emain86

I currently have a full time night shift job and a PRN job. I work about 50-60 hours a week and take home approx 2200$ biweekly. I'm looking at traveling nurse jobs and have a concern about positions and pay. I feel like I can do pretty much anything but I am certified in Post Anesthesia Care and would like to stay in that area as its pretty much similer across the board. My concern is the consistency with assignments. Its not like I can just be like oh here let me take that ICU job right quick because no PACU jobs are open up. I get that you can take three month assignments and I have nothing tieing me down. I love what I do but the place I'm working out is draining me and possibly looking for some changes. Just scared to move away from the consistentcy I have here.

Im a big fan of the whole recovering a patient in the ICU isntead of calling someone in. I work nights and really the standards say one PACU Phase 1 RN and a RN. ICU nurses are more than capable of helping with a PACU patient if things go south. Makes everyone happy and saves the hospital money. What I'm not okay with is that as a nightshift PACU nurse every responsiblity is on me. I'd rather have the on call person come in because then I get a second set of hands; get the patient out early and can get back to my other duties ( mainly making sure things in same day are good and the unit is in good order for the next day.)

For the same reason you send a thank you card after a job interview? To achieve a goal, to look good, to make them think good things about you. Something like " thank you for choosing ___ it was our pleasure to take care of you and we wish you a speedy recovery" studies have shown that people who send thank you cards get more positive feedback. When my dad was a car sales person he had me type out this data base and we mailed out christmas cards to everyone who ever leased a car from him because it helps to put an idea in people's heads. To the person who talked about fluff, patient satisfaction is as one co-worker described it a mystique. It's all fluff.. or a lot of it. At the end of the day I tell people fake it until you make it because you only have to deal with surgical patient's & and their families for a 12 hour day. However, that list of 8 things is a good list that people should be doing strictly based on common sense. I guess the question is how are we going to get all those points across in a scripted manor.

As Satan ( A.K.A) Press Ganey knocks on our doors we are looking for ways to improve our patient satisfaction scores. One of the things that was suggested and I think is an excellent idea is for every outpatient surgery patient to receive a thank you card, hand signed by every person who helped to take care of them. I know it sounds like just one more thing to do, but I really think that patients would appreciate that. On the topic of patient satifaction what are some of the things you guys do to increase patient satisfaction. Our scores are horrible!! I do feel like we do a good job though, and everyone is being pushed to the max but we are still bottom of the barrell. Not all of our patient's get Xanax because its PRN and the stupid same day nurses always ask " would you like a xanax"? Whereas I say "heres the medicine the doctor ordered it wont make you loopy or sleepy just help you relax". How do you guys give information about delays to the patients? Sometimes we are so short staffed we barely have time to think and the OR ends up on hold. Some people find it not feasible to update family thoroughly.

I just did tons of practice questions. I did no review courses. I'll admit I found the test to be harder then the NCLEX. I went in there did the 175 questions in about an hour or so,prob had half of them marked as i don't know and passed. I've only been an RN for a little over a year now but did PACU in the military. My advice for anyone doing any test is practice questions/practice questions. I wouldn't bother going over stuff you already know like trying to read a chapter and then do questions. Overall, not a bad test at all. Also purchase the practice test off of the ASPAN website for a decent representation of the test questions ( types not exact). Its usually 2 test for 50 $. I did 2 test before I started studying and 2 test before I actually took the test.

I work nights so I hate calling people in the middle of the night just to recover a simple patient. On top of that it would literally save thousands of dollars doing it that way. Like thousands. My manager on the other hand wants nothing to do with any change. We don't say what would jesus do we say WW ( insert name) do. Thanks for the response though. I'm over it. Actually about to head over to the travel nurse forums and was totally gonna find out about travel nursing in PACU . That really would be a fabulous way to recover patients and save thousands of dollars a year.literally thousands.

Here comes a bunch of us playing doctor! My first thought wouldn't be UTI, but infection is more than likely the issue. Actually those symptoms all fall in line with sepsis ( ER has a sepsis flowchart/algorythm). They'd still do a UA. Blood cultures x2. Lactic Acid for sure! ABG's.BMP, H&H. (Basically a full sepsis workup). The patient would probably end up in ICU. They'd figure that out based on labs/what not.

