THE ULTIMATE GUIDE TO THE POST-ANESTHESIA CARE UNIT NURSING
Did you know that around the world, approximately 310 million surgeries are performed every year? In the United States alone, forty to fifty patients undergo surgery annually.
According to data from 2009, here are some of the most common surgeries performed in the United States and the prevalence of each procedure:
- Cardiovascular system surgeries: 7.3 million
- Digestive system surgeries: 6.1 million
- Musculoskeletal system surgeries: 5.2 million
- Skin system surgeries: 1.4 million
- Respiratory system surgeries: 1.3 million
- Nervous system surgeries: 1.2 million
- Urinary system surgeries: 1.1 million
- Nose, mouth, and pharynx surgeries: 289,000
- Eye surgeries: 69,000
- Ear surgeries: 24,000
Those are a lot of antiseptic wipes, IV bags, sutures, and gauze—but also a lot of post-anesthesia care nurses helping those patients recover after their operations.
Are you interested in working in a post-anesthesia care unit (PACU)? Read on to learn everything there is to know about this essential and highly demanded nursing specialty.
What Does PACU Stand For?
The abbreviation PACU stands for post-anesthesia care unit. PACUs are staffed by a team of nurses and anesthesiologists who are prepared to care for patients after surgeries. PACU nurses supervise patients carefully, frequently checking vital signs and dressings, managing intravenous (IV) fluids, and administering pain medication.
What Is a Post-Anesthesia Care Unit in a Hospital?
Post-anesthesia care units or recovery rooms are vital components of hospitals. By definition, PACUs are specialized care units where patients are taken immediately after surgery and cared for while they wake up from anesthesia. Therefore, PACUs are located near operating rooms.
What Does Post-Anesthesia Care Mean in Medical Terms?
Post-anesthesia care refers to the care patients receive after surgeries. How long patients require this care depends on many factors, including the complexity of the operation, pre-existing medical problems, and recovery from anesthesia. For example, patients who had epidural or spinal anesthesia must be able to feel or move their legs before being discharged from the PACU. Another prerequisite to be moved from PACU is for patients to have stable vital signs, including blood pressure, heart rate, and respiratory rate. Patients may need medication to control variations in vital signs as well as pain medication. Furthermore, patients who have lost a lot of blood during surgery will also have to stay in the PACU to receive blood products. Ultimately, patients’ anesthesiologists, surgeons, or other doctors must make the decision to keep patients in the PACU, move them to other units, or discharge them from the hospital altogether.
What Does a PACU Nurse Do?
PACU nurses, also referred to as peri-anesthesia or recovery room nurses, care for patients recovering from anesthesia after surgery in a hospital’s post-anesthesia care unit, surgical centers, or ambulatory care centers. PACU nurses are critical care nurses with a high level of training and experience who monitor patients’ vital signs, levels of consciousness, and possible side effects from anesthesia.
When patients first arrive in the post-anesthesia care unit, a PACU nurse receives a report of patients’ surgery and their medical history from the operating room nurse and anesthesiologist. Then, PACU nurses will give patients physical assessments and monitor their blood pressure, pulse, and electrocardiograms (EKGs). Nurses will also dress bandages and administer pain medication. When patients are ready to leave the post-anesthesia care unit, PACU nurses give reports to the next nurse who will take over patient care.
What Is the Role of a PACU Nurse and How Is It Unique?
PACU nurses specialize in post-anesthesia care. Specific duties of PACU nurses include the following:
- Monitoring patients’ levels of recovery and consciousness from anesthesia after surgery
- Communicating with the medical team regarding the condition of post-operative patients
- Treating patients’ pain, nausea, or other symptoms of anesthesia
- Administering medication according to doctors’ instructions
- Checking vital signs regularly to avoid or quickly treat complications
- Keeping bandages and dressings clean and dry
- Educating patients and families on post-surgery care
- Updating charts, patient files, and medical records
One of the primary responsibilities of a PACU nurse is keeping patients comfortable after surgery. Therefore, they will frequently ask patients to rate their pain on a level from zero to ten to ensure that patients are receiving the type and amount of pain medication they need. Nausea is another common post-anesthesia symptom that PACU nurses are trained to treat.
