What types of patients do you all recover in your PACU?

Babs0512 · Aug 8, 2008

We have a small community hospital, approx 275 beds. We recover all C-Sections, Appys, choley's, hysterectomies, bowel resections, other gyn cases, TURP's, ENT, Ortho - etc.. no neuro. We have begun to do cardioversions as we finally have a cardiologist in house.

I see your point and we are worried about the same thing. Our hospital is trying to recruite neruo and cardiac surgeons, and there are plans already drawn up to enlarge our OR/PACU/ASU units. Again, they don't want to give out full time positions now, most of us work part time, but then are asked to work extra days. We've all complained, but it falls on deaf ears. If we want to work full time, and we work mostly full time, we should get full time benefits. I hope things change if we really start to grow.

All4Seasons · Aug 16, 2008

Not to my knowledge do we recover cath lab pts,but that's not to say it hasn't been done when I haven't been on -because just about every other service has tried (and usually wins) to have their pts sent to us. :rolleyes: The icing on the cake last week was the post-neuro angiogram patient from the Minor Procedures suite that was sent to me at 1650,because the nurses wanted to go home! The pt had to lie flat for one more hour,then get up,walk around from 1750 to 1820 then could be discharged if he hadn't bled. He was a lovely guy,a fellow RN,as it turns out -but that wasn't the point. It really burned me up that I had to finish up these nurses' work!! Plus, soon after he arrived,we had to put an OR on hold!

I just found out yesterday the reason! - the nurse manager for MP is ALSO the NM for our Post-Recovery Lounge - and she is renowned to be someone who will NOT pay OT. As a consequence,we in PACU do a tremendous amount of the post recovery work for them -they are never open on w/es or holidays. We have to have the day pts out to them by 1730 (1830 on Wed) - after that,PACU does all their work for them. They will absolutely refuse,no matter how busy we are,to take anyone after that time.

ER has tried on occasion to send pts up to us post conscious sedation. We recover all of the post neuro coilings (though they never think it's necessary to notify us that they are doing one!)

We are tired of being walked over by whoever wants to walk over us -I can't, for the life of me,understand why one nurse manager gets to make the rules that impact other depts,but we're going to find out.

We just lost three excellent ICU nurses who came to work in PACU who were,in a very short period of time,sick to death of PACU being walked over... so I sympathize with everyone on here with the same concerns.

jen

Babs0512 · Aug 16, 2008

Our nurse manager is anything but supportive of the PACU staff. She herself was an OR nurse at one point, has never worked PACU. She is the nurse manager for the OR, PACU, ASU, and ENDO. She acquired ASU only in the past year, and seems to be bending over backward to make them happy. She takes one to three PACU nurses daily and sends them to ASU to help them out - she disguised it by saying "we are going to cross train everyone". The only cross training being done is PACU is being shorted. We asked her "How do you think ASU has gotten by ALL THESE YEARS without PACU helping them?" Her response is "We are all one unit now". BULL DROPPINGS!

One day she took all PACU staff out and left me there alone, she looked at the OR schedule and said "It looks like all the GYN cases will bypass PACU, so you should be okay in here by yourself" I said "That's not necessairly true, sometimes those cases end up as big Mac's or Generals, and they do come in here, I would feel better if you left me at least one nurse" "You'll be fine" she says.

GUESS WHAT HAPPENED? ALL the GYN surgeries came to PACU, as well as the other cases. I was getting two to three patients at a time, by myself :banghead: I ended up calling ASU and asking for at least one PACU nurse back to give me a hand.

My last weened that I was on call, Friday eve through Monday at 0700, I worked 30 hours, 20 of them straight through. That's just unsafe. I could hardly think straight by the time the 20 hour marathon was over (between the 10 hour marathon and 20 hour marathon, I got only a 2 hour nap). We have a second call, the second call is an ASU staff person, they do not do 1st call, they only come in while we are there to "help". So, I had no one I could call and say "Hey, could you cover my call for 6 hours so I could go get some sleep?" Administration gets around this by saying, "Well, you could have clocked out and took an hours nap between cases?" BITE ME:banghead: I end up helping the OR between cases, running specimens and blood to the lab, picking up blood from the lab, helping position the patients, etc...

There, my vent is over. It's a stressful place to work, I just wish we had a nurse manager who cared and supported her staff. Unfortunately, I'm not the only one who feels this way, the majority of the staff feel that the NM is "useless" to us. No, we can't go above her. This is a communty hospital where the majority of those in power are related by blood or marriage - so we have no where to complain to - and no upward mobility either as most of the "power" positions are held by those in their 40's - 50's.