It made me smile that you liked my post . Glad it helped. I'm new to this as well, but like I said did it in military. I try to tell that to every one.

I want a PRN job in a PACU. I work level 1 Trauma Center in PACU so I def see some crazy stuff. I'm talking like you need 2 nurses to handle 1 patient type stuff. ( I mean kind of sometimes haha). But I want the cushy PRN PACU job recovering ortho patient's who get blocks and then get sent home haha. I'll start applying after I get my CPAN.

Wow this is really a good idea! Very inciteful. Using the OR as my secondary nurse isn't always the best because they are basically useless unless I'm calling for a code ( and even still they aren't always an ear shot away. ASPAN standards says 1 phase 1 PACU RN, + an RN at least within earshot). So basically I could look in my bedboard ( our bedding system) and see like oh T2 ( SICU) has 8 empty rooms. Lets just recover the patient up there and when OR calls to say where we putting the patient in room so and so? We actually have a nightshift nurse ( me and one other nurse nightshift) and we work Sun-Friday. Basically we work each others off days and we call in another nurse for patients. So basically since I'm up all night I pick up everyone's call so this could hurt my money haha but its really a great idea. Can you elaborate more on you do your drugs/what not? Do the Anesthesiologist every get mad if they have to walk over to the UNIT? Or maybe I could recover the patient over in SCVICU which is literally right across the hall. This is a good idea. Our drug stuff is funny and I'd have to work on how we'd do that. Overall I really like the idea of doing it that like that. Would really like to discuss this further.

In an ideal world where you have enough Staff those patients can be monitored by 1 nurse on a different side where you allow family to come up and can get them a tray. Once patients are out of phase 1. I usually just do Q4 hr vital signs and 1 full assessment every 4 hours. According to ASPAN standards you can have up to 5 patients. ( its really not bad at all) for 1 nurse. you dont have to do anything for em once they are observation. If/when we don't have a seperate nurse to take the patients.. I've got better things to do than q15 minute vitals so I just put observation whent hey are ready. turn off the light and let them sleep. You can let anyone up out of bed to use bathroom. most of the time its just a hassle. just use your judgement if you think they are going to be fine or not. You can always stay with them in restroom. You are generally worried about fall more than anything. Do you think after that appy was on the floor for 5 hrs they would be okay to get up and go to the bathroom? If so then you could get them up.

I feel like ED and PACU are probably the most similar jobs in the hospital. Only exception is you always have docs right there in the ER. You have many of the same stressors, some different too. The best part is generally dealing with family less and the second best part is most of your patient's don't die. Surgery in general seems to have a lot less BS to do with computers and making sure you do this or that. It seems more patient care oriented.

As much as I want to respond with my thoughts on this subject. It's a can of worms that moderators should probably just close this topic now. Argh but its infuriating. I've sat here for 5 minutes debating wether or not to put my view.. you sign a consent there are risk... could the hospital be at fault yes... and it will come out if they were. We can't just base things on he said/she said. You know when my charting is the very best.. when I have an unstable patient my charting is pristine. And if they did suction the patient ( not typical) they would have suctioned her because the bleeding was so bad it compromised her airway. If your thought process was well "maybe the suctioning caused the bleeding". And we really wont get started on the brain dead topic. got to much stuff to get done.

I have a current ASPAN standards book and am fairly familair with the risk factors for PONV. The problem is Anesthesia here does every single case the same. Zofran, Decadron , Ofirmev ( unless contraindicated), and toradol ( if i'm lucky). Some of the better ones will give some longer lasting narcotics throughout the case but a lot dont. They even localize the port sites. Also I usually dont give reglan and pheneragan together. Lap Chole's to tend to have more PONV than other procedures in my experience. I guess my issue is that we keep getting these patient's returned from Same-Day I give them 12.5-18.75 of phen let them sleep for an hour and then send them on their way. I would like to prevent it more so the patch might be a cheap effective way.

