Recovery room nurses, also known as post-anesthesia care unit (PACU) nurses, treat patients immediately after surgery. PACU nurses monitor patients as their anesthesia wears off and they return to consciousness. They watch for anesthesia side effects, control their patients’ pain, answer questions, and update family members.
After some minor surgeries, recovery room nurses may get patients out of bed and ensure they are stable enough to be discharged. PACU nurses can work with any age group and usually work eight- or 12-hour shifts. Since many surgeries are scheduled, recovery room nurses may enjoy free weekends and holidays. However, all PACU nurses are required to take “on-call” shifts for emergency surgeries.
Where Do Recovery Room Nurses Work?
Since recovery room nurses work with patients coming out of anesthesia, their position falls into the critical-care category and has historically been performed in the hospital. As technology advances continue, however, more and more surgeries are becoming less invasive, with fewer complications and a faster recovery. With these improved techniques, many surgical procedures have become available in same-day or outpatient surgery centers.
Patients who have surgery done at an outpatient surgery center receive the same types of anesthesia, and so need similar monitoring afterward. However, their incisions are smaller, so they can return home that day to recover. Some typical outpatient surgical procedures include:
Bunionectomy
Cardiac pacemaker/defibrillator insertion, revision, replacement, or removal
Cataract removal
Cholecystectomy
Hernia repair
Hysterectomy
Lumpectomy of the breast
Myringotomy
Peripheral nerve decompression
Plastic surgery of the breast
Tonsillectomy/adenoidectomy
Vascular stents (other than head or neck)
Surgeries that must still be done in the hospital require more monitoring and assisted recovery. A hospital stay after surgery also allows for more robust pain management. Some common surgeries that must be completed in the hospital are:
Angioplasty/atherectomy
Appendectomy
Arterial stent placement
Broken bone repair like open reduction and internal fixation (ORIF)
Coronary artery bypass graft (CABG)
C-section
Joint replacement
Oncologic surgical procedures
Organ transplant
Spinal surgery
What Does a Recovery Room Nurse Do?
When a patient is wheeled out of the OR on a stretcher and arrives in the recovery room, their nurse must be ready for anything. In the OR, the patient was under deep sedation, intubated, and even though they couldn’t feel anything, their body was under a lot of stress. When a patient begins to wake up, they can express disorientation and pain.
PACU nurses know how to juggle several vital tasks simultaneously, all while comforting and reorienting their patients. Depending on the procedure, recovery room nurses may have one to two patients. These patients come out stable, but vulnerable. Some react differently to anesthesia medications and can experience side effects upon waking, like:
Confusion
Headache
Itching
Muscle aches
Nausea/vomiting
Shivering/shaking
Sore throat
Patients also may begin to feel pain from their surgical incision as they regain consciousness, and PACU nurses have standing orders to give as much pain medication as patients need, within safety parameters. When the patient first arrives, recovery room nurses must take frequent vital signs, measuring heart rate, blood pressure, respiratory rate, oxygen saturation, and temperature. As patients become more alert and certain benchmarks are met, they may take vital signs less often.
Depending on the facility, PACU nurses may also be responsible for updating patient family members. Families are often asked to wait until patients have woken up before they can see them, so news from the recovery nurse is appreciated. In the hospital, PACU nurses determine when their patient is ready to go to their hospital room and help transport them to their inpatient unit. Once there, they give report to the unit nurse and head back to the recovery room to take another patient.
In an outpatient surgery center, PACU nurses may send patients directly home after surgery. In this case, they get patients out of bed, get them some food, ensure they can urinate, and then send them home with a family member or friend. In these settings, recovery room nurses also must provide detailed discharge instructions and ensure their patients can retrieve prescribed medications from a local pharmacy.
Recovery room nurses see patients in a vulnerable position. Many surgeries are completely successful with few to no complications. However, difficulties can arise, and PACU nurses must be on high alert for any of these issues:
Airway problems
EKG changes
Malignant hypothermia
Oversedation
Wound dehiscence
How Do I Become a Recovery Room Nurse?
