Post Anesthesia Care Unit (PACU) Nurse Guide (2023)


July 18, 2022

Post Anesthesia Care Unit (PACU) Nurse Guide (1)

Post Anesthesia Care Unit (PACU) Nurse Guide (2)

By: Staff

Medically reviewed by Kathleen Gaines, MSN, RN, BA, CBC

A post-anesthesia care unit, or PACU, nurse cares for patients who have gone under anesthesia. They are responsible for observing and treating a patient post-operation and making sure that they safely awake from anesthesia. This means that they must monitor vital signs and levels of consciousness to make sure that the sedation is wearing off properly and patients are regaining consciousness.

Some patients may experience side effects of the anesthesia or have trouble regaining consciousness. Pain, nausea, difficulty breathing fear and agitation are all common occurrences in the recovery room and will require the attention and expertise of a PACU nurse. Depending on the hospital, the PACU nurse may also be responsible for helping patients stand, completing the discharge process and changing dressings.

Because PACU nurses work in the recovery room, they are often the first person patients see after a major surgery. A good PACU nurse will provide comfort and reassurance to both patients and family members who may be worried. They will also need to be able to patiently answer questions and convey important care information, so a calm demeanor and strong communication skills also serve a PACU nurse well.

PACU Nurses vs. Operating Room Nurses

While both nurses are important to the entire surgical process, operating room nurses are responsible for preparing patients for surgery and taking care of them during surgery. An OR nurse also assists the surgeon and may be called on to control bleeding, insert sutures and administer medication. A PACU nurse takes over patient care once they have left the operating room.

PACU Nurses vs. Nurse Anesthetists

A certified registered nurse anesthetist (CRNA) is a specialized and advanced nursing field. CRNAs work with physicians and anesthesiologists to administer anesthesia in a variety of settings that could include: hospitals, dentist offices and pain management clinics. Their responsibilities include pre-anesthesia preparation and observation and maintenance during the procedure.

All of these different nursing positions represent a vital part of the health care system, but it is the PACU that monitors and cares for patients who are coming out of sedation after surgery.

A PACU nurse is a Registered Nurse. According to the U.S. Bureau of Labor Statistics (BLS), the median salary for a registered nurse in 2021 is $77,600 per year, or $37.31 per hour, but conditions in your area may vary. reports the national average salary for PACU nurse as $97,089.

Nurses often work voluntary or mandatory overtime and are compensated with time and a half pay. Additional benefits include holiday, sick time bonuses and other benefits can add thousands of dollars to the total earnings amount.

Top 5 Highest Paying States for PACU Nurses

While the BLS does not differentiate between different types of specialty nurses, reports the following annual salaries for PACU nurses.

  1. Tennessee - $91,975
  2. Massachusetts - $91,470
  3. Hawaii - $91,360
  4. Minnesota - $90,781
  5. Nevada - $90,555

The BLS predicts that registered nurse employment will grow by 9% from 2020 to 2030, much faster than the average career growth rate. PACU nurses should experience the same level of growth, making it an attractive field that offers both job security and lucrative salaries.

(Video) Post-Anesthesia Care – Anesthesiology | Lecturio

Much of this growth in the healthcare field is being driven by a large aging population. Baby Boomers represent the largest generation in America and require more care as they age and enter retirement age.

Show Me Nursing Programs

1. Become a Registered Nurse

Becoming a PACU nurse begins with earning your certification as an RN. There are several paths to becoming an RN. You can earn an Associate degree in nursing, a Bachelor of Science degree or complete a training program, all of which will qualify you to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Once you pass this exam, you can begin working in a medical setting.

2. Gain Experience

There are also several different paths to specializing in PACU nursing. You will need to begin by building experience as an RN. After a couple years, you may be able to move to the recovery unit and learn the specific duties of a PACU nurse. For some hospitals and facilities, the on-the-job experience will be enough to qualify you to be a PACU.

