The Unsung Heroes of the PACU

[WalterWho]

Today I renewed my BLS with some fellow nurses and support staff at my hospital. Yes, the dreaded basic life support class. The one we drag our feet to every two years and desperately try to stay awake for four hours just to burn through the 20 question test at the end. But this time I left the classroom with much more on my mind than compression to ventilation ratios for adults and children.

Like most BLS, ACLS, and PALS instructors, my instructor today was a paramedic with many years of life-saving experience, a nice enough guy too. He's even done a lot of work with my hospital in implementing different response strategies for various code situations, but I couldn't help but notice one thing he did (or didn't do) that irked me: he never once mentioned PACU or acknowledged PACU nurses at all for that matter. Yes, he talked about "critical care" nurses in the ICU and the ER and how valuable they are in code situations, but just like everyone else; a "critical care" PACU nurse never crossed his mind.

This observation got me thinking; Why is it that NO ONE ever recognizes us PACU nurses? Are we not critical care nurses too? Do we not care for critically unstable patients every time those OR doors open and the crew comes rolling in with a fresh post-op? Of course we do!

We are responsible for patients with a list of comorbidities a mile long that may have just undergone a six hour dissected abdominal aortic aneurysm repair, who have blood gases all out of whack, PT/INRs through the roof, and unable to maintain an airway or literally fighting you while you're trying to save their butts!

We give drugs in PACU that some nurses don't even know exist. We are constantly interpreting ECG tracings and actually know what to do when patients have abnormalities. We're damn good at assessing our patients and noticing subtle acute changes. Hell, I don't think I've ever talked to a nurse in another field that has ever chin-lifted a patient with one hand and typed an opening note with the other. We're awesome nurses, so why doesn't anyone care?

These are just a few of the thoughts I had while I left the hospital and I will admit, it took me awhile to get over my frustration. There's something about starting out with bagging a patient who's pressures are 60s over 30s and then dropping them off later on med/surg, completely perfusing and hungry for a cheeseburger, and the receiving nurse complaining about an IV bag being close to empty that just makes me want to shout, but of course I don't.

It wasn't long after I first started my perianesthesia career that I realized; we really are unsung heroes. Yes, it's understandable that our patients may not even remember the recovery room or even be aware that there's a difference between OR and PACU for that matter, but it's surprising to see how many practicing nurses are unfamiliar with what we do, but then again; is it?

In college, when the instructor asked what kind of nurses we wanted to be, we all ambitiously replied; pediatric, ER, ICU, cath lab, nurse practitioner, and even CRNA, but not a one said "I want to be a PACU nurse!", but why is that? We're specialized. We're critical care. We get to do cool things! Yeah, the call can suck, but the hours otherwise can be really flexible. And best of all, we get to really connect with our good patients while saying "hasta luego!" to our bad ones. So why then, do nurses like me just stumble into the profession?

For me, it's because I had never been meaningly exposed to what PACU nursing was all about until one day I just happened to be offered a cool sounding job. I think I did one day in a regional hospital's PACU my senior year of college, but nothing beyond that, not even in the classroom. At my hospital, we don't float to other units and nurses don't float to us. We don't call "codes" overhead. So I guess it wouldn't really surprise anyone that we're kind of a mysterious and hidden unit to everyone but ourselves. I've even had nurses that have worked at my hospital for years wonder in, curiously look around, and ask "is this the PACU?".

Anyways, god knows that none of us got into nursing for the glory, but I wholeheartedly believe that perianesthesia care does not receive near the recognition it deserves. Like all nurses in every field, we rock and we know it, but it wouldn't hurt if other people knew too. Until then, we'll keep you breathing until you're alert enough to remember the doors opening on the way out and I'll keep being one of the many unsung heroes of the PACU.

[OldDude]

The only time I was in a PACU was during a clinical rotation in nursing school. I remember seeing the patients being rolled our of the OR...every one of them looked dead!! I stood around like a dufus with my hands in my pocket (because I was afraid to touch anything) thinking, "geez, how do these nurses coax them back to life?" But they did! I was quite impressed. And that was the last time I was ever in a PACU - uh-uh - too scary for me. So God Gless you borkowskikid and God Bless PACU nurses and thank you for being there!!

[Mavrick, BSN, RN]

Wow! What a wonderful post.

I do understand that most patients won't remember the many bullets dodged by having an attentive PACU nurse at the ready. Yep, they finish your surgery, you uneventfully wake up and thank everybody from the almighty surgeon to the volunteer that held the door open on your way out but skip right over that steadfast PACU nurse.

I like to say I am doing my best work when nothing happens. No respiratory issues. No re-intubation. No codes. No Rapid Response, No rolling vomit-fest on the way to Day Surgery Discharge.

So thanks for the toot of the horn that rarely gets tooted. Rock on fellow PACU nurses!

[ruby_jane, BSN, RN]

We are responsible for patients with a list of comorbidities a mile long that may have just undergone a six hour dissected abdominal aortic aneurysm repair, who have blood gases all out of whack, PT/INRs through the roof, and unable to maintain an airway or literally fighting you while you're trying to save their butts!

We give drugs in PACU that some nurses don't even know exist. We are constantly interpreting ECG tracings and actually know what to do when patients have abnormalities. We're damn good at assessing our patients and noticing subtle acute changes. Hell, I don't think I've ever talked to a nurse in another field that has ever chin-lifted a patient with one hand and typed an opening note with the other. We're awesome nurses, so why doesn't anyone care?

You are awesome nurses. Especially now, with all the comorbidities. Especially now when people go home from surgeries that they'd have spend days in a hospital 10 years ago. Rock on!

[AceOfHearts<3]

I'm so thankful for the PACU nurses who got called in and helped to take care of me when I was in an accident that required surgery. They knew exactly what to do when the Zofran wasn't enough for my nausea and I learned something new- that Benadryl targets certain receptors and can help with nausea associated with anesthesia.

Recovering a patient in the ICU because PACU isn't there is also not my favorite thing (it's totally different when it's an icu patient coming straight from the OR). Hats off to you for knowing how to deal with those patients. I haven't had good experiences- one screamed and screamed no matter what I did or what I gave them (while repeatedly paging the provider for more orders). My unit gets them before they go to their bed on the floor when PACU isn't open.

[DextersDisciple, BSN, RN]

Well since we know you can't be a PACU nurse without ICU experience, I always felt saying "critical care" includes PACU. Same with IR and cath lab. I guess people without critical care backgrounds don't think to include outpatient crit care depts. Im in IR so I know PACU kicks buttí ½í¸œ