PACU Nursing Pros and Cons

Quite often when I speak to other people who aren’t very familiar with the different avenues of nursing, I’m met with blank stares when I mention that I work in the PACU. I’ve also heard tons of misconceptions that PACU is a “retirement job” or that it’s “where ICU nurses go to die.” If you’re interested in learning what a PACU nurse does as well as the pros and cons of PACU nursing, read on! 

*As a side note, if you are an ICU nurse looking to make the switch from ICU to PACU, I wrote an extensive post about it HERE. 

What does PACU stand for?

PACU stands for Post Anesthesia Care Unit. While PRE operative or “pre op” nurses help get patients ready for surgery, the POST operative nurses are the ones who are there when patients are all done with surgery and are waking up from anesthesia. We help manage pain, give discharge instructions and materials, and coordinate rides home or transfers back up to patients’ inpatient hospital beds.

PACU is part of the Perioperative department, which includes the pre (before surgery), intra (during surgery), and post (after surgery) operative areas. While some nurses only work in the PACU, many of the nurses I work with alternate between pre and post operative areas. This means that oftentimes, when patients go in for an outpatient procedure, they might see the same nurses in multiple different areas.

PACU nurses are available in both inpatient and outpatient settings, and don’t usually follow the standard 7am-730pm schedule that most hospitals follow. Much like the ER, PACU nurses are on staggered shifts, meaning you might start your shift as early as 7 or as late as noon, and your coworkers will be constantly coming and going throughout the day.

It is worth noting that if you want to be an intra-op nurse, also known as an Operating Room or OR nurse, this is a very different kind of nursing and usually requires extensive amounts of OR-specific training.

What are the requirements and skills needed to become a PACU nurse?

In order to become a PACU nurse, you usually have to have at least 2 years of critical care experience, meaning most of the nurses I work with are former ER or ICU nurses. If you’re a nurse who doesn’t fit this criteria but you want to become a PACU nurse, rest assured that in some places, “new to PACU” programs are available (though I think those are a bit more rare).

If you’re interested in travel nursing, there are travel PACU nurse positions available, though you should definitely not expect to be paid as much as if you were still in the ER or ICU.

Most hospitals ask that you have critical care experience to ensure that you have the skills that these environments give you. Excellent time management, patience, the ability to think critically and react quickly in emergent situations, and flexibility (just to name a few) are all a must!

PACU nursing pros and cons

PACU nursing pros

• Have a difficult patient? If you move quickly, you might only be with them for 30 minutes. A huge part of the appeal of PACU nursing is stabilizing patients and sending them on their merry way.
• You will learn a lot about different types of surgeries / procedures, dressings, and drains.
• The ratio in PACU is 2:1, or 2 nurses to 1 patient. This means you can still provide detail-oriented, adequate care, even in the busiest of PACUs.
• You get to be familiar with the OR staff, surgeons, and anesthesiologists, who are usually (but definitely not always) a quick page away if you need something. In the PACU I work in, the anesthesia team is also responsible for reintubation and emergency medication management if necessary, which is a nice break from some of the pressure that came with my critical care days.
• Depending on the acuity of the PACU patients at the hospital you work at and the type of surgeries performed, you do keep your critical care skills. Patients can and unfortunately do still code, need reintubation, and have post surgical complications in the PACU.
• If you enjoy patient education, this is the job for you. (I guess this could also be a con depending on what parts of your job you enjoy).
• If you work in a hospital setting and your patient is going back up to their room, your “report” is not at all as detailed or time-consuming as it would be if you were an inpatient nurse.
• Variety. Patients in the PACU come in all ages, have different types of surgeries, are inpatient or outpatient (if you work in a hospital setting) and always need different nursing interventions. This variety keeps it interesting!

PACU nursing cons

• PACU can still be very very busy. One difference though is that PACU busy and ICU / ER busy are different. Sometimes the things that you do in PACU might feel like a “taskier” kind of busy, but I also have had patients crashing that have brought me right back to my ICU days.
• Volume of patients is very different than it is in an ICU setting. While the ratio is the same (2:1), in PACU you might have 10 patients that day vs the 2 (or 3 I guess if your patients are discharging / admitting) that you might have if you work in the ICU.
• PACU nursing can feel like a revolving door. The second you’re done charting on one patient or have finally discharged a patient, you’re getting another. This can be really tough in busy PACUs.
• If you enjoy really getting to know your patients or their families, this unit can be a challenge. You might not get to know your patients as well because you’re only with them for a brief time.
• Transferring some patients out of the PACU can be a pain. We are constantly dealing with logistical issues when coordinating rides home, picking up prescriptions, surgeons needing x y z before the patient is allowed to go home, etc.
• With some patients, waking up from anesthesia can be no fun. Think lots of crying / screaming, nausea and vomiting, and confusion. You may or may not have to tackle some people from time to time, but only in a medically necessary (and professional) manner, obviously.
• Staggered shifts. Because it’s not your standard 7am-730pm shift, you might get put on very early (if you also work in pre op) or very late shifts. When I first started in the PACU, I was working 11am-1130pm for the longest time. For some, this is a huge pro. For me personally, I enjoy the earlier shifts because it means I get to go home and see my family sooner.

So will I be a PACU nurse forever? I’m honestly not sure. Even with all of PACU nursing’s pros and cons, it is my favorite type of inpatient nursing so far. I will never return to a regular inpatient floor again!