Are you a burnt out ICU nurse looking to make a change? For a lot of ICU nurses, one of the most common ways to switch things up involves transitioning from ICU to PACU nursing, because PACU vs ICU nursing feels like a tale as old as time.
If you’re like I was before taking the leap, you might be thinking…
Will I lose my critical care skills?
Is it a huge change from the ICU, and will I like it?
Will I regret leaving the ICU?
The answers to these questions will differ for everyone, but let’s break down some of these common concerns below!
*Side note: If you’re interested in PACU nursing but aren’t sure exactly what a PACU nurse does, I wrote a post about it! Starting there might answer some of your questions.
When you get to the PACU…
You will find that you are surrounded by current or former ICU & ER nurses. There are a few reasons for this.
In PACU, much like these areas, you have to be able to think critically, move quickly, and manage emergency situations.
Which brings me to my next point…
Will you lose your critical care skills? Yes and no. Yes, in the sense that HOW you use your skills might differ. But no, you won’t lose them completely, because you will still use them everyday.
In the PACU setting, I have managed a critical airway, had to reintubate patients, had to titrate drips, and given blood for post surgical complications. Do I do these things as often as I used to? No. Are my patients as sick as they were when I worked in the ICU? Usually, no.
However, in my PACU, we do get ICU patients, which is why you need to know how to manage them. Respiratory distress and hemodynamic instability are very much issues in the PACU, which is why your critical care skills will come in so handy. I would be lying if I said I think that patients are as unstable as they are in the ICU, but that’s probably for the best (and honestly one of the reasons why I needed a break from the ICU).
*Please keep in mind that every PACU is very different. Some are busy, some aren’t. Some are inpatient, some are outpatient. Some get ICU patients, some don’t. Acuity, age range, and types of patients will vary. Doing your research before committing will greatly impact how much you like this transition, and might significantly improve your job satisfaction!*
PACU vs ICU: How PACU nursing differs from ICU nursing
The types of patients
Depending on what kind of ICU you’ve worked in, post-surgical patients in the PACU can be very different. My ICU experience was medical focused (MICU), so PACU was a big learning curve. I had to learn a ton about different surgical procedures, equipment, dressings, and devices that I had never seen before.
Different ORs (and therefore different PACUs) perform different types of procedures. In my case, I work in an extremely busy, fast-paced, inpatient PACU. Our patients are surgical (trauma, burn, vascular, orthopedic, plastics, you name it). We also get all patients who have had GI procedures, IR procedures, and MRIs. For me, it is not uncommon to have a trauma patient next to someone who has had a liver biopsy, but again – this varies based on what kind of PACU you are in!
How long you’re with your patients for
In the PACU, you’re with each patient for anywhere from 30 minutes to a few hours, and then you send them home (or to a room if they’re inpatient). In the ICU, you’re with each patient for your full 12-hour shift. Honestly, one of my favorite parts of the PACU is not having one patient for the entire day. You can love your job and acknowledge that some people are the worst, my friends!
Report & Assessments
Let’s face it: When you work in the ICU, your job is to basically know your patient’s past, present, and future life story. You sit down to give or receive report and painstakingly go through extensive past medical history, reasons for admission, a full assessment of every body system, lines, drips, etc etc etc.
In the PACU, report looks very different, which is actually one of my favorite parts of transitioning from ICU to PACU nursing. When your patients are dropped off to you, you get a quick report from the OR nurse and the anesthesia team. The OR basically tells you what kind of procedure the patient had done and points out any special dressings or assessments that need to be checked. The anesthesia team then tells you what medications the patient received. Short and sweet!
How about giving report? It’s also short and sweet. If a patient is going home, you’ll just give discharge instructions to them or a family member. If you’re sending them to the floor, though, all you really have to tell the nurses is what medications they received in the OR and PACU, what surgery they had done, and give a very quick head to toe assessment, focusing the most on the part of the body they had surgery on.
I used to think it would bother me to not know every little detail about my patients, but the short and sweet report is actually one of my favorite aspects of PACU nursing.
The care team
When I worked in the Medical ICU, I was primarily familiar with a few specialty teams, such as the intensivists, pulmonoligsts, or cardiologists. In the PACU, sometimes it feels like you’re working with literally everyone. You are now working with different groups of OR nurses, surgical teams from every specialty, anesthesiologists, respiratory care providers, and a million other people (as opposed to a handful of people that you are used to working with). As you can imagine, having so many cooks in the kitchen can have it’s pros and cons.
The pace
PACU is fast-paced. I’ve never worked in the ER, but I imagine the two are similar in many ways. In the ICU, you can rest assured that your day will follow some kind of (loose) structure. In the PACU, there really isn’t much structure, and there is no typical day. Your patients come and go and are all too different to follow much of a schedule. Though it can be stressful if you’re a planner like me, I would argue that PACU is “organized chaos”, and I enjoy the variety and learning new things every day.
The intensity
I felt extremely burnt out by the time I left ICU nursing, and I attribute a lot of that to the sheer intensity of taking care of such sick patients every day Transitioning from ICU to PACU nursing has me feeling WAY more relaxed at work. I’m not always on edge that someone is going to code or die that day (yes, it sounds morbid, but welcome to critical care), and that is a huge plus for me.
PACU vs ICU: What PACU nursing and ICU nursing have in common
The nurse:patient ratio
In California, this is 2:1. I have heard from my nurse traveler friends who work in the PACU that this is a nationwide ratio, however I have only ever been an RN in California and therefore cannot comment on this.
Skills used on the job
Much like in the ICU, time management, the ability to manage emergency situations / a critical airway, and continuously assessing hemodynamic instability are all important skills in the PACU.
Though transitioning from ICU to PACU nursing was the right move for me, remember that if you do decide to make the switch, you can always change your mind. For me, both units had their pros and cons, but overall I would probably never go back to the ICU. Do what is best for you!
I hope this post comparing PACU vs ICU was helpful!
Leave a Reply