There, I feel SO MUCH better now :banghead:

RN34TX · Aug 16, 2008

Not to my knowledge do we recover cath lab pts,but that's not to say it hasn't been done when I haven't been on -because just about every other service has tried (and usually wins) to have their pts sent to us. The icing on the cake last week was the post-neuro angiogram patient from the Minor Procedures suite that was sent to me at 1650,because the nurses wanted to go home! The pt had to lie flat for one more hour,then get up,walk around from 1750 to 1820 then could be discharged if he hadn't bled. He was a lovely guy,a fellow RN,as it turns out -but that wasn't the point. It really burned me up that I had to finish up these nurses' work!! Plus, soon after he arrived,we had to put an OR on hold!
I just found out yesterday the reason! - the nurse manager for MP is ALSO the NM for our Post-Recovery Lounge - and she is renowned to be someone who will NOT pay OT. As a consequence,we in PACU do a tremendous amount of the post recovery work for them -they are never open on w/es or holidays. We have to have the day pts out to them by 1730 (1830 on Wed) - after that,PACU does all their work for them. They will absolutely refuse,no matter how busy we are,to take anyone after that time.
ER has tried on occasion to send pts up to us post conscious sedation. We recover all of the post neuro coilings (though they never think it's necessary to notify us that they are doing one!)
We are tired of being walked over by whoever wants to walk over us -I can't, for the life of me,understand why one nurse manager gets to make the rules that impact other depts,but we're going to find out.
We just lost three excellent ICU nurses who came to work in PACU who were,in a very short period of time,sick to death of PACU being walked over... so I sympathize with everyone on here with the same concerns.
jen

Are you sure we don't work together at the same hospital?

When I charge I get the same sob story from cath lab, special procedures, endo, you name it right around 4 pm because the nurses there want to go home instead of finish taking care of their own patients. I can't blame the nurses if management is making them go home for overtime reasons, but sending your patients to PACU just because you just want to leave is unacceptable.

I have no problem in telling them that I don't have a slot for them unless I have so many open slots that I'd have no excuse to not take their patients. I'm sorry but the OR is my first priority and I'm not going to give out my last few slots to endoscopy patients who are still too sleepy while I put the OR on hold.

But just like you, if we had someone with a backbone to properly gatekeep the PACU I wouldn't be getting constant phone calls from other units trying to abuse us in the first place.

One recent stunt came from L&D recovery who told me that they were absolutely swamped and needed our help. We were fairly slow so I agreed to recover "a couple" of c-sections.

Well..... 5 c-sections later the resident delivering the patient to me stated "I don't know why they keep sending me down here with patients when L&D recovery is completely empty!"

I immediately called up to L&D who told me that they were busy relieving for lunches! With an empty L&D recovery room!

The truth was that they were having some freaking going away party for a co-worker of their unit. I had a few choice words with the charge nurse of L&D that day.

Since then, they have only called me one other time for help and I immediately walked up there to see what was going on in their area for myself and to let them know that PACU is not a place to send patients because you either want to go home or have a big potluck lunch without being bothered with recovering your own patients.

Charge nurse says "Oh never mind, we just got an extra nurse and don't need your help anymore".

Yeah right. More like you didn't realize that I was going to actually walk up there this time and see just how swamped you really are.

It's such a shame because PACU could be such a great nursing specialty to be in if we actually worked as PACU nurses instead of being the 911 helpline for all of these supposedly swamped and overwhelmed units.

We need better gatekeeping of our PACU's.

All4Seasons · Aug 16, 2008

Are you sure we don't work together at the same hospital?
When I charge I get the same sob story from cath lab, special procedures, endo, you name it right around 4 pm because the nurses there want to go home instead of finish taking care of their own patients. I can't blame the nurses if management is making them go home for overtime reasons, but sending your patients to PACU just because you just want to leave is unacceptable.
I have no problem in telling them that I don't have a slot for them unless I have so many open slots that I'd have no excuse to not take their patients. I'm sorry but the OR is my first priority and I'm not going to give out my last few slots to endoscopy patients who are still too sleepy while I put the OR on hold.
But just like you, if we had someone with a backbone to properly gatekeep the PACU I wouldn't be getting constant phone calls from other units trying to abuse us in the first place.
One recent stunt came from L&D recovery who told me that they were absolutely swamped and needed our help. We were fairly slow so I agreed to recover "a couple" of c-sections.
Well..... 5 c-sections later the resident delivering the patient to me stated "I don't know why they keep sending me down here with patients when L&D recovery is completely empty!"
I immediately called up to L&D who told me that they were busy relieving for lunches! With an empty L&D recovery room!
The truth was that they were having some freaking going away party for a co-worker of their unit. I had a few choice words with the charge nurse of L&D that day.
Since then, they have only called me one other time for help and I immediately walked up there to see what was going on in their area for myself and to let them know that PACU is not a place to send patients because you either want to go home or have a big potluck lunch without being bothered with recovering your own patients.
Charge nurse says "Oh never mind, we just got an extra nurse and don't need your help anymore".
Yeah right. More like you didn't realize that I was going to actually walk up there this time and see just how swamped you really are.
It's such a shame because PACU could be such a great nursing specialty to be in if we actually worked as PACU nurses instead of being the 911 helpline for all of these supposedly swamped and overwhelmed units.
We need better gatekeeping of our PACU's.

Pretty shoddy behaviour from the L&D Recovery...a party?!? HaHa you called their bluff! Wanna come and work with us?!... our dept needs some good backbone!

I think that there comes a point when "being professional " (if it means saying 'yes' to everyone's request -which this unit does all the time)....is just silly. In our unit,here is just such a lack of knowing for certain what our responsibilities are,in terms of other departments in the hospital -the charge on the day this pt came in,when I protested,said "we don't have a choice" and she's been in PACU for >15yrs! These nurses just seem to be resigned to whatever will be, will be.

I want to see the policies in writing about who can dump on us! However,I doubt it's written down anywhere... it's really up to whichever dept has the more aggressive manager....in which case,we've already lost the game... :banghead:

(It's sure a relief,though,to hear that other PACUs are having the same,darn issues! :rolleyes: