We’re teaming up with Maureen Osuna, MSN, RN, to learn more about life as a nurse in the Post Anesthesia Care Unit. From an inside look at a typical day to what she wishes she would have known before starting her career, we ask Maureen everything you need to know about her professional journey. Take a look! Meet Maureen Osuna, MSN, RN. Maureen currently works as a nurse in the Post Anesthesia Care Unit (PACU), as well as running her website and podcast, Straight A Nursing.

Q: Tell us about your nursing career.

A: I started in the ICU as a new grad nurse, joining a unit that hadn’t hired a new grad RN in years (if ever). Talk about a rocky transition! Luckily I entered practice through a year-long nurse residency program so I had a lot of support and education along the way. For about 6 years I worked in a medical intensive care unit (MICU) that cared for a wide variety of patients – essentially everything except critical cardiac patients. Due to health reasons, I took some time off and when I re-entered practice, I took a position in a trauma intensive care unit. I worked with some great people, but really missed the variety of patients one sees in the medical intensive care unit. I decided to return to the medical ICU while starting graduate school for my master’s degree in nursing education. It turns out that working full-time in a highly-demanding unit while going to graduate school and running an online business wasn’t the best way to maintain my overall well-being. I ultimately made the decision to transfer to PACU where I continue to work per diem. The PACU (post-anesthesia care unit) is a great combination of critical care but without the non-stop intensity of ICU. Plus, I really like that as a per-diem nurse, I no longer work nights, holidays, or weekends!

Q: What inspired you to become a nurse?

A: I was inspired to become a nurse through a business I ran with my husband in the mid-2000s. We operated a healthcare recruitment business and I loved seeing all the different avenues one could take as a nurse. At the time I had been working as an advertising writer for many years and wanted to switch gears to do something truly meaningful in my career. Plus, I was tired of sitting at a desk and wanted a job where I would be actively engaged with others in a dynamic and ever-changing environment. Nursing seemed like a perfect fit!

Q: During your time in your current role, what does your typical day look like?

A: In the PACU, I start my day around 1230 and work until 2100. Depending on how busy it is, I usually have a patient assignment soon after arriving. I’ll take a moment to look up the patient’s history, the surgery they’re having, and any relevant comorbidities that could impact their recovery. The workflow in the PACU is vastly different from the flow in the ICU. In the ICU, I’d get a full report on my patient that often took 10 to 15 minutes, and then keep that patient for the whole day. In the PACU, I get a very brief report from the anesthesiologist and OR RN and will have multiple patients for short periods of time. After I’ve assessed my patient, I’ll get busy intervening in some way and charting in the EMR. In the PACU, common things I’m managing are respiratory depression, hypotension, hypertension, bradycardia, tachycardia, severe pain, and respiratory emergencies. Though these are the most common situations I deal with, a patient could have any type of problem, which makes it an unpredictable but interesting environment. Once my patient meets the criteria for PACU discharge they’ll either transfer to a lower level of post-anesthesia care before going home or transfer to a unit in the hospital. At this point, I’ll give the report to the nurse that is taking over and get ready for my next patient, take a break, or assist my coworkers as needed. Though our patient ratios in the PACU are 2:1, meaning I could have two non-critical patients at the same time, I usually have one patient unless the OR is especially busy. One of the things I like most about PACU is that the stress isn’t constant like it is in the ICU. In the PACU, once I transfer my patient, all that stress ends and I get a small reprieve while I prepare for my next assignment. The other thing I really love about PACU is that I often get to go home early! As the OR wraps up their cases toward the end of the day, if we end up being overstaffed, they’ll send people home early. Since I work full-time running Straight A Nursing, I’m always amenable to getting off work a couple of hours early. This never happened in the ICU! 

Q: What’s the most exciting part?

A: One of the things I love most about working in PACU is I never know what each day is going to be like and I never know what type of patients I’ll have. I could have a simple appendectomy patient who’s being discharged home followed up by a thoracotomy patient with multiple chest tubes who is being admitted to the ICU. It’s definitely never boring!

Q: What is the toughest part?

A: Probably the toughest thing about working in PACU is the fast workflow. We have our patients for very short periods of time, yet they go through massive physiologic changes relatively quickly. We must assess, adapt and intervene quickly in order to keep patients safe and get them discharged from the unit as quickly as possible. This is especially challenging when “doubled” with two patients and even more challenging when one or both of your patients is unstable. Luckily I work in a great environment with very helpful coworkers who are always happy to lend a hand.

Q: Which courses in nursing school helped you prepare for this role?

A: The courses that helped me prepare the most were Advanced Med Surg, Adult Assessment, Fundamentals, and, of course, clinical and sim lab.

Q: Any other tips for in-program students?

A: I always advise students to focus heavily on developing their assessment skills as this is THE priority job of the nurse. You must be able to notice when something “isn’t right” with your patient so that you can apply your critical thinking skills to determine the best course of action. So, get your eyes, ears, and hands-on as many patients as you possibly can. Understand what things your patient is at risk for and actively look for anything that could be abnormal. And if you ever hear a little voice telling you to double-check or follow up on something, always always always listen to that voice…that’s your Nurse Angel and she is looking out for you (and your patients)!

Q: What advice would you give to nursing students wanting to go into this specialty?

A: If you want to work in PACU, get some critical care experience in the ICU or ER. These positions are often difficult to come by, so cross-train to the PACU if you can and pick up a few extra shifts to really see if this type of nursing is for you. That way, when a position does become available, the team and manager will already know you and your work ethic.

Q: What do you wish you would have known before starting your nursing career?

A: I wish I would have known how long it would take me to feel comfortable. Starting as a new grad in the ICU was incredibly stressful and I felt physically ill every time I walked into work for at least the first year. As I became more competent and confident over time, this feeling of anxiety went away but it was definitely something I struggled with for quite a while. Additionally, I wish I would have known how demanding the job actually is. There was just no way to understand this in our clinical rotations as we were focused so heavily on what we needed to do to get through each clinical day. Realizing how physically, emotionally, and mentally demanding the job it was quite an eye-opener for me and I wish nursing school had prepared us better in this regard.