My Specialty

Post-Anesthesia Care Unit, Raquel Gutierrez, Casa Colina Hospital and Centers for Healthcare Pomona

Caring for post-surgical patients at their most vulnerable

By Keith Carlson, RN, BSN, CPC, NC-BCSeptember 3, 2018

2 min read
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Please tell us about the arc of your nursing career.

I graduated from nursing school in the fall of 2012. My first job as a new grad was here at Casa Colina Hospital and Centers for Healthcare, on the acute rehabilitation wing. From there, I transferred to the medical-surgical wing.

I was new and eager to learn, so transferring helped build my nursing foundation and give me the experience and confidence I needed before moving forward to critical care. After two years, I transferred to the post-anesthesia care unit (PACU) and knew right away that this was where I wanted to stay.

What in your early life prepared you for being a nurse? What kind of work did you do before entering nursing school?

Prior to nursing school, I worked as a medical assistant in a multi-specialty physician office. I primarily worked alongside an internal medicine physician/pulmonologist. I enjoyed helping people and knew that being a nurse would give me the opportunity to serve patients and their families.

I entered the nursing program in the spring of 2010, attending school part-time while working fulltime. It was the most important sacrifice I ever made! I now get to take care of patients and their families for a living and have enjoyed every step of my career.

How did you become interested in working in PACU?

Caring for patients in their most vulnerable states was a major interest for me. During nursing school, I initially wanted to work in labor & delivery, but after clinical rotations, my focus quickly shifted to recovery and ICU. Those units require more one-to-one patient contact where critical thinking is crucial for each and every patient interaction.

What skills or experience did you have that made you a candidate for a PACU position?

Prior to PACU, I worked on the medical-surgical wing, as I mentioned. Our team of nurses on that floor was highly experienced and took the time to explain or answer any questions or concerns I had involving patient care. Critical care nurses would also float to that floor and give many in-services on disease processes, treatments, causes, new equipment, etc. After two years, I felt I was ready to move forward and dive into PACU.

So, you never worked in critical care before coming to the PACU?

I did not work in any critical care unit prior to PACU, but I had acute care experience and fast learning skills. After reading many critical care books, articles and journals, I decided to try for the position.

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What are your responsibilities during a typical shift?

In our recovery unit, we have six bays where patients recover after surgery or procedures. It is my responsibility to diligently monitor patients and respond quickly to any critical changes that may arise throughout recovery. quickly to any critical changes that may arise throughout recovery.  Our team of five nurses in the PACU work side-by-side to make sure all of our patients are well taken care of.

Can you share some memorable, HIPAA-compliant patient stories that illustrate the importance of the work done in PACU?

One patient was unable to take adequate breaths on her own due to the effects of anesthesia. I had to react quickly, perform a jaw thrust and insert an oral airway to help keep her tongue from obstructing the airway.

Another patient with a blood pressure of 79/49 had pale skin and significant somnolence. I moved them to a flat position and administered a bolus of fluid. I then notified the anesthesiologist and requested stat labs to make sure that there weren’t other issues needing immediate addition. Twenty-five minutes after a different patient came out of surgery, we noticed a significant change in cardiac rhythm. Once the anesthesia team was aware, a cardiac consult was ordered along with a 12-lead EKG and stat labs.

Thank goodness, each patient turned out to be fine, but these are crucial moments where a PACU nurse needs to think and react critically and have thorough knowledge of the effects of anesthesia and medications on the body.

When a patient arrives to your unit, what are the most pressing issues that first need to be addressed?

There are many pressing issues when it comes to recovery, but the most likely to critically change are the patient’s respiratory status and the maintenance of sufficient oxygenation. Anesthesia has multiple effects on the body, and it’s our job to make sure oxygenation and hemodynamics are stable. When things are unstable, we need to respond efficiently.

What do you see as the optimal personal characteristics of a PACU nurse?

Independence, confidence, great communication skills and the ability to make decisions. Here in our PACU, all of my colleagues have those traits and more! Independence, confidence, great communication skills and the ability to make decisions. Here in our PACU, all of my colleagues have those traits and more! My colleagues are all very knowledgeable and have more experience in the field than me. I’ve been taken under their wings as a novice PACU nurse and am a very lucky nurse for it. I learn from my colleagues every day and admire their expertise and dedication in taking optimal care of our patients.

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How has the advancement of medical technology impacted the care provided in the PACU?

Advancements in anesthesia medications have impacted patients tremendously in terms of their recovery. Most patients wake up in recovery with little to no pain, no nausea and minimal complications. Ultimately, patients spend less time in the hospital and make a full recovery in a shorter period of time.

How do you think robotics and artificial intelligence (AI) may impact critical care in years to come?

Robotic technology will absolutely be beneficial for critical care in the years to come. For example, we currently care for patients undergoing various kinds of robot-assisted surgeries. These patients report little to no pain, have minimal complications and experience faster recoveries compared to traditional surgery.

Robotic-assisted surgeries also benefit patients by shortening hospital stays, performing smaller incisions, reducing blood loss and lowering the possibility of infection. This is such a benefit to the PACU environment now that I can’t wait to see what other positive changes robotics and AI will bring.

How can nurses interested in PACU make themselves the most attractive candidates possible?

Critical care experience definitely helps to cultivate the specific knowledge needed to identify critical changes and understand the physiology of what’s happening with our patients. However, there are also critical care courses and cardiac dysrhythmia classes that can help to integrate the clinical knowledge needed in PACU.

Do you have any career goals that you’d like to share?

Now that my children are a little older, I can more fully concentrate on my nursing career goals. My immediate goals include starting a BSN program in this fall and becoming a certified post-anesthesia nurse (CPAN) after I’ve logged the required 1,200 working hours.

I can picture myself also earning a master’s degree in the future. Such a degree will better prepare me for higher levels of leadership in nursing administration, nursing education or for becoming a nurse practitioner.

Would you encourage your children to pursue careers in medicine, healthcare or nursing?

I would definitely encourage my children to pursue careers in medicine. For instance, at the age of 10, my eldest daughter said to me, “I want to be a doctor for kids.” She’s now 17 and graduating from high school in June 2019. She’ll be applying to colleges and majoring in pre-med. I always share my work experiences with my children. We have many conversations about how rewarding it is when I care for sick people and see them return home to their families.

Keith Carlson, RN, BSN, CPC, NC-BC, has worked as a nurse since 1996 and has maintained the popular nursing blog Digital Doorway since 2005. He offers expert professional coaching for nurses and nursing students at www.nursekeith.com.

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