PACU nurses will also review discharge instructions with patients and their families. These instructions often include restrictions on activity and diet, indications for managing pain medication, warning signs to look out for and report to their surgeons, and the date of a follow-up visit if necessary.
How to Become a PACU Nurse?
PACU nurses are usually registered nurses (RNs) with either associate’s or bachelor’s degrees in nursing. However, this specialty generally seeks experienced nurses, especially nurses with experience in intensive care units (ICUs) but also with experience in emergency rooms (ERs) or surgical floors. Furthermore, having nursing certifications in the area will increase nurses’ chances of being hired to work in PACUs, and some certifications may even be required.
Post-Anesthesia Care Nurse Certification?
The certifications that PACU nurses will often require are Basic Life Support (BLS) certifications as well as Pediatric Advanced Life Support (PALS) and Advanced Cardiovascular Life Support (ACLS) certifications. Nurses can obtain all these credentials through the American Heart Association.
Furthermore, nurses can certify through the American Board of Perianesthesia Nursing Certification, Inc. (ABPANC), which offers two certification options for nurses interested in or already working in a PACU. The Certified Post Anesthesia Nurse (CPAN®) and the Certified Ambulatory Perianesthesia Nurse (CAPA®) programs are designed for RNs caring for patients who have experienced sedation, analgesia, and anesthesia in a hospital or surgical ambulatory care facility.
According to the ABPANC, here are some of the benefits of pursuing these certifications:
- Improving patient care and safety
- Enhancing employer confidence
- Validating professional experience
- Committing to lifelong learning
- Strengthening credibility
- Increasing earning potential
In order to be eligible for either of these certifications, RNs must have valid licenses and a minimum of 1,200 hours of direct clinical experience accrued within the previous two years. Moreover, RNs can also pursue dual certification, obtaining both CPAN and CAPA certifications. In addition to the previously mentioned requirements, applicants must have a minimum of 1,200 hours of direct clinical experience caring for patients in post-anesthesia phase I and a minimum of 1,200 hours of direct clinical experience caring for patients in the pre-anesthesia phase, day of surgery/procedure, postanesthesia phase II, or extended care. For more information regarding these nursing credentials, visit the ABPANC website.
How Long Does It Take to Become a PACU Nurse?
To qualify for work in a post-anesthesia care unit, nurses must study for two to four years to become licensed as RNs. Furthermore, most PACUs will hire nurses with a minimum of one or two years of work experience, which is also the experience required to certify as a PACU nurse. Based on these requirements, becoming a PACU nurse takes at least four to six years.
How Much Do PACU Nurses Make?
How much PACU nurses make depends on where they work as well as their qualifications and experience. The national average salary for RNs is $82,750 per year. However, most PACU nurses work in surgical hospitals and, therefore, earn an average of $85,020 per year. Here are some other settings where PACU nurses may work and the average salary for RNs at each facility:
- Outpatient care centers: $93,070
- Specialty hospitals, excluding psychiatric and substance abuse hospitals: $84,800
- Offices of physicians: $73,860
Furthermore, PACU nurses may have completed graduate or post-graduate studies in nursing, acquiring the title of advanced practice registered nurses (APRNs). In this case, their average salary would be $118,040 per year. APRNs who work in surgical hospitals earn on average $122,960 annually. In addition, here are some other settings where PACU APRNs may work and the respective average salaries for APRNs at each type of facility:
- Outpatient care centers: $129,190
- Offices of physicians: $114,870
- Offices of other health practitioners: $108,890
What Is PACU Nursing Like?
PACU nurses care for a wide range of patients, from babies to the elderly. They usually care for one or two patients at a time immediately after surgery and until patients are ready to transfer to another unit or back to their homes. Although PACU nurses care for a few patients at a time, it is still a fast-paced nursing specialty because each patient may only be in the PACU for a few hours, and more patients are constantly arriving from the operating room. Therefore, PACU nurses see a lot of patients but spend little time with each one.
A unique aspect of PACU nursing is that patients often don’t remember their interactions with nurses at all since they are still under the effects of anesthesia. Although PACU nurses might miss having more interaction with patients, on the positive side, they avoid most negative patient interactions, such as angry or intolerant reactions, while still engaging in direct patient care.