3. Become Certified

However, if you want to further your education and ensure that you are paid for your specialized skills, you will want to become a certified post-anesthesia nurse (CPAN). In order to apply for the certification exam, you must be a licensed RN and have accumulated at least 1,800 hours of clinical experience. Once you pass the certification exam, you will be qualified to practice as a PACU or CPAN.

Show Me Nursing Programs


This list is based on a number of factors including:

  • Reputation
  • NCLEX pass rate
  • Tuition
  • Acceptance rate, when available
  • Only ACEN or CCNE accredited schools are eligible

Because PACU nurses must become RNs and earn professional experience, this list also takes into account clinical experience and BSN outcomes.

Nurse Panel

Our selection panel is made up of 3 Registered Nurses with years of experience and multiple degrees:

  • Tracy Everhart, MSN, RN, CNS
  • Tyler Faust, MSN, RN
  • Kathleen Gaines, MSN, BSN, RN, BA, CBC

There are numerous programs that prepare students to become PACU nurses and our panel of nurses ranked them based on factors mentioned in the methodology. Because individual nursing pathways and careers take various forms, the top 10 programs are ranked in no particular order.

1. Oregon Health and Science University- Portland

Annual Tuition: $93,636

Online: No

Program Length: 4 years

A school that focuses entirely on healthcare and related fields, OHSU ranks among the best universities in the nation for nurse anesthesiology. While undergraduates won't take anesthesiology courses, they will gain clinical experience at OHSU, and that could give them early exposure to PACU nurse duties. OHSU offers an innovative BS with a major in nursing. This three-year program works with local community colleges and doesn't technically lead to a BSN, but it does lead to RN licensure. This quick program makes OHSU an affordable option, and graduates could end up working with some of the best anesthesiologists in the nation.

2. University of Pennsylvania

Annual Tuition: $85,738

Online: No

Program Length: 4 years

The University of Pennsylvania's nursing program ranks among the best in the nation. For future PACU nurses, the BSN's emphasis on clinical practice and mentorship could help students get early exposure to the field. This excellent four-year degree also has students work closely with one another in team settings and gives students the option to study abroad or begin an internship. After graduating, nurses end up working in some of the best hospitals across the country.

(Video) Postoperative Nursing Care | NCLEX RN Review

3. University of Michigan

Annual In-State Tuition: $16,404 Annual Out-of-State Tuition: $55,002

Online: No

Program Length: 4 years

While many people recognize the University of Michigan for its athletics, nurses and healthcare professionals might be more aware of its top-ranked hospital and facilities. Undergraduate students enjoy clinicals at the esteemed hospital, getting exposure to a variety of fields. U-M also boasts an extensive alumni network of more than 13,000 nurses, many of whom could help connect graduates with PACU nursing opportunities. For Michigan residents, U-M also comes at an incredibly affordable cost.

4. University of Minnesota

Annual In-State Tuition: $16,108 Annual Out-of-State Tuition: $35,348

Online: No

Program Length: 4 years

Located in the Twin Cities, the University of Minnesota's BSN program has two routes of entry: direct admission from high school or transfer, including internal transfers. Transfer students study at the Rochester campus which is also home to one of the best hospitals in the world -- the Mayo Clinic. To go this route, applicants must first complete one year of prerequisite courses, followed by a three-year nursing program. Students complete clinicals during the final two years of the program, earning valuable experience at the Mayo Clinic.

5. Johns Hopkins University

Annual Tuition: $72,017

Online: No

Program Length: 2.5 years

Aside from being the home of one of the best hospitals in the nation and top-ranked medical programs, Johns Hopkins University also has a unique nursing program for new nurses: a direct-entry MSN. Created for students with a bachelor's degree in a non-nursing field, the direct-entry MSN satisfies requirements to sit for the NCLEX. The only difference between John Hopkins' MSN and other schools' BSN programs is that nurses graduate with a master's degree from one of the top universities in the world. The MSN helps graduates compete with BSN-holding nurses for some of the top positions -- including PACU nurse jobs.