Anyone who wants to be a PACU nurse must first attend and graduate from an accredited nursing program with a Bachelor of Science in Nursing (BSN), which takes four years to complete. Some programs offer an accelerated degree option that can be finished in a year to 18 months. PACU nurse candidates may also earn an Associate Degree in Nursing (ADN), which takes two years. However, more and more employers are showing a preference for the BSN.
After graduation, nurses may apply for recovery room nursing positions as graduate nurses (GNs). They can begin their orientation as GNs under nurse preceptors: experienced nurses who train them as they prepare for the National Council Licensure Examination (NCLEX-RN), their state licensing exam. Once they pass the NCLEX, GNs become registered nurses (RNs), and after their orientation period, they can practice nursing on their own. Before treating any patients, recovery room nurses must obtain their basic life support (BLS) and advanced cardiovascular life support (ACLS) certifications.
After a few years of experience, recovery room nurses may want to take an exam to earn a specialty certification. They can also return to school to earn a Master of Science in Nursing (MSN) and become surgical nurse practitioners (NPs). Recovery room nurses can graduate with their MSN in two years but can take longer to complete it if they work full-time.
PACU nurses can earn their certified post-anesthesia nurse (CPAN) and certified ambulatory perianesthesia nurse (CAPA) through the American Board of Perianesthesia Nursing Certification (ABPANC). To do so, they will have to give evidence of:
A current RN license
1,200 hours of direct clinical experience within two years before application
These two certifications focus on different aspects of surgical nursing. The CPAN covers postanesthesia phase I, while the CAPA specializes in:
Preanesthesia phase
Postanesthesia phase II
Extended care
Recovery room nurses can test for both certifications at once, but dual certification requirements are a little different:
A current RN license
At least 1,200 hours of direct clinical experience with patients in postanesthesia phase I AND
At least 1,200 hours of direct clinical experience caring for patients in pre-anesthesia phase, postanesthesia phase II, and/or extended care
How Much Does a Recovery Room Nurse Make Per Year?
A recovery room nurse can earn the same annual salary as any other registered nurse. RNs make an average of $81,220 per year as of 2022, according to the U.S. Bureau of Labor Statistics (BLS). Salary can differ by location and experience, from a low-end average of $61,250 to a high-end of $129,400. Depending on your workplace, your employer may be able to offer higher or lower compensation:
General Medical and Surgical Hospitals: $90,600
Outpatient Care Centers: $97,200
Salaries also vary depending on which state a recovery room nurse practices. The West Coast, New England states, and Alaska pay their nurses the best, but the cost of living in these areas can also be high. The lowest paying states are in the Midwest and some southeastern states.
Recovery room nurse practitioner salaries are higher than RNs’, with average annual earnings of $121,610, according to BLS data from 2022. The low-end average was $87,340, and the high-end was $165,240. Salary can also change based on employment type:
General Medical and Surgical Hospitals: $129,330
Outpatient Care Centers: $134,030
The location of employment can affect recovery room nurse practitioners as well, with differences similar to RNs.
The top paying areas for recovery room nurses and nurse practitioners include:
San Jose-Sunnyvale-Santa Clara, CA
San Francisco-Oakland-Hayward, CA
Napa, CA
Vallejo-Fairfield, CA
New York-Newark-Jersey City, NY-NJ
Yuba City, CA
Sacramento–Roseville–Arden-Arcade, CA
Recovery room nurses with a specialty certification can earn more than nurses who are not certified. The more experience a recovery room nurse has, the more they can earn.
Are Recovery Room Nurses in High Demand?
All nurses are in short supply in the United States. The U.S. Department of Health and Human Services reports that 24% of U.S. hospitals have critical staffing shortages. According to a study published in the International Journal of Surgery, 40 to 50 million Americans have major surgery annually. With aging comes increased health risks, and more surgeries may be needed in the near future. According to the U.S. Census Bureau, everyone from the baby boomer generation will be 65 or older by 2030. As surgery demand increases, so will the demand for PACU nurses.
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