Abstract
Purpose
Design
Methods
Findings
Conclusions
Keywords
Methods
Development of Survey
Data Collection
Data Analysis
Results

Education
Length of Education to Qualify for Eligibility to Practice as a Registered Nurse | Formal Education for Perianesthesia Nurses | |
---|---|---|
NL | 4 y | Yes |
IRL | 4 y | Yes |
GR | 4 y | No |
CAN | 4 y | No |
DK | 4 y | No |
USA | 4 y (2 y Associate's Degree in Nursing) | No |
FIN | 3.5 y | No |
AUS | 3 y | Yes |
NZ | 3 y | No |
SWE | 3 y | No |
UK | 3 y | No |
Staffing in the PACU
Stationed at PACU | On Call/As Consultants | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Never | In Some PACUs | In Most PACUs | In all PACUs | Do not Know | Never | In Some PACUs | In Most PACUs | In all PACUs | Do not Know | |
Anesthesia provider | AUS DK FIN IRL NL NZ | CAN GR USA | SWE | UK | — | AUS CAN | GR NZ USA | DK FIN IRL NL SWE UK | — | |
Surgeon | AUS DK FIN GR IRL NZ NL USA | CAN SWE | — | UK | — | AUS CAN GR | NZ NL USA | DK FIN IRL SWE UK | — | |
Nurse assistant | CAN GR NL IRL | AUS DK FIN NZ USA | — | SWE | UK | AUS CAN DK FIN SWE NL USA | NZ | — | IRL | GR UK |
Pharmacist | AUS CAN DK FIN GR IRL NZ NL | SWE USA | — | — | UK | — | AUS FIN NZ | CAN DK USA | IRL UK | GR SWE NL |
Physical medicine/physiotherapist | AUS CAN DK FIN GR IRL NZ NL USA | — | SWE | — | UK | AUS | FIN NZ NL | CAN USA | IRL UK | DK GR SWE |
Respiratory therapist | AUS CAN DK FIN GR IRL NZ SWE NL | USA | — | — | UK | AUS DK FIN NZ SWE | — | CAN USA | IRL UK | GR NL |
Occupational therapist | AUS CAN DK FIN IRL NZ NL USA | — | — | — | GR SWE UK | AUS DK FIN | NZ USA | CAN | IRL UK | GR SWE NL |
Advanced practice nurse | CAN DK IRL NZ NL SWE | UK USA | AUS FIN | — | GR | CAN NZ | USA | AUS FIN | IRL | DK GR SWE NL UK |
Other | USA: Social workers, child life specialists (pediatric specific settings), radiology |
Phase I Recovery, Critically Ill Patients | Phase I Recovery, Stable Patients | Phase II Recovery (Day Surgery) | |
---|---|---|---|
GR | 2:1-1:1 | 1:1 | 1:1-1:2 |
UK | 1:1 | 1:1 | 1:1 |
IRL | 1:1 | 1:1 | 1:2 |
CAN | 1:1 | 1:1 | 1:4 |
USA | 1:1 | 1:2 | 1:3 |
NZ | 1:1 | 1:1-1:3 | 1:3 |
SWE | 1:1-1:2 | 1:2 | 1:4 |
AUS | 1:2 (Unconscious 1:1) | 1:2 | 1:3-4 |
DK | 1:2 | 1:2 | 1:2 |
NL | 1:3 (max) | 1:3 | 1:3-1:4 |
FIN | Depends on unit and nurse experience | Depends on unit and nurse experience | Depends on unit and nurse experience |
Job Tasks in the PACU
Never | Under Direct Supervision | Supervision on Call And/or According to the Protocol | Autonomously | |
---|---|---|---|---|
CAN | 5 | — | 1 | 31 |
NZ | 3 | — | 1 | 31 |
FIN | 3 | — | 4 | 30 |
USA | 3 | — | 5 | 29 |
UK | 3 | — | 1 | 27 |
DK | 10 | — | 1 | 26 |
IRL | 8 | — | 3 | 26 |
SWE | 1 | 2 | 11 | 21 |
NL | 12 | 2 | 3 | 20 |
AUS | 7 | — | 16 | 14 |
GR | 6 | 9 | 9 | 13 |

Resuscitation

Discharge from the PACU
Scoring/Discharge Criteria | Discharge | |||
---|---|---|---|---|
Phase I recovery | Phase II recovery | From PACU, Phase I recovery | From day surgery unit, Phase II recovery | |
AUS | Aldrete. Pain score, GCS | FAS, ABC, activities scoring | Supervision on call/according to the protocol | Supervision on call/according to the protocol |
CAN | Modified Aldrete | Criteria laid out by the management | Supervision on call/according to the protocol | Supervision on call/according to the protocol |
DK | National recommendations | National recommendations | Autonomous | Autonomous |
FIN | Local discharge criteria | Local discharge criteria | Supervision on call/according to the protocol | Supervision on call/according to the protocol |
GR | Spontaneous breathing | Good level of consciousness, hemodynamic stability and pain score <5 | Autonomous | Autonomous |
IRL | Aldrete | Aldrete | Autonomous | Autonomous |
NL | Aldrete, VRNS | Aldrete, VRNS | Autonomous | Autonomous |
NZ | Apgar/adjusted Apgar | Discharge score. | Supervision on call/according to the protocol | Supervision on call/according to the protocol |
SWE | Local guidelines | Local guidelines | Supervision on call/according to the protocol | Supervision on call/according to the protocol |
UK | Alderete/NEWS2 | Depending on hospital | Autonomous | Autonomous |
USA | Aldrete/local specific elements | PADSS/local specific elements | Supervision on call/according to the protocol | Supervision on call/according to the protocol |
Discussion
- Juhász E.H.
