Transitioning from med/surg to ambulatory care?

Loxam10 · Dec 19, 2017

You may want to also post this in the PACU nursing group. I currently work in a pediatric OR but I can tell you that nursing in the OR or preop/PACU is completely different then any kind of nursing. I'm not sure what exactly is destroying your spiritâ€ but I want to be honest, It is also a tough culture to get used to. I've been in the OR for 2-1/2 years and I am looking at transferring to an ambulatory care clinic.

brownbook · Dec 19, 2017

My wish would be for every nurse to be able to work ambulatory surgery. I LOVE it, it is like working at Disneyland.

Okay now that is out of my system. I, and many co-workers in ambulatory surgery, worked ICU or CCU, never PACU. Just apply and keep applying. Many ambulatory surgery centers do GI procedures. If you can get your foot in the door working for the GI team take it.

You'd have to have ACLS, and PALS would look really great on your resume, many ambulatory surgery center do minor procedures on children. Maybe even get moderate sedation certified.

Being great with IV's, (or really really good), is a plus, most pre-op nurses start the IV's, but in some centers anesthesia starts the IV's. Even if you're just ok with IV's you will quickly improve, nothing like repetition, starting 10 - 20 IV's a day improves your ability quickly.

All I can think of using med/surg experience on a resume, outside of the "normal" stuff is emphasizing caring for and discharging post operative patients. Going over post operative discharge instructions. And being "quick".....unfortunately in surgical centers a lot of emphasis is put on getting the most patients in and out the door as quickly as possible. That is how they make money. So doing a quick assessment in recovery giving the patient a pain med early if needed, with juice and crackers, and out the door is the "routine".

Conversely knowing what to watch for in a fresh post op patient. Are they too sedated from anesthesia. Do you know how to open an airway, use an oral pharyngeal airway or nasal pharyngeal tube. How does narcan work, what is it used for...how about romazicon? Maybe a little familiarity with anti-emetics?

Quelea · Dec 20, 2017

Loxam10, good idea, thanks! I'll try to cross post this to PACU.

brownbook, well who doesn't want to work at Disneyland?! Sold. Haha. There is an open position that I found in our outpatient pavilion in outpatient ortho surgery. This would allow me to do an internal transfer, which would be way nicer than starting at an entirely new establishment. But I'm open to whatever I have to do, or wherever I have to go, to get in somewhere.

It's somewhat difficult to gauge what exactly the job responsibilities are by how vague most nursing job postings are, especially since I do not know anyone working at the clinic I am hoping to apply to. Is it safe to assume that ambulatory surgery center nurses are generally present in the OR as well? That is the only area I do not have specific experience with, other than observing. Otherwise, I do have some clinical, or at least volunteer experience, in pre-op, PACU, and post-op.

Your post is so helpful in regards to the skills/experience that apply to ambulatory surgery. I have skills/experience in the following that I will definitely be highlighting in my resume:

-Work with a 5:1 nurse to pt ratio on a 32 bed unit, often discharging up to 2-3 pts per day, and admitting 2-3 more.

-Proficient in IV starts, administering CAPD to renal pts, tele monitoring/interpretation, pain mgmt, PCA use, and monitoring for alcohol and opioid withdrawal

-ACLS, PALS, BLS certified

-ECG course

-Provide pre-op and post op discharge teaching for pts after I&D of wounds, amputations, and GI procedures and surgeries

-Volunteer experience providing perioperative care (including PACU) for children receiving cleft lip and cleft palate repairs

-Externship as a student in L&D where we had our own PACU and had to monitor post c-section pts for 2 hours

-Further volunteer work providing wellness exams, assessments, and diabetes education in a variety of settings for a variety of demographics

-Volunteer work in busy outpatient hem/onc clinic

What do you think... any chance the above might give me a shot at an interview? I'll also look into a class on sedation as you mentioned, too.

brownbook · Dec 20, 2017

All I can say is WOW! You have more experience than I ever had, and more than many of my co-workers in our general surgery ambulatory center!

Usually surgery centers, both in patient and out patient, have nurses only cross train, work, pre-op and PACU. OR nurses are a unique specialty, I would assume the listing would say OR circulating nurse. However I did see one post here on allnureses where a nurse was going to be trained for pre-op, PACU, and OR.

Orthopedics do a lot of regional or peripheral nerve blocks (same thing). The two centers I worked in did them in pre-op. Doing some research on that (Youtube is great) would be better than moderate sedation.

Orthopedic surgery is one of the most painful type of surgeries to have. Just in case they ask you anything about post op pain control. You have to stay waaaaay ahead of the pain. Even if they had a peripheral nerve block you have to enforce to the family, and educate the patient, to start early with the pain meds before the block starts to wear off.