6. University of Washington

Annual In-State Tuition: $12,078 Annual Out-of-State Tuition: $39,906

Online: No

Program Length: 4 years

The University of Washington's BSN is a two-year program, though students must first complete two years of prerequisite courses. What makes UW's nursing program stand out is more than 1,000 required clinical experience hours at sites across the state, including excellent facilities like the UW Medical Center and Seattle Children's Hospital. This breadth of options lets future RNs work closely with different types of patients. Graduates often find positions in the region, and nurses can begin gaining PACU nurse experience quickly after.

7. University of California Los Angeles

Annual In-State Tuition: $37,448 Annual Out-of-State Tuition: $68,474

Online: No

Program Length: 4 years

Another excellent school with its own world-class hospital, the University of California Los Angeles also boasts one of the nation's best BSN programs. Great for nurses who plan on continuing their education or finding a specialty area (including PACU nursing), the BSN blends clinical learning and theory, providing a more academic-minded education than nurses might find elsewhere. UCLA uses a quarter system and students begin taking nursing courses during their first year.

(Video) Phase I in the PACU. What is Phase I?

8. University of Wisconsin

Annual In-State Tuition: $10,796.40 Annual Out-of-State Tuition: $39,427.44

Online: No

Program Length: 4 years

With many great hospitals in the area, the University of Wisconsin lets nursing students get their clinical experience at multiple sites. Outcomes for the program are highly positive with 93% of recent graduates passing the NCLEX on their first try. UW-Madison uses a two-year nursing program, meaning students complete prerequisites during their first two years but don't start gaining clinical experience until their sophomore year. However, students earn 720 clinical hours during those two years, and graduates find work in various roles across the country.

9. University of Maryland

Annual In-State Tuition: $9,695 Annual Out-of-State Tuition: $37,931

Online: No

Program Length: 4 years

The Baltimore-based University of Maryland has an unbeatable location near some of the most important cities in the nation. Maryland's nursing program more than adequately prepares students for their future career despite only being a two-year program (students complete two years of prerequisite courses first). As with other schools, Maryland's excellent academics and great clinical partners help it stand out and prepare RNs to start gaining PACU experience.

10. University of North Carolina Chapel Hill

In-State Program Cost: $32,255 Out-of-State Program Cost: $91,120

Online: No

Program Length: 4 years

A Public Ivy located in Chapel Hill, the University of North Carolina prepares RNs for an array of careers with graduates working in nearly every field of healthcare (including PACU nursing). Nursing students thrive in part due to UNC's day-one application of knowledge, requiring students to begin gaining experience during their first semester. Students should prepare for a rigorous program, though, since UNC suggests that students complete several courses during the summer.

As with any nursing position, being a PACU nurse means that you work in a fast-paced environment where you have to quickly make critical decisions in order to provide the best patient care. A PACU nurse has to be diligent about monitoring patients as they come out of sedation and immediately take action if there are any complications.

This is a unique position because the patients may not be able to articulate their discomfort. It is up to the PACU to make observations and act.

A big part of being a PACU nurse is comforting patients who have just undergone surgery. They may be scared and confused once they wake up and the anesthesia can exacerbate feelings in some patients. A successful PACU nurse will be able to handle these situations with care and compassion so that the patient is put at ease and can continue their recovery.

Finally, a PACU nurse also serves as a point of contact for patients and their families. They need to be able to clearly communicate care instructions and answer any questions. Being able to work with the public and effectively communicate during stressful times is truly a skill and an important part of being a PACU nurse.

PACU nurses do not necessarily have specific requirements beyond state-mandated continuing education. However, the CPAN recertification does.

All PACU nurses are required to maintain an RN license.

Continuing education requirements for the license differ for each state. Monetary fees and other state-specific criteria are also associated with all license and certification renewals.

