Recovery of OR patients in CCU

Specialties CRNA

Published

Nurses Month 2024 | Discounts & Freebies AORN Celebrates Nurses Month

Hi, I have a question for this group. I am a CCU nurse in a rural hospital and found out today that we are to begin recovering the surgery patients after hours to avoid overtime for the PACU nurses. 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.

I am wondering what is the standard of care. I personally feel that this is not the same standard of care because if you are having surgery between 0700 - 1530 you will be recovered in the PACU. seems like each person deserves that same standard . They did say that if we are busy we can call in the PACU nurses, otherwise we will do the recovery. Don't these patients sometimes need 1:1 care while waking up?

Who is responsible for this patient if something happens to them on the way to CCU, the OR is two floors down, so they have to go up on an elevator and down a very long hallway to get to the CCU. They will have portable suction and O2 of course. I am thinking about the possibility of some immediate complications of general anesthesia. Are we heading for trouble or is this a common practice in small towns? I would appreciate any feedback you all can offer.

T

In our PACU we have only 3 full time nurses (counting myself). The remaining staff are pool nurses and one PRN nurse. We can cover pretty well during the day and very seldom do we ask for (though sometimes we need) help. Once we get off the call is rotated between 4 of us (giving about 7-8 days a month of call) and starts at 1900-0700 Monday-Thursday and 1700 on Friday with call lasting until 0700 the following Monday morning. This does not include Holidays in which the PACU staff has to cover any shifts that OR is working.

Recently our ICU was told (not asked) by their manager (who just so happen to have been promoted to our manager also), that they would be recovering our after hour patients in an effort to protect the patients and the nurses. It was not uncommon for the PACU nurse to have to work 16-20 hours and return at 0630 the next morning. I believe it was how it was approached but the ICU staff have been fighting this every since. I don't think it is unreasonable for the ICU staff to recover since the manager is making sure that they are overstaffed by one staff member. We also come in when ICU is truly to busy (which is all the time this time of year). The patients are recovered in the ICU area regardless because that is where we recover after hours patients. I do disagree with how the ICU staff were approached and believe that cross training between the two departments would be more beneficial.

Up Vote Up Vote ×

I truly don't mind overtime myself, but when I work in excess of 120 hours per pay period because of call backs when the ICU staff in our hospital are sitting at the nurses station reading magazines and papers while I am recovering patients, I get a bit miffed.

Originally posted by zrmorgan

...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 :p

Up Vote Up Vote ×
Specializes in CRNA, ICU,ER,Cathlab, PACU.

"sitting at the nurses station reading magazines and papers while I am recovering patients, I get a bit miffed."

sorry about all of the sitting around reading newspapers and magazines at the nurses station...with that bit of testimonial I am sure your icu nurses at your hospital will now gladly accept the duty of recovering pacu patients "after hours" (what is it now 3:30pm?) IN ADDITION to taking the sickest patients in the hospital, all while you are sitting at home reading newspapers and magazines. No sweat....no thanks needed.

I like what you said about the "cross training" pacu nurses are very capable...try again

Up Vote Up Vote ×

In our CVICU all open-hearts are recovered in the unit. They go from the OR straight to the unit. Other than that we have PACU nurses 24-7. We have more of a problem with PACU getting ICU holds than we do getting OR patients recovered in the unit.

Up Vote Up Vote ×
Originally posted by FlyingED

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

If you read Morganz first line you would see this

This is typical clipboard jockey/ bean counter managers and the way they work

So I don't think it was jump right to whiney PACU nurses I think this was statement about PACU nurses in the facility Morgan works in (just trying to clarify)

I do agree with your comment on solidarity though, I read many of these posts where nurses are tearing each other down instead of building each other up. We need to stick together as much as possible and attempt to educate with kindness and not just jump to critisizing and offensive behavior.

