What is a PACU Nurse?

Maybe it’s your father who just had heart surgery, or your partner had their gallbladder removed, or maybe you had a health condition flare-up that required surgical intervention. Who’s taking care of you as the anesthesia wears off? Who makes sure your vitals are stable, checks that your dressings are clean, and remains in contact with everyone from your doctor and treatment team to your loved ones waiting on a status update? The answer is the PACU nurse. 

Keep reading to find out more about the roles and responsibilities of a PACU nurse, the education required, and even what salary and support you can expect once you become a PACU nurse.

What is a PACU nurse?

The post-anesthesia care unit (PACU) nurse closely monitors patients who have just undergone procedure(s) with anesthesia, and treats them as needed while also documenting their progress. Because these patients are still coming off their anesthesia, they cannot be relied upon to verbally account for their symptoms and so the PACU nurse must have extremely strong observational skills combined with a keen eye for detail.

Post-anesthesia patients may be vulnerable to rapid physical changes, so the PACU nurse must handle fast-paced, high-pressure environments well while also communicating effectively with everyone from doctors to patients’ loved ones.

What does a PACU nurse do?

A PACU nurse monitors patients recovering from surgical procedures, ensuring that they come down from anesthesia smoothly and that they are on track to heal up safely and effectively—whether they remain in the hospital for ongoing observation or they end up in an outpatient setting to heal remotely. PACU nurse responsibilities include:

• Monitor patient recovery and communicate with their treatment team as needed to provide updates
• Regularly checking vital signs to quickly intercept any potential issues and ensure a smooth recovery
• Keep bandages, dressings, etc. clean, dry, and safe
• Administer medication as prescribed and get ahead of any potential issues or interactions
• Provide patients and any loved ones on hand with detailed instructions and expectations about homecare and recovery.

Why is a PACU nurse so important?

Recovery starts as soon as surgery ends, and the operating room staff hand off a patient’s care to the PACU nurse. Ensuring a smooth transition from the operating room into recovery is necessary to ensure the highest probability of successful patient outcomes. Everything from maximum patient health through minimal healthcare costs can be secured by the work of the PACU nurse.

When there is a problem, the PACU nurse’s handling of their patient can make all the difference in their medical outcomes. If any issue flares up under the direct care of the PACU nurse, they need to rapidly recognize what’s going on and act effectively under high pressure and stress. On the other hand, should any problems arise after the patient leaves, the notes and observations made by the PACU nurse will provide essential clues for successful downstream care.

How to Become a PACU Nurse

Perhaps the greatest personality traits a PACU nurse should have are a calm demeanor, sharp observational skills, and the utmost clarity in their ability to communicate with people of all backgrounds, from medical professionals to emotional family members. The special blend of calmness during stress and meticulous medical care allows the PACU nurse to intervene as needed and hold their patients firmly on the path to recovery.

Education Requirements and Training

In order to be a PACU nurse, you must first earn an RN designation. You can do this by attending an accredited institution and obtaining either an associate or bachelor’s degree in nursing or a hospital nursing diploma. Online coursework is available towards an RN, although clinical hours must also be performed alongside coursework. If you suspect that you might be interested in the PACU specialty while you are still in your nursing program, you might elect coursework in anesthesia-related healthcare or you may choose a perianesthesia concentration. RN graduates must take and pass the National Council Licensure Examination (NCLEX-RN) in order to become licensed nurses.

Usually, hospitals will require that you work as a nurse for at least a couple of years before you can transfer into a specialty such as post-anesthesia care. Checking with your hospital to pinpoint their precise requirements for you to work as a PACU nurse is recommended. While there are hospitals that allow for on-the-job training, many hospitals require certification, which is administered by the American Board of Perianesthesia Nursing. In addition to passing an exam, this certification requires a minimum of 1,800 clinical hours over two years and must be renewed every three years.  

The PACU Nurse Career Outlook

The Bureau of Labor Statistics anticipates as much as a 19% growth in the total number of nursing jobs between 2012 and 2022, with experts touting a likely increase in the number of PACU positions because of the growing senior population who will require surgical procedures.

PACU Nurse Salary and Employment

According to Payscale.com, the average PACU nurse earns an average of $31.66 per hour, with an hourly rate ranging from $24.21 to $44.30. This hourly rate tends to vary based on the state. Demand for this career remains steady, although the potential for PACU nurse jobs is strong since their skills lend well to several other critical hospital specialties, including those in the emergency room, Critical Care Unit, and operating room.

PACU nursing is its own specialty, but any skills learned from emergency or critical care can help strengthen a PACU nurse’s abilities and help them gain an increased salary. Aside from gaining PACU nurse certification, taking on roles in management or professional education are other ways to raise one’s salary.

Of note, the 5 top-paying states for PACU nurses are:

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

Top Specialities

Although PACU nurses effectively enjoy their own specialty, their skills carry over well into a few other specialties, giving them more job opportunities and job security. These specialties tend to hinge around high-stress, high-risk nursing environments. These specialties include:

• Operating room (OR) nurses – These nurses tend to patients just before as well as in the middle of surgery. They are capable of diligent observation, swift action, and effective team communication. OR nurses average about $32.43 per hour.
• ICU nurses – Intensive care units accommodate critically ill patients and therefore require attentive care and fast action. ICU nurses average about $30.35 per hour.
• Sub-acute nurses – This level of long-term nursing carries more urgency than long-term care (think: the average in-home nurse) but is less intensive than acute nursing like seen in the ICU or OR. Pay for a sub-acute nurse varies widely based on their specific skills and certifications.

PACU Nurse Resources

PACU Nurse FAQs

1. Can a licensed practical nurse (LPN) or a vocational nurse (VN) work in the PACU, if they have the skills needed?
Each state has a board of nursing that determines the guidelines for what duties an RN, LPN, and VN can perform, and whether they can fill in for a PACU nurse. As a nurse grows their emergency and critical care skills and demonstrates a positive track record in these types of roles, they should consider speaking with hospital management to determine what course of action is needed to grant them PACU access.

 2. Do PACU nurses have to work late hours and be on-call?
This topic is widely debated in the industry, including by ASPAN. While it is up to the individual institution to develop guidelines for staffing the PACU, there needs to be an order of accountability in place that puts patient safety first. After all, each patient deserves to receive quality healthcare administered by a competent individual, no matter when the care is given.

That said, PACU nurses are typically given a backup RN with whom to work so that there is a contingency in place should the primary PACU nurse get pulled away into an emergency case.

3. Can a patient be extubated by a PACU nurse?
Yes, they can, provided three central criteria are met:

1. There are no state restrictions that prohibit a perianesthesia nurse from performing the extubation.
2. The department has a clear standard policy on extubation in the PACU.
3. Is there an extubation competency being administered to all PACU nurses before they are cleared to extubate a patient?

Helpful Organizations, Societies & Agencies

From networking to continuing education, the following organizations can provide you with a supportive community on your path to success as a PACU nurse.

• ASPAN (American Society of PeriAnesthesia Nurses) 
• ABPANC (American Board of Perianesthesia Nursing Certification)
• AORN (Association of periOperative Registered Nurses)

PACU Nurse Scholarship

Looking for a way to become a healthcare professional? Check out our scholarship here!

List of PACU Nurse Programs

Check out this list of potential nursing programs to get you started!

What Now?

Are you or someone you know considering a career as a PACU nurse? Feel free to reach out to us with any questions you may have about choosing this career.