Examples of continuing education requirements for RNs are as follows:

(Video) How to be a PACU Nurse: Phases of PACU

  • California - 30 CEUs every two years
  • Florida - 24 CEUs every two years
  • Hawaii - 30 CEUs every two years
  • Oklahoma - 24 CEUs every two years
  • Pennsylvania - 30 CEUs every two years

Some states do not require CEU’s to maintain an RN license. Examples include Arizona, Colorado, Connecticut, Maine, Maryland, and Indiana. Several states also require HIV/AIDS education such as Florida or mandatory child abuse such as Pennsylvania. It is important for nurses to check their state’s RN credentialing body for exact CEU requirements. A comprehensive list can be found here.

The American Board of Perianesthesia Nursing Certification (ABPANC) is the main body that oversees the CPAN certification process. Remember that you must complete 1,800 hours of direct clinical experience over a period of two years before you can apply for certification. In order to earn your certification, you must pass a computer administered exam.

The CPAN certification will need to be renewed every three years. You can either take the exam again or complete 90 contact hours. How many hours need to be split between direct and indirect contact will differ depending on how many times you have been recertified. Outside of the recertification process, there are no there are no other continuing education requirements for PACU nurses.

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While you don’t necessarily need a specialized certification to become a PACU nurse, pursuing a certification is a great way to advance your career and increase your earning potential. Once you have worked as an RN for at least two years and accumulated clinical hours, you can become a Certified post-anesthesia (CPAN) nurse and/or a Certified Ambulatory Perianesthesia (CAPA) nurse. With both certifications, you will be able to oversee both pre and post-surgery care of patients.

To become certified, you will need to pass a comprehensive exam that will test your knowledge of the psychological needs of patients, physical effects of anesthesia, behavioral changes that may occur and other complications that may put the patient at risk.

As an RN, there are many different career paths and opportunities for higher education that you can pursue. For PACU nurses who want to continue to work with patients and anesthesia, you can become a Certified Registered Nurse Anesthetist (CRNA). These highly specialized nurses perform many of the same duties as anesthesiologists. For those with a passion for patients and healthcare, working as a PACU and/or a CRNA nurse can provide a fulfilling and rewarding career that offers opportunities for advancement.

Nurses are part of a tight-knit community that offers a wide variety of professional associations that offer support and will help you keep on top changes and opportunities in the profession, including national conferences. For those exploring various nursing careers, these associations can also be helpful sources for information. Professional associations for PACU nurses include:

According to the U.S. Bureau of Labor and Statistics, there are over 3.1 million nurses or 10 nurses to every 3 doctors. It might be hard to imagine that there are enough nursing positions to accommodate sure a large workforce, but nurses are a vital component of our healthcare system and many facilities are suffering from nursing shortages.

With the right educational background, you can secure a lucrative and fulfilling position that will also offer opportunities for professional development and advancement. Check out nursing jobs hiring in your area on our job board.

If you are willing to relocate, then there are certain states that stand out as great places to work as a PACU:

California: While the housing prices can be high, California is the only state to have mandated patient to staff ratios and other legal protections for nurses. You will be able to provide your patients with the best possible care and avoid burnout.

Texas: There are other states that offer higher salaries, but with a low cost of living, your money will go further and there are plenty of reputable university and VA hospitals where you can gain valuable experience.

Vermont: If you are concerned with your own quality of life, then Vermont offers an attractive combination of outdoor activities, healthy living, and fair salaries. It also offers universal healthcare to residents.

As our population continues to grow and age, the demand for highly skilled nurses will only continue to increase with thousands of new positions becoming available each year.

If you get joy and fulfillment from helping others and you have a tolerance for medical situations, PACU nursing can provide a truly rewarding career along with a lucrative salary.

  • What does a nurse do in PACU?

    • PACU nurses are responsible for all aspects of patient care after they've had surgery. This includes monitoring vital signs, administering medication for pain and nausea, updating and educating the family, and transferring to the inpatient unit or discharging depending on the acuity of the patient. PACU nurses will also be responsible for monitoring the surgical site immediately postoperatively.
  • What makes a good PACU nurse?