Now let’s see how PACU nurses themselves describe their jobs:
“Typically you have 2 pts max, they come out from or and as you settle you get super quick report from anesthesia. What happens next depends largely on the case and the particular pt. You either send to floor or d/c within a couple hours, so it’s very fast paced. You have to be willing to work hard, be diligent and work as a team. There’s airway management, BP management, bleeding...anything that could go wrong, probably will, but if it’s anything horrible you stabilize-ish and send to ICU. If they’re awake enough to be annoying they either go home or to the floor. It’s a pretty great job so far.”
“I recently transition to PACU!...It for sure is a lower stress job then the floors. Procedural nursing is honestly underrated, the happiest nurses I know are procedure nurses (ie GI lab, bronc, cath, PACU/PSCU). I like to say that PACU is ICU/PCU level patients on a ED pace. You get them in, manage the airway, give high doses of pain meds, watch for immediate post op complications and get them out (there are much more details than that but that’s the big picture really)!”
“Not life or death (except when it is) but usually not boring…I promise you will learn a lot…The flow is different. The goal is to get them in and get them out.”
Is PACU Nursing Hard?
Caring for patients post-anesthesia might seem straightforward. However, while many patients will recover smoothly from anesthesia, others might experience complications, such as the following:
- Airway issues
- Malignant hypothermia
- Changes in EKGs
- Complications with incisions
Furthermore, nurses must stay calm and comfort patients while making detailed observations of vital signs and responsiveness. Nurses must also keep up with charting in a fast-paced environment with frequent rotation of patients.
“Keeping your charting up to date seems to be one of the bigger struggles for nurses that don't have ER backgrounds. When one pt rolls out another rolls in. You don't have half an hour to get caught up before your next pt.”
Why Choose Post-Anesthesia Care Nursing?
PACU is a highly sought-after specialty. In fact, many nurses refer to it as a “retirement” specialty because nurses with the most experience are more likely to get these jobs. When a nurse on Reddit asked if they should accept a PACU position, another nurse responded, “Take it - that’s the holy grail of nursing jobs! (Not kidding).”
Another reason nurses love PACU is that they get to care for just one or two patients at a time. Furthermore, patients are often grateful to receive care after surgery and relieved that the operations went well—that is when they are awake because, most of the time, patients in PACU are too groggy to interact at all! Whether this is seen as a positive or negative aspect of the job is highly subjective and depends on nurses’ personality profiles.
“I personally love the pain management part. I love making people feel better.”
What Makes a Good PACU Nurse?
One of the most essential skills to develop as a PACU nurse is effective communication. These nurses are responsible for keeping the rest of the healthcare team informed of any changes in the patients’ recovery, as well as requesting information and delegating work to other nursing team members when appropriate. They must also communicate with patients and their families regarding post-operative care, including guidelines for taking their medication and administering pain. Evidently, the ability to communicate effectively involves other essential skills as well, such as the ability to work as a team and excellent interpersonal skills.
Tips for New PACU Nurses?
As important as education and certification are, often the most important knowledge is learned empirically on the job. Here are some valuable tips from an experienced PACU nurse:
“If a patient complains of pain not at the surgical site check to see where the tourniquet was placed. I’ve taken care of multiple patients who complain of tourniquet pain. And check their position in the stretcher and that they’re not laying on a plastic cap, their limb is pressed against the side rail or the IV tubing is caught underneath them. It’s a basic nursing thing but you’d be surprised as what gets caught in the linens when the patient is being moved in and out of the OR, and how often they change positions when trying to wake up from anesthesia.”
“If you’re having trouble with controlling a patient’s pain, consider if they’re displaying symptoms of anxiety. I’ve taken care of people before that were having issues with pain control, and not only were they hurting but they were anxious.”
“If you get an opportunity to observe surgery in the OR itself I highly highly highly recommend that you do it. You’ll learn a lot, and you’ll be able to see exactly how the procedure goes down. You’ll also understand why patients experience pain the way that they do because of the techniques involved, the way their positioned and the manipulation of their tissues to achieve the surgical outcome.”
Ready to Provide Post-Anesthesia Care?
Now that you know what PACU nursing is like, do you think it is the right specialty for you? If you’d like to land a job in a PACU or pursue a PACU certification but don’t have enough work experience, consider picking up per diem shifts in your free time or even transition to working per diem full time. These jobs are an excellent way to beef up your resume while you explore different nursing specialties to help you discover the type of nursing you enjoy the most.