Post Anesthesia Care Unit (PACU) Nurse Guide

    May 28, 2020
    Nurse checking on patient laying in bed

    Part One What Is a PACU Nurse?

    A post-anesthesia care unit (PACU) nurse cares for patients who have gone under anesthesia. They are responsible for observing and treating a patient post-operation and making sure that they safely awake from anesthesia. This means that they must monitor vital signs and levels of consciousness to make sure that the sedation is wearing off properly and patients are regaining consciousness.

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    Some patients may experience side effects of the anesthesia or have trouble regaining consciousness. Pain, nausea, difficulty breathing and fear and agitation are all common occurrences in the recovery room and will require the attention and expertise of a PACU nurse. Depending on the hospital, the PACU nurse may also be responsible for helping patients stand, completing the discharge process and changing dressings.  

    Because PACU nurses work in the recovery room, they are often the first person patients see after a major surgery. A good PACU nurse will provide comfort and reassurance to both patients and family members who may be worried. They will also need to be able to patiently answer questions and convey important care information, so a calm demeanor and strong communication skills also serve a PACU nurse well.

    PACU Nurses vs. Operating Room Nurses

    While both nurses are important to the entire surgical process, operating room nurses are responsible for preparing patients for surgery and taking care of them during surgery. An OR nurse also assists the surgeon and may be called on to control bleeding, insert sutures and administer medication. A PACU nurse takes over patient care once they have left the operating room.

    PACU Nurses vs. Nurse Anesthetists

    A certified registered nurse anesthetist (CRNA) is a specialized and advanced nursing field. CRNAs work with physicians and anesthesiologists to administer anesthesia in a variety of settings that could include: hospitals, dentist offices and pain management clinics. Their responsibilities include pre-anesthesia preparation and observation and maintenance during the procedure.

    All of these different nursing positions represent a vital part of the health care system, but it is the PACU who monitors and cares for patients are they are coming out of sedation after surgery.

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    Part Two PACU Nurse Salary

    A PACU nurse must also be an RN. According to the U.S. Bureau of Labor Statistics (BLS) the median salary for a registered nurse in 2019 is $73,300 per year, or $35.24 per hour, but conditions in your area may vary. Nurses often work voluntary or mandatory overtime and are compensated with time and a half pay. Additional benefits include holiday, sick time bonuses and other benefits can add thousands of dollars to the total earnings amount.  

    Top 5 Highest Paying States for PACU Nurses 

    While it is difficult to find specific numbers for PACU nurses, it is safe to assume that the same states that offer the highest salaries for RNs would also pay top dollar for a PACU nurse. The top 5 highest paying states include:

    1. District of Columbia
    2. New York
    3. Nevada
    4. Massachusetts
    5. Alaska

    Part Three What Is the Career Outlook for a PACU Nurse? 

    The BLS predicts that registered nurse employment will grow by 12% from 2018 to 2028, much faster than the average career growth rate. PACU nurses should experience the same level of growth, making it an attractive field that offers both job security and lucrative salaries.

    Much of this growth in the healthcare field is being driven by a large aging population. Baby Boomers represent the largest generation in American and require more care as they age and enter retirement age. 

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    Part Four How Do You Become a PACU Nurse?

    Becoming a PACU nurse begins with earning your certification as an RN. There are several paths to becoming an RN. You can earn an Associate degree in nursing, a Bachelor of Science degree or complete a training program, all of which will qualify you to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Once you pass this exam, you can begin working in a medical setting.

    There are also several different paths to specializing in PACU nursing. You will need to begin by building experience as an RN. After a couple years, you may be able to move to the recovery unit and learn the specific duties of a PACU nurse. For some hospitals and facilities, the on-the-job experience will be enough to qualify you to be a PACU.

    However, if you want to further your education and ensure that you are paid for your specialized skills, you will want to become a certified post-anesthesia nurse (CPAN). In order to apply for the certification exam, you must be a licensed RN and have accumulated at least 1,800 hours of clinical experience. Once you pass the certification exam, you will be qualified to practice as a PACU or CPAN.

    If you want to challenge yourself and make sure that you are an attractive PACU nurse job candidate, then you may want to work on earning your BS-RN in order to build a solid educational foundation. Here are the top five schools in the country for RNs:

    • University of Maryland-Baltimore
    • Oregon Health and Science University
    • University of Washington
    • University of Pennsylvania
    • University of Minnesota 

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    Part Five What is It Like to Be a PACU Nurse? 

    As with any nursing position, being a PACU nurse means that you work in a fast-paced environment where you have to quickly make critical decisions in order to provide the best patient care. A PACU nurse has to be diligent about monitoring patients as they come out of sedation and immediately take action if there are any complications.

