PACU Nursing: Interview with Diana Chu, RN
Caring for patients as they recover from surgery
Diana Chu, RN, Valley Presbyterian Hospital, Van Nuys
Tell us a little about your nursing career.
I came to the United States from Taiwan in 1991. Although I had worked as an RN for five years in my own country and then an additional five years in Saudi Arabia, the U.S. did not accept my petition to receive a nursing license here. So, consequently, I had to earn my American LVN license and eventually my associate’s degree. I’ve been an RN in this country since 2008. I’ve worked at Valley Presbyterian since 1998, except for a few short periods when I was employed elsewhere.
What brought you specifically to PACU?
Before I came to the U.S., I had an ICU background in both Taiwan and Saudi Arabia. In the U.S., LVNs cannot work in ICU, so I spent time in telemetry until I could graduate with my associate’s degree and pursue my career in the PACU.
I love PACU because there’s more patient contact and critical thinking. It’s a very fast-paced environment that requires sharp clinical skills and the ability to react quickly. When patients come to PACU, anesthesia is still in their system, and you have to be aware and alert to each individual patient’s unique clinical situation.
What role do you play in your specific area?
We have ten beds, and the flow of patients in and out of the unit is very important. In our unit, we have a “float nurse” instead of a charge nurse, and I often work in this capacity. The float nurse assists bedside nurses as the need arises and makes sure that patients are cared for correctly. Most of the time I assist in troubleshooting any problems or challenges that come up in PACU.
How has technology changed your work?
Of course, equipment is always changing and being updated. There are often new types of monitors, pumps and other technology, and the nurse needs continuing education in order to remain up-to-date on the changes. Anesthesia agents change as well, and staying aware of these drugs is crucial, in terms of their effects, interactions, allergies, and so on. Here at Valley Presbyterian Hospital all of our patient charting is computerized and documented through a program called Meditech. As a result, information is accessible immediately by all concerned parties in order to give the patient the best possible care.
Since you have worked in three countries as a nurse, have you noticed any differences in how care is delivered or the technology that is being used?
There are no big differences, although Saudi Arabia always has the most up-to-date technology. The names of medications can be different in various countries, so a nurse who travels must be aware of this and learn quickly.
What certifications are generally required?
Any nurse working in PACU needs to know how to read ECGs, so a special ECG class is very important. ACLS and PALS are also necessary.
What experience is needed?
If a nurse has ICU experience, he or she will find a job quickly, but previous ICU experience is required. ER experience is also very helpful for finding work in PACU, but Med Surg is just not enough.
For new grads interested in PACU, what do you recommend?
New grads must first get their med/surg experience. They should then gain experience in telemetry, ICU, or the ER and then apply for a position in the PACU. Cardiac experience, understanding ECGs and hemodynamics, and the ability to think quickly and critically are essential. The ABCs are also just as important. PACU involves a very specific knowledge base, so that’s something to keep in mind.
Is there a patient story that you can share to illustrate what you do?
Just today I had a patient in his 60s who came to our unit following a total hip replacement. He had no cardiac history. He was aware and awake, and was talking with the staff. We noticed that his BP was dropping, and eventually reached a low point of 60/30. Even so, the patient was awake and interacting with us.
We assessed the amount of blood loss during surgery, which was 700 ccs. I asked the nurse attending him if she had checked the hemovac, and when we did, it was full. The patient had already lost an additional 500 ccs. Looking at his labs, we saw that the pre-op hemoglobin was 12 and was now eight. We immediately started another line, ordered three units of blood, administered Hespan (a volume expander), and then administered even more blood. At this point, the patient’s heart rate dropped, his BP increased, and he was stabilized. We gave this patient 2000 ccs of fluid in just 45 minutes, and he remained aware and awake the entire time. He never knew what was happening, other than the fact that he received a lot of attention!
What is next for you in your career?
Although the language barrier is a big thing for me, I want to go back to school and get my bachelor’s degree, even though I already earned this degree in Taiwan. My supervisor wants me to pursue management but I like patient care a lot. Being a float nurse in PACU is good enough for me.
Did You Know? PACU Nursing
In the PACU, post-operative patients are in need of astute and vigilant nursing care, and the PACU nurse must be well-versed in anesthesiology, pain management, hemodynamics and other crucial areas. The nurse must also have knowledge of wound care, cardiac life support, the management of post-operative nausea and vomiting, as well as forms of invasive monitoring like arterial lines and central lines.
Post-op patients often call for complex care, and emergency situations such as cardiac arrest, respiratory arrest, laryngospasm, pulmonary edema or pneumothorax may occur. The PACU nurse must be clinically astute and able to respond calmly to emergent situations with critical thinking and swift, decisive action.
Nurses who work in PACU must have extensive experience including ICU, emergency nursing, telemetry or other intensive nursing specialties. Advanced Cardiac Life Support (ACLS) is required, and some facilities may require classes in ECG interpretation. Some units may also require Pediatric Advanced Life Support (PALS).
Although not always required, many PACU nurses pursue CCRN and other certifications as a form of continued education and career advancement. These certifications provide further specialized knowledge and skills for the PACU nurse who wants to provide the most knowledgeable and astute care possible.
Technology plays a major role in the PACU. Nurses must be willing to stay abreast of changes as they are adopted and implemented.
Aside from technology, evidence-based nursing and medical practices often lead to changes in treatment protocols and standards in the PACU, which is reflected in how care is delivered. Changes in anesthesia practices are also crucial for the PACU nurse to understand and integrate into his or her knowledge base. Thus, nurses must also be willing to observe, integrate, learn and evaluate new protocols and standards as they are introduced.
As mentioned in the article, CCRN (Critical Care Registered Nurse) certification is highly recommended for nurses in this particular field of nursing specialization. The American Association of Critical Care Nurses (www.aacn.org) is a great place to look for information and pursue certification. Some of the certifications offered by AACN include:
CCRN: Critical Care Registered Nurse (adult, neonatal and pediatric acute)
CCRN-E: Adult Tele-ICU Acute/Critical Care Nurse
PCCN: Progressive Care Certified Nurse, which includes intermediate, step-down, telemetry, transitional care and ED.
CMC: Cardiac Medicine Certification
CSC: Cardiac Surgery Certification
CNML: Certified Nurse Manager and Leader
To qualify for CCRN certification, applicants must pass a 150-question, 3-hour certification exam, and eligible nurses must log 1,750 hours “in direct bedside care of acutely or critically ill patients within the last two years preceding the date of application, with 875 of those hours accrued in the most recent year preceding application,” according to the AACN website.
Keith Carlson, RN, BSN, is a registered nurse, writer and blogger. He writes for a variety of nursing and health websites, and has been included in several nonfiction nursing books by Kaplan Publishing. His blog can be found at www.digitaldoorway.blogspot.com.
This article is from workingnurse.com.