RainMom

Thanks again Ned. You always have such great info & advice. I appreciate it.

Thank you, good to know. I wasn't sure how much weight such things were given when applying for travel positions.

Considering traveling in the future (maybe a few yrs down the road). I've been a PACU nurse for almost 10 yrs now. How important or helpful is it to have specialty based certifications, ie CPAN/CAPA, at least when starting out as a new traveler?

Surely they don't expect that every single phase II pt is ready to discharge by 45 minutes? That seems very unrealistic unless all the pts are simple things like cataracts or endoscopies which can often be discharge at about the 30 minute mark (our policy minimum). On average, we probably have most other pts stay about an hr. But many cases like mastectomies, breast reconstruction, cholecystectomies, etc often stay closer to 2 hrs. We never set a time limit on when a pt should be discharged (although some pts DO need a little extra encouragement, LOL). We usually don't have more than 2 pts although picking up a 3rd isn't unheard of. As far as wheeling out pts or doing some of the hands on, is there never anyone between tasks that's able to jump in & help? On busy days, we grab anyone with a few free minutes to help walk a pt to the restroom, dc an IV, or take them to their vehicle; sometimes even calling over a Phase I nurse if they are having a lull while Phase II is slammed. I also wonder why you are having to put in discharge orders; that should be on the surgeon to complete. Otherwise, is there not a charge at the desk that can help facilitate that?

True re: MAC but it will truly depend on the facility. Our local free standing surgical center does outpt TKR & my understanding is there is a push for doing more of these types of procedures as outpt. They also do a lot of urology & plastic surgery, much of which also requires general anesthesia; it may not just be a bunch of scopes & cataracts. Hopefully OP gives an update how things turned out.

Absolutely! Recovering an outpatient is no different than recovering an inpatient when it comes to anesthesia. You may not be seeing more critical patients but your initial priority will always be airway & breathing. It takes time to become confident with managing airways & feeling comfortable doing that jaw thrust, removing/inserting orals, recognizing & treating laryngospasms, inadequate reversals...Just thinking about all the outpt peds cases with only 2 weeks training (& part of that sounds like it will be pre-op training). ? My rural facility is 3 months; does not require prior critical experience. OP, did you take the job? Curious how things are going?

Do not stress over IV skills. Personally I would not sign up for any IV courses; you have the know how, you just need the repetition. You will have soooooo much practice in ER that before you know it, you'll be able to get an IV on pretty much anybody that comes thru the doors. If it really worries you, ask to spend a day there or in pre-op to get some extra practice before you transfer.

It's likely dependent on the school or program. Best bet would be to contact the advisor for the program to find out if your earlier classes & credits would be accepted or if you will have to repeat some classes.

https://www.skillstat.com Decent source for reviewing rhythms

Yay, Congrats!! No specific advice, just go in ready to learn. Maybe keep a small pocket notebook to keep quick notes in...passwords, codes for door entry, etc. Good Luck!

Have you spoken with the advisor for the nursing program? The ADN program I went to took that into account when accepting applicants. All but one student in my class had most, if not all, of the non-nursing courses completed prior to admission to the program. It will definitely be less to worry about, especially if you plan to work as well.

Wondering if anyone uses the ASPAN orientation program for training new PACU nurses? We don't really have a very structured orientation program for new hires. We will be filling 2 positions soon & it seems that I will be assigned as one of the preceptors. I've worked in PACU now for 7 yrs & have been with orientees for random days here & there when the preceptor was off for the day, but have never been the primary trainer. It makes me nervous! I want to be sure I do a good job ?. I feel like I can be a bit of a rambler & worried I may seem disorganized, so I'm trying to think thru a game plan so to speak. Orientation is 12 weeks typically. Any suggestions, resources...prayers?

Update: So, it took some time but they came up with a "safe labeling system" that we now use for narcotics (started around a yr or so ago). After pulling from pyxis, we then go to a labeling unit, scan our badge & then the vial. A label is printed with a barcode that is then scanned (instead of the vial) when we administer the med & we are now allowed to give our incremental doses from one vial, limiting the waste. An extra step but so much better than wasting 50-75% of the narcotics we removed from pyxis!