    This is a unique position because the patients may not be able to articulate their discomfort. It is up to the PACU to make observations and act. 

    A big part of being a PACU nurse is comforting patients who have just undergone surgery. They may be scared and confused once they wake up and the anesthesia can exacerbate feelings in some patients. A successful PACU nurse will be able to handle these situations with care and compassion so that the patient is put at ease and can continue their recovery.  

    Finally, a PACU nurse also serves as a point of contact for patients and their families. They need to be able to clearly communicate care instructions and answer any questions. Being able to work with the public and effectively communicate during stressful times is truly a skill and an important part of being a PACU nurse.

    Part Six What are the Continuing Education Requirements for PACU Nurses?

    The American Board of Perianesthesia Nursing Certification (ABPANC) is the main body that oversees the CPAN certification process. Remember that you must complete 1,800 hours of direct clinical experience over a period of two years before you can apply for certification. In order to earn your certification, you must pass a computer administered exam. 

    The CPAN certification will need to be renewed every three years. You can either take the exam again or complete 90 contact hours. How many hours need to be split between direct and indirect contact will differ depending on how many times you have been recertified. Outside of the recertification process, there are no there are no other continuing education requirements for PACU nurses.

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    Part Seven How Can I Advance My Career as a PACU Nurse?

    While you don’t necessarily need a specialized certification to become a PACU nurse, pursuing a certification is a great way to advance your career and increase your earning potential. Once you have worked as an RN for at least two years and accumulated clinical hours, you can become a Certified post-anesthesia (CPAN) nurse and/or a Certified Ambulatory Perianesthesia (CAPA) nurse. With both certifications, you will be able to oversee both pre and post-surgery care of patients.

    To become certified, you will need to pass a comprehensive exam that will test your knowledge of the psychological needs of patients, physical effects of anesthesia, behavioral changes that may occur and other complications that may put the patient at risk.

    As an RN, there are many different career paths and opportunities for higher education that you can pursue. For PACU nurses who want to continue to work with patients and anesthesia, you can become a Certified Registered Nurse Anesthetist (CRNA). These highly specialized nurses perform many of the same duties as anesthesiologists. Here is the typical path to becoming a CRNA:

    1. Earn a Bachelor of Science in Nursing
    2. Become a certified RN
    3. Work in an acute care setting for 1-2 years in order to gain experience.
    4. Be admitted into an accredited nurse anesthesia program. These programs are highly competitive, so it is important that you understand the application requirements before you apply.
    5. Completing a CRNA program takes 2-3 years. Upon graduation, you will have a master’s degree although a select number of programs also allow you to earn a Ph.D.
    6. After graduation, you will need to pass the National Certification Examination administered by the National Board of Certification and Recertification for Nurse Anesthetists before you can begin working as a CRNA.

    For those with a passion for patients and healthcare, working as a PACU and/or a CRNA nurse can provide a fulfilling and rewarding career that offers opportunities for advancement.

    Part Eight Where Can I Learn More About PACU Nurses?

    Nurses are part of a tight-knit community that offers a wide variety of professional associations that offer support and will help you keep on top changes and opportunities in the profession, including national conferences. For those exploring various nursing careers, these associations can also be helpful sources for information. Professional associations for PACU nurses include:

    Part Nine Where Can I Find the Best PACU Nurse Jobs?

    According to the U.S. Bureau of Labor and Statistics, there are over 3.1 million nurses or 10 nurses to every 3 doctors. It might be hard to imagine that there are enough nursing positions to accommodate sure a large workforce, but nurses are a vital component of our healthcare system and many facilities are suffering from nursing shortages.

    With the right educational background, you can secure a lucrative and fulfilling position that will also offer opportunities for professional development and advancement.

    If you are willing to relocate, then there are certain states that stand out as great places to work as a PACU:

    California: While the housing prices can be high, California is the only state to have mandated patient to staff ratios and other legal protections for nurses. You will be able to provide your patients with the best possible care and avoid burnout.

    Texas: There are other states that offer higher salaries, but with a low cost of living, your money will go further and there are plenty of reputable university and VA hospitals where you can gain valuable experience.

    Vermont: If you are concerned with your own quality of life, then Vermont offers an attractive combination of outdoor activities, healthy living, and fair salaries. It also offers universal healthcare to residents.

    As our population continues to grow and age, the demand for highly skilled nurses will only continue to increase with thousands of new positions becoming available each year.

    If you get joy and fulfillment from helping others and you have a tolerance for medical situations, PACU nursing can provide a truly rewarding career along with a lucrative salary.

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