If you ever tried to take my phenergran away I'd probably quit this job. I wish ours didn't have pain issues. I don't know what it is. Some days I feel like all I do is slam people with narcotics and they are still screaming for more. I'll look into the scolpamine thing. I mean nausea is so common in these patient's. They need to try anything.

It's probably about 50/50 but these patients seem to be the ones that take a long time to get into phase 2 and then when they do get into phase 2 our SD nurses can't seem to get them out and then they end up returning to PACU. I feel like I handle them appropriately and some nurses hate to give promethazine because then they have to wait longer to get them on room air to meet discharge criteria. I was looking at other post and I know sometimes with nauseous patients sometimes they just need to sleep it off. I wish they'd give everyone that Emend stuff prior to surgery or at least ones that cause PONV most frequently. If I notice the patient has history of GERD i'll usually try to give pepsid depending on which anesthesiologist is on call ( some are just weird and wont do what i want). Also I like Reglan. I'll only usually give 12.5 of phenergran with all that. Technically I read since they both end in zines it can cause those extrapyramidal side affects, but has anyone ever seen that? Last for some reason in my PACU we dont use fentanyl. I think that is absurd. We end up giving so much dilaudid because the morphine just doesn't work fast enough. I usually do 10 of morphine switch to dilaudid... I'd much rather do 5 of morphine, 50 of fent, 50 of fent, 5 of morphine. and be done. What are tricks/tips you use when you recover lap chole? do you guys push fentanyl? I think this would be a great project/ PI project, patient satisfaction increaser, and patient safety.

Just wondering if Sweet Wild Rose has had any problems with using the OR as back up? Do they complain? We have same-day nurses up here on Saturday mornings and when I say oh okay you'll just be my second person in the room they look at me like I'm a crazy person. They go " We dont have ACLS" and I'm like "you're still a nurse". My boss told me it was okay to use OR as backup... plus there is CRNA and a multitude of other people. Whenever a surgery happens there are 4 OR nurses there just in case of traumas. How well does this fit with the whole ASPAN standards. Have you had any problems at all? Would like to know just so I can have the info so I'm less paranoid when I dont call on call person in for a healthy 20 y/o appendectomy.

Really Really Wide QRS. and thats about it. I mean obviously I've seen other things but they are usually short lived. I'd agree with what the one person said about cardiac issues in PACU. I haven't had to code someone in PACU in 4 years. The other morning the person was completely blue,septic,and near death and he still had a pulse and a fairly sinus rythym ( side note after I post this I'm sure I'll be doing CPR)

I worked in the PACU as a medic when I was in the militiary and this is my first job out of nursing college. I am literally going to retire from this job. I'm sure you are doing fine and the other person who commented is absolutely correct you will be slower because you are PRN. I was originally going to say after a year you should have most things down... but I swear things change monthly half the time. You have two jobs in PACU and one all encompassing job. 1. Airway 2. Pain Your main job is to just notice if something is wrong. You mentioned that patient with the bed delay and what not. By the time you did all that... the patient is stable and been there plenty long enough. So at that point the fresh post op coming out takes priority. Sometimes that fresh post op will come out with an oral airway in, resting comfortably ( I do a quick assessment, and let that patient sleep it off) and finish what I was doing with the other patient. The worst truly is when you have two patients going down the tube. At that point you just need to ask for help no matter how much you think people will get annoyed. I'll tell you what as far as nursing goes I know NOTHING. I told this nurse the other day" No really I'm not even going to bother trying to put a foley in a female so you go ahead and do it before you leave cause if not someone else will". I mean I probably could... Art Lines --- I can zero it and draw labs... What's going on with all these tubes and drains and everything else... um who cares your breathing and stable ( for the mostpart ). I could go on and on about why I love being a PACU nurse. but really you will NEVER know about every single surgery and its unrealistic for us to be expected to know whats going on with each. Its good to have a general idea about whats going on. You can't control bed delays/ transport delays or the ammount of patients that roll out at the same time. You can only control how you deal with it.

