Pacu.teletriagern

So.... many of us- i think- have started to finally feel the impact of Ohio remaining isolationist. It used to be that a compact state license really only mattered for travel nurses. But increasingly more and more of us still in OH are practicing over state lines. Working near a state border, working for a large company, working for an insurer while livong here basically means you will likely have to start getting additional licensure. The world is shrinking. Tele health and telecommuting are growing. Multi state licensure for those of us who need it os time consuming and expensive. You may only need a few extras... or you may need ALL of them (ive been there folks) and its a complicated nightmare I respect that the BON is not really for us. Its for the public. I respect that there have been concerns. However the time has come. If this issue doesnt impact you yet it may soon esp if you transition away from bedside care or travel. Now that the compact has changed some of its looser unacceptable pracrices and instituted things like background checks recently its time for this to be revisited and give all OH nurses ewual footing with nurses in states that provide compact states. It is a financial and time consuming barrier to our great nurses in OH to fail to do so. I found this online when trying to see if there was any update to our situation today. The following is a petition to the following once completed. State of Ohio Board of Nursing Senator Sherrod Brown Representative Marcia Fudge Governor John Kasich Ohio State House Ohio State Senate It is a simple call for attention review and movement. Please consider taking a look and adding your support..... (Pardon typos my phone keyboard hates me!) Petition link: Petition * State of Ohio Board of Nursing : Please join the Nursing Licensure Compact (NLC) * Change.org

I don't know how most places work, but with my company its a FT job. I work 36 hrs a week from home. A good place to start looking is with most all of the major insurance companies, look at their postings. Some have a place where you can click telecommute or something like that. Others you have to just look at all your postings and see what offers the work from home option. Also you, for triage at least, need to have some experience across the ages, including peds.

My friend went to a review class. She had TONS of handouts she gave meto study with, and that was helpful since i hadn't been able to go along to the class. I also used the Core book as well. Also study the meds, brand and generic names, effects, side effects and such. Even if you don't use a drug in your PACU, the meds and practices vary A LOT and often depend on the anesthesia practice, so study them even if you don't ever use them. Example, one PACU I worked at used ketamine post op frequently. Most of the others not so much.

I agree with the others. I have only once called a real code in the PACU, on a patient we cardioverted, cardio left because everything looked ok, and then we lost the rhythm. All the rest of the incidents are handled with the PACU staff and anesthesia. And again, its almost always airway related. Many times ICU will go straight back. Almost always if they are vented and in the unit preop. Sometimes and with certain MDs the patient will make a pit stop in PACU and then go to ICU. Depends.

PACU loves- quick turn around, fits my personality so its a win for me. Pt care is focused on a few main goals, and because things from other areas like call lights, family meetings and such don't really occur you can really focus on the patient and their care. LOVE having anesthesia available, but I have been blessed with good anesthesia groups, you need help, call and BANG there are several right there to handle the situation. Great relationships with anesthesia (depending on the group) because you are working closely with them quite a bit. Really makes caring for the patient a lot easier, they know and trust you and vice versa- and that's good for the patient too. Getting to have the critical care element ( I tend to take the sicker cases) but again with a good quick turn around. And not to be mean, but quite frankly, doors that aren't labeled for the general public and that lock. The environment in the PACU, I think, gives you more control and autonomy than almost anywhere else. Issues: Hospital full? Good luck you just became the holding tank, and ER will get beds before you. That means for hours, or overnight you are holding people in an environment NOT designed for anything but short stays. Often no pt bathroom, no TVs, no privacy, family cant stay, etc...... I hate being the holding tank, because the patients and families are often upset, and its justifiable and often there is no solution. Surgical residents that have no clue. They don't know but there are the "oncall", so hope you know what you are doing well enough to make up for them Visitation that isn't appropriate. This is a big deal right now because managers feel like it might help satisfaction and are really pushy about it now, but I follow the standard. With the normal adult patient you get a phone update after I make sure everything is ok, and a visist at 2 hrs if they are still there. The PACU has no privacy for others, and is NOT the waiting room. The pt is recovering and doesn't need to entertain visitors. The patient says they are feeling ok til grammy asks them 70 times if there are "really sure" they aren't nauseated, then suddenly they have been convinced they are. Pts don't recall PACU most of the time, but families do. My mom was in horrible pain in PACU, and knowing she would not recall it I opted to NOT visit. She wouldn't remember, but I would Always remember seeing her that way, wouldn't have helped either of us. MRDD, children, and such do require ONE caregiver at bedside for obvious reasons which I fully support. I also always give that 2 hour visit. Its short, come see she is okay, say hi, and head back out. I have had too many visitors with front row seats to another patients reintubation, and its NOT appropriate. Peoples attitude that if you worked ICU you are the same as a PACU person, and its the same. It ISNT I have worked both, and PACU and anesthesia have a number of very important differences.

Wow you guys, NOT normal!!! At one major facility I was at there was a special block team that did the pre op blocks. Then if your patient needed a block post op just call them, they check it out, and almost always do a block. Regionals, Tap blocks, femoral, pops, you name it. It was GREAT. Way less narc usage, patients had better recovery, and faster since they were comfortable and not all doped up. Other places I have worked its a mixed bag, some blocks, though perhaps not as many as they could, and scattered medication usage throughout the cases, but never NO meds during the length of the case, no wonder your patients feel horrible and need so much post op medication! Sorry, that sounds awful!!!

Hello :) First of all, although I understand careful monitoring and guidelines about narcs, you have to understand that the PACU is a different bird than the rest of the units folks often work. The environment, med orders and administration, and everything is just really different. Having worked all over I understand how this conversation sounds to someone who has never worked in the PACU, and I agree that having rules regarding these drugs is important. That said.... If you haven't worked PACU you have a hard time understanding why this is an issue, but it is. Rules are only as good as the nurses ability to, within her care and workflow, reasonably follow them. Special guidelines are, I think, needed in certain units. I have worked in 5 different PACUS, and one if them in one of the foremost teaching institutions in the US. PACUs all handle this differently, but NONE of them handle it like an ICU or floor. One PACU has little locking acrylic boxes at each bedside that meds are locked in after being labeled, and the nurses have the keys. You draw up, medicate, and lock right there by the patient. Seemed to work pretty well Then when they patient meets criteria and leaves you waste. Some places simply leave the meds at the bedside, a disaster waiting to happen quite frankly. I wear a scrub jacket. I stand between my two patients. I leave one pocket for one patient, and one for the other. I tape the vial with clear tape to the med syringe so I can scan my med as many times as needed, and then Label the cap with the patient label. I then check the label and scan the med for each administration. What is helpful is a REAL look at the environment. The best place I worked had a meeting about the issue, and that's how they came up with their box system. The manager and nurses discussed the real situation and needs of the PACU environment and came up with REAL solutions. Simply saying, that's not what you should do doesn't help. Clear guidelines prevent problems and help us to work more efficiently as well!! (When you are medicating every 5 minutes with 50 mcg of fentanyl per dose it is just not going to work out to waste50 mcg every 5 minutes and get out a new vial)