PACURN1818

I am in the states, and the PACUs I have worked in for the most part have done preops as well, however, then they have to staff a little better, because they really do have to try and keep them as separate as possible even though you are in the same space. OR tends to call for patients far too early, then the patient takes up valuable PACU space and staffing because the OR didn't bother to be accurate. In 3/4 facilities I have worked in after the OR call for the patient they are then expected to be responsible for monitoring the patient, even if its just having a support person around. Of course it seldom happens, and the PACU end up babysitting anyways. Its a poor model or care, its hard for the family of the preop patient to be so restricted, stressful for the preop patient, detracts from good privacy for the post op patient, and places a larger than needed burden on nursing staff.

A follow up note, though this post is old. I have worked in 4 separate PACUs, 1 medium, 2 very large, and one tiny rural facility. Only 1 person with a recovering patient is NOT acceptable and ASPAN makes that clear. Your coworkers should be ashamed. I have NEVER been in a unit that allowed 1 person with a recovering patient. there is a reason the standard is there, IT ISNT SAFE to have less than 2 pairs of hands. You should be proud to have stood up and done the right thing, though I am sorry your are being put over the ringer for it.

Hello. In response- often a BSN is NOT absolutely needed. I do not have one, and have now been working from home x 3 years. It can help and it depends on the job. Experience is a common obstacle. Example: you can work from home in medical management/utilization/preauth, in triage, in Disease management, in Case management, or a number of other areas, HOWEVER for many of these ESP Utilization type roles experience in the area is nearly mandatory. Also for like CM, they really like previous CM experience or certification. I also have a friend working from home x2 years now, for a different company. Her background and experience fall a bit short of mine, but she actually makes MORE, is salary, and gets full benefits as well. These are hard jobs to get. My friend just got hired in my company after trying for nearly 2 years. I was a referral for her each time. When I was originally hired I had put in countless applications different places and had no referral, however I did eventually get a position Again much of this is luck of the draw and persistence. Expect to put in multiple applications even if you have someone on the "inside" to refer you. Best of luck to you all. In the end it is TOTALLY worth it to be out of clinical and sitting comfortably in my home office. Also, in reference to another comment about bad pay and such, I and my other friend have not experienced this in EITHER of our companies. Neither of us are overworked to the point of breaking, have had salary hour or benefit reductions or anything like that. I guess another word of advice is look at peoples reviews of working for these companies overall. You will be treated the same as others !

Hello, You may find a lot of us reluctant to talk about these jobs when we have them, its NOT something you want to blab about online and then lose. But here is some info in general YES these jobs are real, you can work from home for some of the companies, and they are full time with benefits in most cases- I for example work from home, did my training from home, and have never been on site as I live a decent distance from my "home office" PAY depends on where and who you work for. I work for, quite frankly, near what I made clinical with nearly 15 years floor and critical care experience. Not all of these positions are like that though EXPERIENCE best to have a good resume with a variety of experiences. Seems like my company likes lots of peds experience, experience with in and out patients, experience across the age groups and geriatrics, and experience with multiple diseases and conditions or body systems. I also had old call center experience which perhaps didn't hurt... ENVIRONMENT either on site or from home. All from homes that I am aware of Require fast broadband internet connection, and a private secured room that locks and that others may not use. A real big deal is it need to be QUIET, and the quieter the better especially once you are working. FINDING them and being PERSISTANT. I am told that sometimes there will be over a hundred applicants for Each open position or more. I know a girl who eventually got one of these jobs that applied about 5 times before she got in. You must be persistent if you want this. I also know that many of the major insurers have these lines. I suggest looking at Kaiser, Anthem, Aenta, and Humana online. Some of these job searches you REALLY have to pick through carefully. Using terms to search their jobs like telecommute, work from home, triage, and telehealth will help but it takes time to find them. I have also heard that some hospitals offer this service as well, so you can check that avenue. CALLERS are still patients. you will have rude and frustrated people. You will also have perverts calling as well. Just as if you are in a clinical setting you have to deal with them, and you have to be assertive but polite. People will be angry or difficult no matter what area of nursing you are in, at least after they hang up you are on to the next one, and some are just sweet older folks or scared first time parents. Again just like clinical there is good, bad, and ugly..... Love working from home, no plan to go back to the bedside!

So, I found 1 old closed thread about this, but it is SUCH a big concern. I am licensed in nearly every state, and have recently realized at least about HALF of those states list my name, lic number and HOME ADDRESS for anyone to see. I get that there is a need to have nurses accountable, and that people should be able to lodge complaints, but this shows COMPLETE disregard for the privacy and ID security of every nurse working in these states, and even retired ones! ID theft is SO easy today, its like they are handing our info to these people on a platter since anyone can easily find the info. Anyone else notice this issue or have thoughts on it? I am totally horrified.

We use the ETCO2 monitors, but not for all patients. Patients who are suspected of retaining CO2, or who had a rough extubation, or have a history of sleep apnea usually end up with them ordered. They stay in PACU 2 hrs most of the time, and go with the ETCO2 monitor to the floor. If they are going home through same day the monitor comes off when they leave PACU. This is a chargable service item for us. The real issue comes when most of the patients are stuck in PACU minimum 2 hrs even if they would be ok to go otherwise. The flow can back up real quick. I do question how accurate the number reading is, and sometimes it will say the patient isnt breathing even when can tell they are.