- Iversen M.
- Samuelson A.
- Bäckström R.
- Nilsson U.
Implications for Global Practice
Limitations
Conclusions
Supplementary Data
Appendix 1. Copy of Items Included in the Survey
- 1.Which country do you represent?
- 2.Is perianaesthesia nursing recognized as a professional nursing specialty in the country by governance board?
- □Yes
- □No
- 3.Are there established national guidelines or practice standards for the nurse working in the PACU?
- □Yes
- □No
- 4.Are there local guidelines or policies (hospital or regional driven) for the nurses working in the PACU?
- □Yes
- □No
- 5.Length of education completed to qualify for eligibility to practice as a registered nurse (please answer in years)
- 6.In your country, is there a formal education for the nurse working in the PACU?
- □Yes
- □No
- 7.What kind of training is offered for nurses working in the PACU?
- 8.Length of that training? (months)
- 9.Please specify who is responsible for that training? (eg, University, clinic, unit educator)
- 10.The common nurse patient ratio in PACU in Phase 1 recovery, critically ill patients.
- 11.The common nurse patient ratio in PACU in Phase 1 recovery, stable patients.
- 12.The common nurse patient ratio in PACU in Phase 2 recovery (day surgery)
Caring for the Pediatric Patient | Never | In Some PACUs | In Most PACUs | In all PACUs | Don't Know |
---|---|---|---|---|---|
13. Infant (0-1 yr) | |||||
14. Toddler (1-3 yr) | |||||
15. Preschool age (3-6 yr) | |||||
16. School age (6-12 yr) | |||||
17. Adolescent (12-20 yr) |
Tasks performed by the nurse working in the PACU | Never | Under direct supervision | Supervision on call and/or according to the protocol | Autonomous (without supervision) | Don't know |
---|---|---|---|---|---|
18. Suction of airways | |||||
19. Suction of tracheostomy | |||||
20. Insert oropharyngeal airway | |||||
21. Remove oropharyngeal airway | |||||
22. Insert nasopharyngeal airway | |||||
23. Remove nasopharyngeal airway | |||||
24. Removal of laryngeal mask | |||||
25. Removal of endotracheal tube | |||||
26. CPAP device | |||||
27. Patient on ventilator | |||||
28. Insert IV cannula | |||||
29. Insert a central venous catheter | |||||
30. Insert arterial line | |||||
31. Sampling blood for lab analyses | |||||
32. Sampling arterial blood gas | |||||
33. Bladder scanning | |||||
34. Urethral catheters | |||||
35. Bladder irrigation | |||||
36. Mobilization of the patient in the PACU | |||||
37. Monitoring heart rate | |||||
38. Monitoring ECG | |||||
39. Monitoring SPO2 | |||||
40. Monitoring end tidal CO2 | |||||
41. Monitoring noninvasive blood pressure | |||||
42. Monitoring invasive BP | |||||
43. Monitoring CVP (central venous pressure) | |||||
44. Monitoring PCWP (pulmonary capillary wedge pressure) | |||||
45. Monitoring ICP (intracranial pressure) | |||||
46. Connecting and adjusting a pacemaker | |||||
47. Temperature assessment | |||||
48. Pain assessment | |||||
49. PONV assessment | |||||
50. Informing next of kin | |||||
51. Intravenous injections | |||||
52. Intramuscular injections | |||||
53. Injections into an epidural catheter | |||||
54. Starting PCA/PCEA |
Resuscitation | Never | Under supervision | Autonomous | Don't know |
---|---|---|---|---|
55. Heart compressions | ||||
56. Ventilation during resuscitation | ||||
57. Defibrillation |
Discharge | Never | Under direct supervision | Supervision on call and/or according to the protocol | Autonomous (without supervision) | Don't know |
---|---|---|---|---|---|
58. From PACU | |||||
59. From day surgery unit, Phase 2 recovery | |||||
60. What kind of scoring/discharge criteria's are used for Phase 1 recovery? | |||||
61. What kind of scoring/discharge criteria's are used for Phase 2 recovery (day surgery)? | |||||
62. Are communication tools used for handover? | |||||
63. Please specify the type of communication tool. |
Other professions in the PACU | Stationed at PACU | On call/as consultants | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Never | In some PACUs | In most PACUs | In all PACUs | Don't know | Never | In some PACUs | In most PACUs | In all PACUs | Don't know | |
64. Anesthesia provider | ||||||||||
65. Surgeon | ||||||||||
66. Nurse assistant | ||||||||||
67. Pharmacist | ||||||||||
68. Physical medicine/physiotherapist | ||||||||||
69. Respiratory therapist | ||||||||||
70. Occupational therapist |
Australia | Canada | Denmark | Finland | Greece | Ireland | New Zealand | Sweden | The Netherlands | United Kingdom | United States of America | |
---|---|---|---|---|---|---|---|---|---|---|---|
Suction of airways | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Suction of tracheostomy | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous |
Insert oropharyngeal airway | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Never | Autonomous | Autonomous |
Remove oropharyngeal airway | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous |
Insert nasopharyngeal airway | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Under direct supervision | Autonomous | Autonomous |
Remove nasopharyngeal airway | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous |
Removal of laryngeal mask | Autonomous | Autonomous | Never | Autonomous | Under direct supervision | Autonomous | Autonomous | Under direct supervision | Autonomous | Autonomous | Autonomous |
Removal of endotracheal tube | Never | Autonomous | Never | Supervision on call and/or according to the protocol | Under direct supervision | Never | Autonomous | Under direct supervision | Never | Do not know | Autonomous |