Up Vote Up Vote ×
Specializes in CRNA, ICU,ER,Cathlab, PACU.

ccu-

i have never known the pacu nurses at my facility to whine, it is now us, the icu nurses who are doing the whining when we have to recover their patients after hours...no one likes extra work, especially when it is doing someone elses job who rarely reciprocate.

the whining i was refering to was goosers original post "PACU nurses are making a fuss about all the OT they are putting in"

i have been a bit brash on this subject and apologize if anyone has taken offense, however, if we scratch the backs of the pacu, they should do the same.

i agree with the solidarity as well, and also like the cross training ideas

Up Vote Up Vote ×

i understand the frustration - although I always enjoy fresh post-ops -

are they giving you post-ops over and above your full pt load?? that would be a problem - otherwise I enjoy the challenges.

want to hear a real kicker..... i also do ED - I have had pt's that coded on the floor (and ICU was full) brought to my ED to recover..... that is bull$hit......

Up Vote Up Vote ×

I would ask for extensive PACU training and compensation for this.

Up Vote Up Vote ×

I don't blame Pacu nurses for not wanting to put in endless OT, because they won't hire more Pacu staff. Pacu is supposed to be a day/eve job that burnt out ICU nurses, like myself, can progress to when we can stand ICU for one more second!!!

Up Vote Up Vote ×
Originally posted by zrmorgan

"sitting at the nurses station reading magazines and papers while I am recovering patients, I get a bit miffed."

"IN ADDITION to taking the sickest patients in the hospital, all while you are sitting at home reading newspapers and magazines. No sweat....no thanks needed."

I am sorry I have to disagree here. If these nurses were taking care of the sickest patients in the hospital, then I would think they would not have time to play games, read newspapers and magazines. This is not occuring at 330pm, but instead at 0200 in the morning after I have already worked a 15 hour day, get called in to recover a simple case and then return to work at 0630.

I also disagree that PACU nurses are not as capable as a ICU nurse. While it may be true at your facility, our hospital does not have open heart surgeries, or other super serious type of illnesses or surgeries. I have to deal with drips, low blood pressures, bleeders, laryngospasms, and the list can go on forever. My after hours recovery does not start until after 7pm, so not sure where the 330pm comes from.

sorry about all of the sitting around reading newspapers and magazines at the nurses station...with that bit of testimonial I am sure your icu nurses at your hospital will now gladly accept the duty of recovering pacu patients "after hours" (what is it now 3:30pm?) IN ADDITION to taking the sickest patients in the hospital, all while you are sitting at home reading newspapers and magazines. No sweat....no thanks needed.

I like what you said about the "cross training" pacu nurses are very capable...try again

Up Vote Up Vote ×

The anesthesiology department should be in an uproar over this!

You are absolutely right about the standard of care. Our PACU nurses that take call get the same benefits that the OR nurses do. We get overtime prevented by scheduling the call team off the day after call. So if we work all night, it isn't overtime. We are guaranteed 40 hrs. a week, and they let the call people leave early whenever possible. There are other nurses that work regular day hours to finish up the schedule. Anything past hours is done by the call team.

We have 5 call teams, so it rotates every day (every 5th weekend). One team is on call every day, including holidays.

We have on call an RN (to circulate), a scrub tech, the PACU nurse, CRNA and the anesthesiologist. So there is no need to send patients to ICU, unless they are on the vent and we need their help. But we don't depend on them to do OUR jobs!

Up Vote Up Vote ×

Hi Janet,

We are just now getting to par with enough staff to lighten the overall call. Prior to now, we had 3 nurses to take call for recovery room. That was over 10 days a month of call at time. Getting the overtime just was unavoidable. Those same 3 call nurses were the nurses responsible for working in the recovery room, so it was not unusual to come in on a call at 0200, go home at 0400 be back at 0630 for another 12 hour day. Now we do have 6 people rotating call so only 5 days a month. The problem is getting those who did not experience the 10 days of call to understand how good they have it now. I have never heard people gripe about taking call as much as I do now and they only take 4 or 5 days month. It seems you just can't please everyone (sometimes noone).

Up Vote Up Vote ×
+ Add a Comment