    • PACU nurses should be well versed in the surgical care of patients. They must have strong nursing skills and the ability to make independent decisions regarding the care of the patient. Often PACU nurses will be given an order set that will include medications for different levels of pain. It will be based on the nurse’s assessment to determine which medication is best for the patient. PACU nurses should also be compassionate, good educators, and have the ability to work in a team environment.
  • How many patients does a PACU nurse have?

    • PACU nurses will generally have between 1 and 2 patients at a time. Once a patient is transferred to a unit or discharged, the nurse will receive another patient from the OR.
  • (Video) Neuraxial Anesthesia, Epidural & Spinal Blocks! Pain Management 5.2

    What does PACU mean in a hospital?

    • The PACU is a post-anesthesia care unit. This unit is for the post-surgical care of patients that DO NOT need the ICU.
  • Is PACU nursing considered critical care?

    • The PACU is considered critical care and most units will require critical care experience before hiring. Some units will hire without this experience but it is rare.
RN $70,000 - $90,000 Associate Bachelors PACU Bedside


What should the PACU nurse assess first? ›

Phase 1 is the immediate post-anesthesia period, when the patient is emerging from anesthesia and requires one-on-one care. The PACU nurse assesses the level of consciousness, breath sounds, respiratory effort, oxygen saturation, blood pressure, cardiac rhythm, and muscle strength.

What are 3 priority assessments of the PACU nurse? ›

  • Assess air exchange status and note patient's skin color.
  • Verify patient identity. The nurse must also know the type of operative procedure performed and the name of the surgeon responsible for the operation.
  • Neurologic status assessment. ...
  • Cardiovascular status assessment. ...
  • Operative site examination.
Jan 23, 2014

What are the three phases of PACU? ›

The postanesthesia period may be separated into three levels of care: Phase I, Phase II, and Extended Care.

What happens in the post anesthesia care unit? ›

After receiving anesthesia for a surgery or procedure, a patient is sent to the PACU to recover and wake up. The PACU is a critical care unit where the patient's vital signs are closely observed, pain management begins, and fluids are given.

What is a PACU nurse responsibilities? ›

The responsibilities of a nurse in the PACU may include: Monitoring post-operative patients' levels of recovery and consciousness from anesthesia and providing updates to the treatment team as needed. Treating pain, nausea, and other post-operative symptoms of anesthesia and administering medication as prescribed.

What is the most common PACU emergency? ›

PONV 9.8%, upper airway obstruction 6.8%, and hypotension 2.8% are the most common.

What is the criteria for discharge from the PACU? ›

Clients must have a score of “9” to be discharged from PACU unless otherwise approved by the Anesthesiologist.

What are five major risks the RN should be aware of when caring for patients with planned general anesthesia? ›

The following are possible complications of general anesthesia:
  • Sore throat.
  • Nausea and vomiting.
  • Damage to teeth.
  • Lacerations (cuts) to the lips, tongue, gums, throat.
  • Nerve injury secondary to body positioning.
  • Awareness under anesthesia.
  • Anaphylaxis or allergic reaction.
  • Malignant hyperthermia.

How often should observations be done after surgery? ›

Background: Current protocol for post-operative patients admitted to medical-surgical/telemetry units from post anesthesia care units states vital signs are taken every 15 minutes for 1 hour, every 30 minutes for 2 hours and then, every 4 hours for 24 hours.

What is the difference between Phase 1 and Phase 2 PACU? ›

Definition. The PACU is traditionally divided into phases 1 and 2. Phase 1 has monitoring and staffing ratios equivalent to the ICU. Phase 2 is a transitional period between intensive observation and either the surgical ward or home.

What is a normal Aldrete score? ›

A score of 8-10 is considered adequate to discharge a patient from Phase I of post anesthesia care. The specific aim of this project was to determine the effectiveness of the Aldrete scoring tool at this facility.

What is the difference between PACU and post op? ›

Nurses practicing in the post-anesthesia care unit (PACU) care for post-op patients as they regain consciousness after receiving anesthesia. PACU nurses work in both inpatient and outpatient facilities. The PACU is a fast-paced environment, one in which nurses must always remain prepared for an emergency.

