When I started the call shift, almost 4 years ago now, I was asked if I could be the second nurse in PACU. Because I liked learning and shit. And so they wouldn’t have to call in their second PACU nurse.
I like learning and shit so I agreed. Every opportunity to learn is a good opportunity in my books.
Not every call nurse does this. I know this.
However it is a good avenue to learn about what happens after the drapes go down.
But what if there is another case? And only the call PACU nurse is there?
Well, you get the details of the second case. You give them the standard time. I have gotten some push back here. “Aren’t you already there?”
Yes, but the second PACU nurse isn’t. The first step is to call the second PACU nurse in.
The next thing you do is call the anesthesia team and give them a heads up. And then you coordinate with the scrub tech to pick the case and prepare the room.
And you schedule the case.
This is when you ask the CRNA to wait in PACU and be the second nurse while you get the patient from the ER. If they cannot (OB), you call the nursing supervisor and ask for them to come down and be the second nurse or send someone from the floor.
I mean you could put in transport but you know that there is limited transport at night. And the OR is never first priority.
It seems like a lot but it really isn’t. It is basically all the steps that you do when a call case is scheduled. Plus a second nurse in the PACU who is caring for their own patient. The second case is just stacked on the first case.
A second nurse has been obtained. You get report from the ER nurse and you go to the ER to pick up the patient. It takes less than 5 minutes usually.
This is where the 2 back to back cases blend into each other. This is normal.
The only thing you have to remember to do is bring the patient and their family member to the other side of the PACU.
Privacy reasons, you know?
The second nurse is dismissed.
You prep patient number 2. This is also familiar to you because you do it every call case. Anesthesia is alerted to the patient in the PACU, the surgeon pops in (if it is the same surgeon, but that doesn’t always happen that way). Consents are signed, pre-op checklist is completed and the Quick Prep that you always use to prep a patient is completed.
And just as you are finishing, the second PACU nurse arrives.
You hand over the patient’s family to the second PACU nurse and they take them to the waiting room. But not before you mention again the instructions to pick up the waiting room phone if it rings.
In truth it takes about 20 minutes to prep on a more standard day. This is just a little wrinkle.
But both PACU nurses are now in PACU, the second patient is in the OR, and the first patient is still waking up.
If the surgeon complains about the thirty to thirty-five minutes it took to get the second patient on the table kindly remind them that back to back call cases at night are not the usual. But next time they could go get the second patient from the ER. Or they could sling a mop and turnover the room.
OR call is all about managing the expectations of the surgeon, the anesthesia team, the scrub tech, and hoping there is a bed. Plus thinking about all the possibilities and ensuring you have what you need to answer them. It is a matter of perspective.
Dispatches from the Evening Shift 