PACU is all about monitoring patient's for change and life-threatening things. Managing pain and getting them safely to their next level of care; wether that is home, a med surge floor, or an ICU. So base your goals off of that. Here are a few of my bullets that I thought could be good goals. 75% of the time you'll be bored and pushing drugs, but you have to be spot on when your patient stops breathing or you wonder why they're still tachy with a ETCO2 of 70 and septic. •Provide acute care for adult post-operative patients recovering from anesthesia, encompassing ambulatory surgical procedures, invasive and extensive surgeries, and trauma •Identify and manage life-threatening post operative anesthetic complications •Implementing plan of care to facilitate transfer to surgical floors •Managed post-surgical pain while monitoring patients for critical changes in vital signs •Assessing and monitoring patients from the operating room, facilitating emersion from anesthesia •Assisting with extubation of ventilated patients •Ventilator management •EKG monitoring, maintenance of arterial lines, determining patient's stability to return to surgical unit •Exceptional capacity to multitask: manage numerous, often competing priorities with ease

Hmm a google drive type of spreadsheet could be handy. Maybe one that everyone can update on their own to add like bed delays/such. How did you make the log /spreadsheet available as a read only at each of the bays? I work with people who are very computer challenged but I just think these spreadsheets could help to improve the flow of patients.

What I do is get my new patint settled in and pray they aren't screaming and trying to get out of bed ( if they are I'll start medicating and chart later i write it all down). Then I'll go back to my original patient and try to keep charting getting him ready to go. I'll usually put in for transport and continue to chart. ( if your hosptial has transport that is). If not I'd get charting done and then send patient downstairs. During that time I make sure my second patient status isn't changing. Then I just chart all at once as long as everything is the same. For me it ends up being faster that way than going back and forth between screens on the computer anyways. Im still trying to get used to organizing things the problem comes when you have both patients unstable. Then thats when you need to ask for help/delegate if possible.

I live in Ohio. We do have a "charge nurse" and an additional nurse that works with her to relieve breaks. The problem I'm seeing is that they just write down on a sheet of paper whos turn it is to get a patient without really looking at whats in the room. They can't see everything and on top of that they have to cover breaks and answer phone and tell OR where patient's are going. Its hard to keep complete tabs on the entire room when relieving people for breaks. Plus they usually aren't taking into account the type of patient you have. Half the time they can't even see. I just think it could help to organize things a little better. Like just because its your " turn " to get get a second patient doesn't mean that its best to give you another patient while you are in the process of getting your unit patient out. Also like today for instance one nurse literally had 2 patients for 6 hours due to bed delay. They could have easily had him relieve people for break while they took report on those patients and pretty much just watched them. I'm just trying to see what other people do as I'm trying to come up with some kind of way to improve this process. I hate to be one of those people who jump in and try to change things, but something is not working with it and I'm the type of person who thinks having all the info right in front of you makes it easier to triage.

I'm a new RN at a PACU in a level 1 Trauma Center, but prior to this I worked as a medic in the PACU at a military hospital. We have a 14 bay recovery room ( there is another half but we don't have staff for it). 7 Nurses take patients, 2 nurses triage/relieve for breaks. Basically the OR calls nurse answers phone looks through the 9-12 page surgery schedule for the patient, writes down case # and procedure and hands it to nurse who is taking that patient. Sometimes you end up with a nurse who has 2 patients the entire day because of a 7 hour bed delay. I'm thinking about a lined board where we put the patients last name and we have little magnets that say like transport, bed delay, same day, ICU. So that way when they are triaging they can try to even out the flow of the room a little better. I'm also not used to getting breaks, in the service we just got a break when we could and scarfed down food as fast as possible... apparently it is a pretty big deal to get both their breaks in. 12 hour shift staff get one 45 minute break and one 30 minute break... which is obscene. Our two triage nurses relieve for break but I think if we had a board we could possibly triage it to where they just have nearby stations relieve each other for break. I love my job and as crazy as it sounds. I plan on retiring from this job want to make it the best place to work as I can.