Recovery of OR patients in CCU

Brenna's Dad · Oct 16, 2003

I had tons of OT when I worked in the PACU. I was great, except for being called in for those stat C-sections at 0200.

Anyway, ya, PACU patients require 1:1 nursing care for a certain period of time and then probably 2:1.

glascow · Oct 16, 2003

Not uncommon in our ICU on the night shift, weekends, or holidays.

meandragonbrett · Oct 16, 2003

happens all the time here....ICU takes PACU overflow and vice versa.

zrmorgan · Oct 16, 2003

This is typical clipboard jockey/ bean counter managers and the way they work. Being an icu/ critical care nurse you are expected to do everyones extra work. Freakin PACU's extra stuff because they whine about working past 1500 or overtime.

This happens all over the hospital where I work. When other units are short staffed, who do they send? My icu nurses. When we are short staffed who do they send? No one from other floors, because they are not upward compatible...so we stay short staffed, fix peoples mistakes, and are expected to cover the PACU and Cath Lab when their nurses go home to eat dinner with their families.

I think you should galvanize your CCU nurses and put your foot down...the hospital can afford to hire more PACU nurses. This is especially true, in that each surgical admission will pay for a PACU nurse to work overtime.

If the PACU nurses are c/o too much overtime, then tell them they need to go work in a clinic...besides we are in a national nursing shortage where you can choose your lifestyle.

As for 1:1 1:2...depends on the case...most I think can be paired. For example the nurse on your floor with a stable patient who can be left alone for 30min.

BE SURE...that your anesthesia dept people call report...you are not the PACU and you need to assign recoveries based on patient load. We had quite the revolution in the last few weeks as our anesthesia providers were rolling back with suprises.

FlyingED · Oct 16, 2003

Typical nursing response zrmorgan. It is much easier to stab your fellow nurse in the back then to look at the real culprit, whoever it may really be. Take your pick, doctors, insurance companies, greedy management, pharmaceutical companies, an aging America and a ever increasing patient load and a shrinking nursing supply. But, I am glad that you were able find the real culprit, whiny PACU nurses!:chuckle

I am new at this whole forum thing, but I tell you stabbing your fellow professionals in the back is not a good way to build solidarity.

FlyingED

squeek · Oct 17, 2003

hear hear, It is rarely the PACU nurse responsible for this decision ...

ALL patients should be recovered in PACU, ration of 1:1 while unconscious or unable to maintain their own airway, 2:1 when stable... most patients in PACU will need 1 on 1 care to enable adequate and effective pain relief ....

I suppose sending these patients to ICU is more appropriate than sending them directly back to the ward area ... but I pity the ICU nurses who must find the time to care for them....

I doubt that the PACU nurses are the ones to blame, try validating your concerns and approaching management!

good luck

London88 · Oct 17, 2003

We had this same issue in our hospital. After numerous battles with the director of anesthesia, and the head of PACU It was agreed upon that ICU would not recover patients during the off shifts as there was not enough nurses available to provide 1:1 care when needed. We backed management into a corner when we brought in a copy of ASPAN standards and asked them how do they plan to honor it. Usually elective surgery is not done during the night, when that patient has to go to the OR emergently you can expect complications. This argument got real ugly in our ICU when a pt was brought up unrecovered during the night with a systolic of 58, vented, swaned, low sats because we found out the next day after the pt died that she was tubed in the right main with a collapsed left lung. 3 ICU nurses were running back and forth trying to stabilize the pt. Who do you think was taking care of the other ICU patients? If the pt remained in PACU anesthesia would have been there to manage the pt, but ICU nurses can hold there own so anesthesia would not come to the floor. This is not about PACU vs ICU it is about appropriate care where a pt can loose their life.

P.s. The anesthesiologist is no longer at our institution.

zambezi, BSN, RN · Oct 17, 2003

I work in a CCU, we recover all of our open hearts in the unit, they never go to pacu...Our unit is on the third floor...OR is on the first...we have an elevator that goes directly from the OR to our front doors...The patient is bagged on the way from OR to CCU, accompanied by anestheologist, surgon, first assist RN, and tech...RN and RT are ready in unit to assist in situating the patient, connecting to tele, ventilator, Alines/swans, etc...pretty sure that we haven't had any issues coming up to surgery...its worse when we have to take them back down for tamponade...We try to extubate approx. four hours after return (earlier if possible), but we have a checklist of requirements that are necessary before extuation.

As for our ICU...I am pretty sure that most of their patients are recovered in PACU...unless unstable or dr. is planning to keep tem vented, then they will come up after surgery...not exactly sure what their policies are there though...

zrmorgan · Oct 18, 2003

"This is something that has not been done for about three years in this facility and now they want to start it all up again. PACU nurses are making a fuss about all the OT they are putting in."

Flying ED- did not infer that whiny PACU nurses were the culprit...it was the typical "clipboard jockey/ bean-counting" management I was puting my dagger into...and no not all managers are this way either...just the type that use "to avoid overtime for the PACU nurses" as their poor rationale for taxing the ICU. Who is stabbing who here?

I have learned as a PACU and an ICU charge nurse that you can build significant solidarity by being an advocate for your staff while respecting their limits. Being a push-over and allowing ineffective use of resources is dangerous to patient care (both the recovery patients, and the icu patients) and promotes burnout of staff.

I am suprised to hear this type of reply from someone who used to work on a unit.

FlyingED · Oct 19, 2003

zrmorgan,

You are right, the only part of your message that caught my eye was the part where you were saying that PACU "could go home to dinner".

At my hospital, just to tell you a story, the management insists on planning there staffing needs on the the 80% of capacity assumption. We haven't, I don't think, been down to 80% in the three years that i have worked there. Which means ICU is always full. I, as you can tell by my name, work in the ED. When there is a code on a MT or MEDSURG we always get the patient. Because the whole dang hospital is full.

Nursing, what a glorious commitment to our fellow human beings.

zrmorgan · Oct 20, 2003

...sorry...this thread activated a sorespot with a very similar situation where I work...nothing intended towards pacu nurses in general, but we all have to work extra...I will give an optimistic example...

some people like ot and use it to their advantage...I will gladly work a 12h incentive shift on my day off from the unit to staff the PACU...so long as 1) pay me 1.5x, and 2)keep me there the whole shift without floating me back

there is always a better solution than to abuse human resources...unless we like to be abused