What Is a PACU Nurse? An Introduction to This Nursing Specialty

Every year, millions of surgical procedures are performed in the United States. Whether major or minor, these procedures often have an entire team of healthcare professionals dedicated to getting their patients back to or as close to good as new as possible. Often among that team of healthcare professionals are post-anesthesia care unit (PACU) nurses.

If you’ve ever been put under for major surgery or any other intense medical procedure, you’ve likely been in the care of one of these professionals. While most former patients may have an understandably fuzzy idea of what a PACU nurse does, don’t worry—we can help provide a much clearer picture. Read on to learn more about the nurses tasked with ensuring their patients make a smooth transition from the operating room.

What is a PACU nurse?

PACU nurses, sometimes called perianesthesia nurses or recovery room nurses, are responsible for observing and treating a patient after they’ve undergone anesthesia. PACU nurses work with patients at highly vulnerable moments as they are coming out of sedation. All PACU nurses must be registered nurses (RNs).

As the first point of care after major surgery, PACU nurses offer patients in post-op recovery with comfort and a calm manner, all while making intense, detailed observations of vital signs and responsiveness.

Airway issues, malignant hypothermia, changes in EKGs, oversedation and monitoring incisions are just some aspects of a patient’s recovery a PACU nurse must observe. While most patients recover from sedation without a hitch, some can have adverse reactions to anesthesia. PACU nurses are trained to spot the symptoms of these adverse reactions.

“There is a criteria that patients must meet before we discharge them from the PACU, called the Aldrete score,” explains Amy Furth, RN and PACU nurse at Allina Health.

The Aldrete score assesses consciousness, mobility, breathing, circulation and color. Meeting the correct number on the Aldrete score is what allows a patient to leave the unit and move to a general hospital bed or be discharged home.

What makes PACU nursing unique?

While all nursing roles draw from the same foundation of patient care, specialized registered nursing roles often come with their own set of unique circumstances. Furth, who transitioned from intensive care unit (ICU) work to the PACU, reports great satisfaction with her work with patients recovering from surgery. Furth says some of the initial draw of her PACU role was the ability to keep more predictable hours and a desire for a change of pace.

“It’s a faster-paced department, which I love,” Furth explains.

PACU requirements vary depending on the hospital, but many PACU nurses, in addition to being established RNs, must also complete further training in anesthesia medications as well as Pediatric Advanced Life Support (PALS) and Advanced Cardiovascular Life Support (ACLS).

Furth adds that her employer also required a year of ICU or Emergency Department (ED) to move into PACU nursing. While that’s not necessarily a universal requirement across all hospitals, this is a nursing specialty that generally seeks out experienced nurses.

What is rewarding and challenging about PACU nursing?

Having the opportunity to help people is one of the obviously rewarding aspects of being a nurse—so how do the unique circumstances of working in a PACU change the picture? Furth knows that many patients often don’t remember the interactions she has with them. That’s not necessarily a bad thing, however, as patients are less likely to be cranky or combative in the care of a PACU nurse.

“It’s usually a blur to them,” Furth says. “But I love PACU patients. They’re generally happier to be in your care because they’re there to get a better outcome from surgery.”

Like with any specialization, there’s good and bad. For Furth, the downsides of PACU nursing have to do with the rapid pace of patient churn that comes with busy surgery schedules.

“Patients are coming, no matter how busy you are,” Furth explains. “The OR is like a machine that keeps going, no matter what.”

Because of this, PACU nurses generally spend less time with patients, but they see a lot more of them.

How do I become a PACU nurse?

As we mentioned above, PACU nurses must be RNs. The first step toward becoming a registered nurse would be enrolling and completing coursework for either an Associate’s degree in Nursing or a Bachelor of Science in Nursing. After graduation, would-be registered nurses will need to sit for and pass the NCLEX-RN® exam as well meet all other state licensure requirements before getting started in a registered nursing role. Building your experience is also important, especially for finding work in a recovery unit.

Additionally, PACU nursing hopefuls can benefit from pursuing professional certification. The certified post-anesthesia nurse (CPAN®) exam is open to RNs who meet certain eligibility requirements. The CPAN exam is administered by the American Board of Perianesthesia Nursing Certification, and successfully passing the CPAN can help a PACU nurse potentially command a higher salary for their in-depth knowledge and specialized experience.

Is PACU nursing in your future?

If this type of nursing, with its demand for detail-oriented, comforting personalities, sounds like a good match for you, maybe it’s time to take the next step toward a nursing career. While PACU patients will certainly be groggy, your pursuit of a nursing education doesn’t have to be. To learn more about some of your options for becoming an RN as soon as possible, check out our article “How to Become an RN Fast: 3 Potential Paths to Pursue.”

NCLEX-RN is a registered trademark of the National Council of State Boards of Nursing, Inc.

Certified Post-Anesthesia Nurse (CPAN) is a registered trademark of the American Board of Perianesthesia Nursing Certification, Inc.