comming home and beating on a punching bag to get out my frustration before I decided to make a change. You know the saying the grass is always greener, well sometimes it actually is. I used to work at a hospital that had a small number of PACU nurses. On a good day we had enough to run all the bays with a free charge nurse to relieve for lunches and breaks. We also took call by ourselves with no other RN or ancillary staff to help unless you got to busy then you could call in your back up. If you did call in your back up it better be for a good reason, you know budget and all. After almost 10 years of working in that PACU environment with no change in site and yet another outside consulting group telling us how to do things I left. I now work in a PACU at a magnet hospital with a staffing ratio that actually meets ASPAN standards. We have various commities throughout the hospital that our nurses sit on as well as a unit based committee. We have the ability and are encouraged to make practice changes based on research if it will have a postitve effect on our patient care or working environment. It's very empowering to know that you have the ability to effect change within your unit and house wide if needed. I'm not telling you to quit your job. I just want you to know that if you ever get to that point the grass can indeed be greener you just have to do a little research to find it. GOOD LUCK!

I work as 50% staff and 50% education coordinator in the PACU. When hiring people for PACU it used to be you had to have at least a year of floor nursing under your belt but in these days the the nursing shortage has forced units like PACU and ICUs to hire new grads. I can tell you that it is an easier transiton if you already have some type of floor nursing under your belt and especially med surg or IMC experience. We had 2 new grads this past year and they both have done very well. They had a 6 month orientation process. Experiencrd nurses generally get a 12 week orientation but will be extended if need be. As far as taking tests, we use the ASPAN competency based orientation manual which covers all body systems, anesthetic agents, and more. Although there are tests at the end of each section we do not make them take them. This is used as a resource throughout their orientation. We also have videos for them to watch. As far as certifications go there are two, CPAN and CAPA. CPAN is for the hospital based PACU nurse that cares for general to critical patients and CAPA is more for the ambulatory PACU settings such as free standing outpatient clinics. I would be glad to participate in your research project.