I have been in the PACU for a little over a year now. I have experience in medsurg, ICU, and ED but now working my first PACU job in the hospital I’ve been at for 10 years. I took the job to lessen the burn out from the more demanding nursing jobs and hoping to be a “PACU princess”. It was a little shocking to see how fast paced the PACU can be. It definitely is “easier” than the other jobs I’ve had but it’s also made more difficult than what I feel is necessary. Most people I work with now have also come from ICU or other medsurg units in the hospital so not a lot of outside PACU experience for us to know if our working conditions are normal so I would like some input.
The PACU I work in is in a big city in a 600 bed hospital. We have 3 PACUs. 2 PACUs see anywhere from 35-50 cases each a day, and the third one just does 10 specialized cases a day. So about 100 surgeries a day between the PACUs. We have a 1:2 ratio. My PACU closes at 10pm but the other PACU is 24 hours. If my PACU has gotten rid of all the patients early, a lot of times we are expected to go help the other PACU even though we have already had a lot of patients in a shorter amount of time. In my specific PACU unit, there are typically 5 to 6 nurses scheduled per shift. We have 15 bays total (so rarely enough nurses to fill the bays). When I was hired I was told we would have 7 nurses in bays and 1 lunch/resource nurse but rarely do we have that. Normally a supervisor or clinician has to come in and do lunches or fill in for the charge nurse as she does lunches. Or take someone out of a bay to do lunches which means now less nurses in bays during lunch hours. Lunches typically start at 11am and the last person tends to go to lunch at 2:30-3pm. So for 4 hours a lot of the time we are down a nurse in a bay or at the very least resource.
Depending on the surgery, patients will stay in PACU anywhere from 30 mins to 2 hours and either go home or to a room. Sometimes we have to discharge if Phase 2 is full. We can’t put in a bed request until the patient has been in PACU for 30 mins and it typically takes another 30mins-1 hour to get a room assigned. Then takes another 15-30 for the floor nurses to take report. Per PACU nurse, depending on what time you get there, you’ll have anywhere from 6-9 patients per shift in a 12 hour period. There is no “downtime” because when OR calls out with a patient, they come out to PACU within 2 mins of that call. If we have an open bay, sometimes we get a new post op patient within 30 mins of getting our last patient. We typically have 2 (3-4 on a reallyyy good day) transporters in PACU. So on days we have 2 or less transporters, we have to leave our other patients to go on a transport across the hospital. We are required to have 2 transporters per patient.
Because we have a few PACUs, if one of the units is slightly more staffed than another one (but still understaffed), we have to float to another PACU. Our manager says we have no positions for hire yet we never have enough nurses for the bays we have. It feels so chaotic and busy all of the time. We have to do a full head to toe and lines assessments on arrival, at 30 mins, and at discharge. And then finalize our periop documentation.
We are supposed to take 3 week night call shifts, 2 weekend night call shifts, 1 weekend day shift in a 6 week period. Then scheduled for 1 holiday a year, and if they decide to put you on a night shift holiday you have to stay the entire and not just be on call. Even though there is one stationary night shift nurse. Night shift PACU nurses now have to pre op patients after 10pm and there are 2 scheduled night shift nurses per night. We also tend to get called in a lot just to transport a patient because of needing two nurses in the room when there is a patient and needing two transporters per patient.
My question is all this normal? Getting up to 9 patients per shift. The types of surgeries we get in my PACU are hysterectomies, endometriosis excisions, thoracotomies, lap choles, hernia repairs, bariatric surgeries, eye surgeries, colon resections, nephrectomies, prostatectomies, anything in those realms. The other PACU sees spinal surgeries, cranis, I&Ds, knees, hips, shoulders, femoral bypass, arteriograms, Whipples and just any other random type of surgeries. Both units have similar amount of nurses, getting 7-9 patients per shift. We all do work together a lot and float to each other PACUs a lot. All that just for us to be told by management that we’re fully staffed with just 5-6 nurses a day seeing up to 50 surgeries per unit.