CPAP device | Do not know | Autonomous | Autonomous | Autonomous | Under direct supervision | Supervision on call and/or according to the protocol | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Do not know | Supervision on call and/or according to the protocol |
Patient on ventilator | Never | Supervision on call and/or according to the protocol | Never | Autonomous | Supervision on call and/or according to the protocol | Never | Never | Do not know | Never | Do not know | Supervision on call and/or according to the protocol |
Insert IV cannula | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Insert a central venous catheter | Never | Never | Never | Supervision on call and/or according to the protocol | Never | Never | Never | Never | Never | Never | Never |
Insert arterial line | Never | Never | Never | Never | Under direct supervision | Never | Never | Supervision on call and/or according to the protocol | Never | Never | Never |
Sampling blood for lab analyses | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Never | Autonomous | Autonomous |
Sampling arterial blood gas | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Under direct supervision | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Never | Autonomous | Supervision on call and/or according to the protocol |
Bladder scanning | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Never | Never | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous |
Urethral catheters | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Never | Autonomous | Don't know | Autonomous | Autonomous | Autonomous | Autonomous |
Bladder irrigation | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Never | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Mobilization of the patient in the PACU | Supervision on call/according to the protocol (safe moves mandatory assessment yearly) | Autonomous | Never | Autonomous | Never | Autonomous | Do not know | Autonomous | Autonomous | Autonomous | Autonomous (per licensed provider (physician, APRN) orders) |
Connecting and adjusting a pacemaker | Supervision on call/according to the protocol (magnet device) | Never | Never | Never | Never | Never | Supervision on call/according to the protocol (specialized PACU care. reworking in cardiac unit) | Do not know | Never | Do not know | Supervision on call/according to the protocol (variable based on location, dependent on patient type, procedures performed (cardiovascular surgery center vs freestanding ambulatory surgery center), skill and training of nurses). |
Informing next of kin | Supervision on call/according to the protocol (with Dr orders. Depends on what information you are giving. We only inform that the patient is in the PACU) | Autonomous | Autonomous | Never | Supervision on call/according to the protocol | Supervision on call/according to the protocol | Autonomous (in some PACUs) | Autonomous | Never | Autonomous | Supervision on call/according to the protocol (Depends on the content that is being shared with the next of kin) |
Monitoring heart rate | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Monitoring ECG | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Monitoring SPO2 | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Monitoring end-tidal CO2 | Never | Autonomous | Never | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Never | Autonomous | Autonomous |
Monitoring noninvasive blood pressure | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Monitoring invasive blood pressure | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Monitoring central venous pressure | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Never | Autonomous | Autonomous |
Monitoring pulmonary capillary wedge pressure | Supervision on call and/or accordingto the protocol | Never | Never | Supervision on call and/or according to the protocol | Under direct supervision | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Never | Do not know | Autonomous |
Monitoring intracranial pressure | Supervision on call and/or according to the protocol | Autonomous | Never | Autonomous | Under direct supervision | Never | Autonomous | Supervision on call and/or according to the protocol | Under direct supervision | Do not know | Autonomous |
Intravenous injections | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Intramuscular injections | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Injections into an epidural catheter | Never | Never | Supervision on call and/or according to the protocol | Autonomous | Under direct supervision | Never | Autonomous | Autonomous | Autonomous | Never | Supervision on call and/or according to the protocol |
Starting PCA/PCEA | Supervision on call/according to the protocol | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Under direct supervision | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous | Autonomous |
Temperature assessment | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous |
Pain assessment | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous |
PONV assessment | Autonomous | Autonomous | Autonomous | Autonomous | Do not know | Autonomous | Autonomous | Autonomous | Supervision on call and/or according to the protocol | Autonomous | Autonomous |
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Footnotes
Conflict of interest: None to report.
Jan Odom-Forren, who is co-editor of Journal of PeriAnesthesia Nursing, was not involved in the editorial review or decision to publish this article. The entire process from submission, referee assignment, and editorial decisions was handled by Vallire D. Hooper, the other co-editor of this journal.
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