Role of a PACU nurse?

Editorial Team / Admin · Jan 19, 2013

1. What is the nurse patient ratio?

Typically, it is 2:1, unless one is a critical patient or peds at my facility. These patients are 1:1. However, at times when there are no beds available, one nurse may essentially be acting as a med/surg nurse and be responsible for several patients who no longer need the PACU environment but can't be transferred out.

2. How long are patients on the floor?

This is variable, and depends on several reasons: patient's level of consciousness, availability of beds, pain level, meeting criteria for discharge from PACU. For most patients, the goal is about 1 hour.

3. Are there scheduled medications like home meds given or is it just pain management and Versed, if needed?

Again, depends on how long the patient is there. The most common meds are analgesics and antiemetics, but pretty much any drug is fair game.

4. Is PACU available in 12 hour shifts and night shifts - which is what I prefer.

This is facility dependent.

5. Is there much family present?

Again, facility dependent. Many PACUs have a no visitor policy, although mine makes exceptions for patients being held for extensive times in PACU (2 visitor limit, and PACU must be fairly quiet- no codes, no critical patients, etc.).

6. Why do people say ICU is required? What for?

You may be responsible for managing vents, invasive monitors, and drips. Not all places require ICU experience as they are willing to train, but it will be beneficial.

7. Are tasks usually done - such as blood draws, IV starts, foley insertions, etc...?

Yes, if needed. Many surgeons order stat labs, chest x-rays, etc. to be done in PACU.

8. Are vented patients on PACU floors?

Again, can vary from facility to facility. Mine tries to send patients who are expected to remain vented directly to the ICU. Sometimes they don't have beds available and the patient must go to PACU. Other patients are expected to only temporarily need a vent. Our policy is that if the patient is expected to be extubated within 2 hours, they go to PACU.

9. Is there RT present?

Facility dependent. Our PACU nurses run their own vents and only call an RT for treatments.

10. What is your typical day like? What is the actual role?

I'm an OR nurse, so I can't really answer this one for you.

meandragonbrett · Jan 19, 2013

The PACU is essentially a short stay ICU.

dah doh, BSN, RN · Jan 19, 2013

Ratio is 1:1 initially, more once stable. Patients are in PACU until they are at nearly baseline status (minimum 30-45 minutes), then transfer to a room or are sent home. PACU usually deals with pain, anxiety, and antiemetic meds, but also antibiotics and other meds like anti-seizure meds, pressors, etc. PACU can be 8 hr or 12 hr, depends on your facility. There will most likely be "call shifts" for evenings and night shifts and weekends. Family presence in PACU; not usually. ICU experience is usually preferred but not absolutely necessary; depends on your facility. Why ICU? To deal with swan, ventric, arterial lines, cvp monitoring. To deal with vasopressors and vasodilators. To deal with respiratory distress and avoid reintubation if possible versus reintubation ASAP! Some tasks are done like Cxr and blood draws , but others are not done. Some patients are vented but the goal is recover them to near baseline and get them elsewhere. If you can't move them out, you get to stay overnight for them. RT presence, depends on your facility. Usually the anesthesiologist will extubate them in OR or PACU but will stay with patient for a short while after surgey. The sickest patients will bypass PACU and go straight to ICU. Your shift would be recover patient then transfer out then do again.

born2circulateRN · Jan 19, 2013

Thanks everyone for the information; I really appreciate it! It's given me a much better view on this specialty. Anyone please feel free to add anything else.

Thanks!

born2circulateRN · Jan 19, 2013

Another question to anyone, do the patients come to PACU intubated or are they extubated in the OR? Thanks!

born2circulateRN · Jan 19, 2013

Ignore the previous question.

dmh2007 · Jan 20, 2013

At my facility we do bring family in after the patient is awake and pain/nausea is under control.

born2circulateRN · Jan 20, 2013

That's one of pros I like about PACU, USUALLY no family (per facility), which I prefer not to deal with. Well, hopefully that doesn't happen often. Thanks a lot!

Also, to anyone, what's the pros and cons of PACU- in everyone's individual perspective of course? Thanks!

Editorial Team / Admin · Jan 20, 2013

I think for you to get an idea of what your pros and cons might be plus the role of a PACU nurse in your facility would be to ask for a shadow day. That way, you can see it firsthand rather than hear about it secondhand.

born2circulateRN · Jan 20, 2013

I agree. I do plan to. I just wanted to see other people's view on it before shadowing and applying just to know a little bit of what to expect instead of being totally clueless. Thanks for all of your input; you've been really helpful!

meandragonbrett · Jan 21, 2013

One of the biggest cons for me is being on call. My favorite thing is that it's everything one loves about the ICU but very little of what one doesn't.