1. Weiser, Marcia Lynn RN


If you want to use your assessment and critical care skills to help vulnerable patients recovering from anesthesia, consider a career in this vital transitional unit.


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IF YOU'VE JUST COMPLETED nursing school and are wondering where to work, may I suggest the postanesthesia care unit (PACU)? Likewise, if you're an experienced nurse who's looking for a new challenge, a move to the PACU is well worth considering. In this article, I'll tell you about the PACU and the responsibilities of a PACU nurse.


Road to recovery

Formerly known as the recovery room, the PACU is a vital part of hospitals, ambulatory care centers, surgical centers, and other medical facilities. This area, normally attached to operating suites, is designed to provide care for patients recovering from anesthesia, whether it's general anesthesia, regional anesthesia, or local anesthesia.


PACU nurses are highly trained critical care nurses. After a surgical operation or a procedure performed with the patient under anesthesia, the patient is transferred to the PACU.


At this time, the PACU nurse must connect the patient to the appropriate equipment for vital signs such as BP, cardiac monitoring, pulse oximeter, and oxygen devices. A thorough knowledge of these tools is essential. The patient is usually still under anesthesia and asleep. The PACU nurse's job is to monitor the patient until he's conscious, has stable vital signs, or meets other criteria depending on your facility's policies and procedures. Then this nurse either sends the patient to the unit or helps discharge the patient to home.


Because a large part of what a PACU nurse does is to manage postoperative pain, the PACU nurse must be knowledgeable about pain medications and proficient in administering them as well as in helping patients recover from anesthesia. Additionally, the PACU nurse needs to know how to care for a patient with postoperative nausea and vomiting.


Although working directly under the care of a physician, the PACU nurse often has standing orders and must make her own decisions about what medications the patient needs. PACU nurses must be able to think critically and quickly. Missing a change in the patient's condition could be life threatening.


PACU nurses should know how to use patient-controlled analgesia pumps and I.V. or epidural infusions, as well as how to monitor invasive tools such as arterial lines and central venous lines.


As a PACU nurse, you may also care for patients who have had cardiac catheterization or pediatric patients who have just undergone an invasive procedure. You must be certified in advanced cardiac life support (ACLS) and you may also need to be certified in pediatric advanced life support (PALS), depending on your setting.


Most importantly though, for pain management, PACU nurses need a thorough knowledge of anesthesia and its effects on patients.


Rousing role

After spending from 30 minutes to a few hours in the PACU, the patient should be stable and easily aroused. If the patient is staying in the hospital, he's promptly discharged to his room.


If the patient is discharged home, he must first be able to tolerate fluids, void, and be able to ambulate, depending on the procedure. Because the patient has been sedated, you'll give him discharge instructions, including warnings not to operate machinery, drive, or sign any legal documents. Additionally, you'll be responsible for explaining information to the patient and his caregiver, such as when to take medications and what to do if he experiences problems.


Now let's consider some other factors about PACU nursing.


More about the PACU

PACU nurses' involvement with families may be limited to giving them an updated report on the patient's condition by telephone. A pediatric patient may be allowed to have one parent by her side. Visitors are kept to a minimum to keep the unit as germ-free as possible.


If you're a qualified RN, you can become a certified post anesthesia nurse (CPAN) or a certified ambulatory perianesthesia nurse (CAPA). Certification is under the auspices of the American Board of Perianesthesia Nursing Certification, Inc. These programs are accredited by the American Board of Nursing Specialties.


Home sweet home?

If you like to function independently and are a critical thinker, the PACU could be the place for you.




American Board of Perianesthesia Nursing Certification, Inc.


American Society of PeriAnesthesia Nurses.


American Board of Nursing Specialities.


Web sites last accessed November 18, 2008.