Is PACU stressful? ›

It's a stressful juggling act.

How long should a patient be in PACU? ›

Average length of stay in the PACU is 1 to 1.5 hours for minor surgeries and up to 3 to 4 hours for major surgeries. If your family member stays longer than expected, do not be alarmed; a longer stay may be necessary to ensure that the patient receives the very best of care and is comfortable before being discharged.

How many phases are there in PACU? ›

Phase I and II care — PACU care is typically divided into two phases.

Why do you love PACU nursing? ›

There are many reasons why someone may love being a PACU nurse. Some may be attracted by the short patient stay and relatively narrow focus on a core set of patient problems. Others may be relieved by having fewer duties on weekends. Still, for others, the inspiration comes from a deeper sense of fulfillment.

What medications are used in PACU? ›

Usually we give Toradol, IV Acetaminophen, Zofran and occasionally some PO Oxycodone for pain relief. Narcotic analgesics (IV first, PO when able) and anti-emetics are the usual medications given in PACU. In recent years there has been movement toward non-narcotic pain relievers to reduce narcotic use.

What is a potential complication in the post anesthetic care unit? ›

tremors, nausea and vomiting; urinary retention and degree of dependence on care; cardiac dysrhythmias and general complications; complications in the. elderly and surgical positioning.

Are PACU patients intubated? ›

Many patients will be extubated on arrival to the PACU, however a small number will need further support with tracheal intubation. Patient assessment is a key role for the PACU staff and using the ABCDE approach will provide a systematic method for assessing the patient and determining suitability for extubation.

Who is responsible for discharging a patient from PACU? ›

A PHYSICIAN IS RESPONSIBLE FOR THE DISCHARGE OF THE PATIENT FROM THE POSTANESTHESIA CARE UNIT. 1. When discharge criteria are used, they must be approved by the Department of Anesthesiology and the medical staff.

How often do you do the Aldrete score? ›

As a general rule: 3 points below baseline: Every 5 minutes with constant (1:1) monitoring. 2 points below baseline: Every 15 minutes with constant monitoring of vital signs. 1 point below baseline: Every 15-30 minutes with vital signs depending upon patient condition.

How is Aldrete scale used? ›

Aldrete's scoring system is a commonly used scale for determining when postsurgical patients can be safely discharged from the post-anesthesia care unit (PACU), generally to a second stage (phase II) recovery area, hospital ward, or home.

How do you set up a PACU? ›

How to setup your PACU Bay for a successful shift - YouTube

What makes a good Anaesthetic nurse? ›

The anaesthetic nurses requires: good assessment skills. a knowledge of anaesthetic methods, anaesthetic agents and equipment. an understanding of fluid balance and respiratory monitoring, cardiac monitoring and haemodynamic monitoring, and the ability to identify any changes that may have impact on the patient.

What is a Post op assessment? ›

Post-operative checks are a formal means of assessing how a patient is doing following an operation and if necessary, to make appropriate changes in the patient's post- operative care. • This should be performed 4 to 6 hours following an operation.

What is a pacu quizlet? ›

post-anesthesia care unit.

How do you individualize a patient's care plan Epic quizlet? ›

To individualize your patient's care plan, edit the goals and interventions by adding one or two sentences to the goals and interventions that are specific for the patient? The student nurse successfully discontinued an IV in the right forehand of their client.


1. Anesthesia to PACU Handoff
(Abby Davis)
2. Post Anesthesia Care Unit
3. PACU and Observation Unit - Behind the Scenes - Nebraska Medicine
(Nebraska Medicine Nebraska Medical Center)
4. Laryngospasms, lets talk complications in the PACU!
(PACU Nursing Minutes)
5. Day of Surgery -- Post Anesthesia Care Unit
(Irwin Army Community Hospital)
6. Post-Anesthesia Recovery - (Dr. Fain)
(University of Kentucky Department of Anesthesiology)
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