By now, hopefully you have settled into the PACU routine. While it can have some slow days where you twiddle your thumbs waiting for a pt to come out, I don't find it monotonous at all. Babies stress me out, so for me, it's definitely less stress than NICU! ENT days are full of baby wrangling, so there is that; those days move fast. Location will definitely affect what the hiring requirements are. I'm in a rural area & while critical care experience is a plus, it's not required; only 2 of our current PACU nurses have ICU experience.

Our pre-op/same day surgery dept preps all OR pts including ICU. With add-on cases, PACU sometimes will prep a pt if SDS is short staffed & our staffing allows. If a pt is truly critical, they bypass pre-op altogether with the OR team/anesthesia doing their bedside visits in the pt room & taking pt directly to surgery.

Our PACU nurses also do pre/post-op; we also have one who cross trained to the pain clinic & another one to cath lab. The other nurses in pre/post are also cross trained to preadmissions testing.

Where I am, the PACU nurse continues care of an outpatient thru phase II as well & does the discharge for after hours. Our phase II nurses do not take call.

Small rural hospital, 10 room OR but mostly only using 3-6 rooms at any given time. We lost some surgeons over the past year (& before that really) & still trying to recover. Average day has probably 12-15 cases. For PACU, we take turns. We have a log book to keep track of pts & it shows who took care of them. On a busy day, we might get out of order if a nurse is able to discharge someone quickly while someone else has to hold another for an extended period of time. In other words, we don't make a nurse take a 2nd pt just because it's their turn if there is another nurse without a pt. While we technically have a charge nurse in PACU, we all fill that duty on a rotating basis & everyone takes pts. For pre-op, the charge assigns a nurse to each surgeon. That can change as the day moves along, especially if a surgeon is working faster/slower than we expect, cancellations or add ons happen. A lot of adapting & changes happen along the way. Prior to covid, our pre-op charge only took pts in a pinch. We had a lot of staff cuts since & our charge now pre-ops & runs the desk. Usually by 1100, they are able to solely focus on charge duties & preparation for the next day's schedule, only taking a pt if needed.

If this a block nurse position, I'm surprised it wouldn't require ACLS considering the potential for codes r/t LAST reactions. Our pre-op dept had one several yrs ago that did not end well ?

I'm in a small hospital (120ish beds) & I think in the past 6 yrs I've worked PACU, we've had about 3 codes in OR. We don't do trauma/cardiac procedures so shipping those pts out keeps our #s down I'm sure. Pts with complicated histories that very likely could require cardiopulmonary specialists get referred out as well.

Got my 2nd vaccine on 1/7. Mildly sore arm but nothing significant. I did have very mild tingling for a few seconds after the 1st dose; thought I was probably just freaking myself out until I read later that a lot of people have had some degree of numbness & tingling. The 2nd dose I was watching for it, but instead I felt more like sharp pinpricks running down my arm, again lasting only seconds. Thankful I didn't have any chills, fever, etc since I had an early shift the next day.

I've read that the vaccine elicits an immune response 400x that of a natural response from infection & that it is expected to last around a year.

This is one of the big reasons I pulled thr trigger & took the vaccine. I'm reading more & more studies about long term effects from mild & asymptomatic cases. 4 different studies show that 50% or more of asymptomatic cases have some degree of lung damage though they can't tell yet whether it will resolve or be permanent. I think it was around 15-20% show elevated cardiac markers; one study stated that the highest levels were in an asymptomatic pt, rather than a critical one.

Got mine today! I was quite skeptical about it initially. I'm in a rural area & really didn't think I would have access to it until a much later date. However, my county is one of the top 10 for fatalities per capita in the state, so we were among the first to receive it. Probably 90% of my coworkers think it's too soon & say they don't want it (but most aren't eligible either right now so it's a moot point; we'll see what they say when it's offered). What helped me to make up my mind was looking up older articles about mRNA vaccines & research. That way there was no info about Covid to muddy the waters, trying to sway the reader one way or another. It's about 8 hrs post & just a little tenderness as expected. We were also kept for 15 minutes for observation; no drinks or snacks though! ETA we also have out 2nd dose scheduled 3 weeks from today, same appt time given .

You should file. I just filed a few days ago myself (also IL) & one of the options you choose from states that you are still attached to your employer but are working no or very limited hours (or something to that effect).