A few other threads over this issue.... Check them out. I am trying to be better about visitors, because our management is all about it. Officially it is the nurses decision any time before 2 hrs, except kids under 16. However if family complains you didnt let them back then you can be in a sticky situation. I acutally had a woman angry at me LAST WEEK because someone was going bad, md at bedside, anesthesia cart ready to go, and I pulled the curtain. She says "dont do that I am trying to watch!" Was for real angry and expected me to open it back up... Really?! Sometimes they help. Most of the time they watch other peoples family members waking up, talk about suzie dating tommy or bills, dont allow the patient to rest, or interfere with care. A MD i like when we had issues a while ago said to me "If visitors dont like what is going on in PACU, they shouldnt be in here. This isnt where you order what you want and can pick and choose. Good medicine, esp good anesthesia can look brutal if you dont understand what is going on. If people have an issue with it, then they BELONG IN THE WAITING ROOM." High five on the one G!

This is why I like PACU. With time and experience sliding into PACU is one of the few areas left with autonomy. Because of the way our protocols are worded we can go ahead and do things medically needed for the patient which also make sense without waiting until the doc runs to the bedside or calls back (though they are usually right there in a flash) I can fluid bolus, change levels of oxygenation and other things depending on what I see is happening with the patient, and am covered by the protocol that the anesthesiologists sign when they arrive in PACU. Anywhere else you just stand there waiting for the RRT team to show up when the doc doesnt call back. Thats why I stopped floating in house for extra cash. If my patient had chest pain I was calling for a 12 lead, and then getting fried by the charge even though the doc always covered me afterwards. Its a different environment, and it isnt for me anymore.

I will second the scores getting crazy attention, esp now that it is a funding thing. As in the other post Was has been up more recently where I was frustrated, I feel it gets to the point where it doesnt matter if safety is compromised as long as the patient will mark good things on their survey.

LOL, THAT would be fantastic! Its been a huge issue lately, and I think the situation is going to be discussed in practice council. We do utilize the extra transport monitors with O2 on the sides to take extra folks. I have often wondered why in these instances ICU couldnt take their patients straight from the room, it makes sense and is an excellent point

We have visitation issues. with HCAHPS starting up our manager is all visitor gun ho, but there are many problems. She feels that privacy isnt an issue since we dont say first and last names, but even if they didnt say my first name, if the staff was talking about my perianal abcess surgery I would be embarassed. We allow 2 parents back, then one stays with kids under 16. Or special needs. Otherwise we do updates. If a patient is there more than 2 hours we allow a short visit. I love that people have no consideration. Its not about the patient, its about them. Or they come back and dont pay attention to their family member and just stare at all the other folks.. Or just wander into PACU and dont want to leave. Or force their way into PACU. It is supposed to be every nurses decision, until someone complains. My favorite is, patient needs attention, having problems, only out of OR for 15 minutes and the sister wants to come back WITH HER FRIEND so they can leave For The Mall. ??!!! I dont really feel that visitation in PACU is appropriate, family members dont understand the things that go on, and as one of my fav anesthesiologists said a while ago when we had an issue.... "Good medicine, especially good anesthesia care often either is brutal or looks brutal. Its the safety that matters."

We use the revised one for surgical patients as part of our criteria. A score is done on arrival, after 30 minutes and prior to discharge. A pt cannot leave PACU with a score of less than 10 out of 12 unless they are going to a critical care unit or had a pre-existing issue, (such as having a 0 for being on a vent, but were already vent/trach dependant long standing preop) This works well for us, and yes I believe its an ASPAN standard.

wow that sounds nice. For us its pot luck, when the doors open we have no idea which patient it is, or how big a case it was until they slide into a place. Knowing the size and severity would really help us to be better prepared and let the OR know right where to go. It seems like a better way to go. Thanks!!

Ok.... So nearly ALL our patients scheduled today came out in a three hour time span, like stacks of three at a time, killing us. At one point we are out of PACU bays, putting people on the edges with transport monitors. THEN we send total joints over to inhouse holding. THEN three more come out with an ICU at the end, all angry we have no where to put them and crazy impatient as we scramble to put them places. One of our nurses is a long time PACU nurse with experience in other hospitals and said several places she worked the OR had to call and see if they could come out, and had to actually HOLD patients in the OR until their bay was available. Our OR chugs along completely unconscious of our capacity or resources, and we are all getting a bit worried about missing something, or not giving people enough attention. Whats up in your PACUs?

You have been getting all the patients all day because no one else is moving theirs You know by looking at your anesth. doc all your patients will be in PACU two hours because they are slightly overwt your patient who is vomiting is angry that you wont give them water Your NPO x24 hour thoracotomy has a family member bring them 4 mcdoubles, a 20 pc chicken nugget a large fry and a milk shake into recovery (for real) Your 10 hour abd surgical patient comes out on a cart, but your thyroid comes on a bed