Betsy Garton-Park, BSN  
Research and Evidence Based Nursing Chair
Precept Coordinator PACU/Critical Caring Service Team

Background

I received my BSN from Alfred University. I attended ASU, but I did not complete my Master's thesis in SICU Clinical Nurse Specialist. I worked in Phoenix, Arizona for 11 years in a SICU and PACU. I also was clinical instructor for Maricopa Community College System for 5 years.

Time at Highland Hospital

When I moved back to Rochester in 1988, I interviewed at larger hospitals in the area, but I liked the atmosphere at Highland. I've been here ever since. It's so comfortable to be able to walk through the hospital and know people, if not by name at least by their faces. It's my home away from home.

Career Path at Highland Hospital

I started per diem in the ICU and then moved to the PACU.

My Dominant Personality Traits

I'm empathic with my patients but competitive with myself. I always have a new goal. I like being accountable and performing my job at the highest level. I'm naturally analytical and can work through problems easily and remain calm under pressure. Quick decisions have to be made in the PACU and I'm comfortable with that.

About the Post-Anesthesia Care Unit

It's fun to work on this unit. We recover inpatients, including day of surgery admissions and short-stay patients as well as outpatients in our 14-bed main PACU.

We see a wide variety of patients undergoing all types of surgeries including orthopaedic, bariatric, plastics, gynecology and neuro, and of course we’re the best place in the city for all your general surgery needs. We do treat children, but mostly we see adults.   

When our patients arrive, they're extremely vulnerable and anything can happen. You need top-notch assessment skills, and a critical care background really helps. I like having to use my mind to critically think and anticipate potential complications before they happen. Patients may start out very unstable, requiring ICU care, but after our intensive nursing care they’re better and on the way to their rooms. We occasionally discharge patients home, especially if it's getting late in the evening. The great thing about working as a PACU RN is that I may interact with a elderly gentleman who is undergoing a procedure to eradicate prostate cancer and send him home and my next patient rolling into the PACU could be a critically ill patient on a ventilator with an assortment of monitoring lines and IV medications and drips after undergoing a long procedure.

In the PACU we see about 40 cases a day, hopefully between 7:30 a.m. to 11:30 p.m., but we are responsible for all post-operative care 24/7. Our ORs are very busy and fast-paced, as we have one of the shortest turnover times (the time between OR cases) in the city. In the PACU you have to be energetic. We get ‘em in and get ‘em out! I might have 6, 7, or 8 patients a day. We have staggered shifts of 8- and 12-hour people. We are supported by national standards set by American Society of Perianesthesia Nurses, and take care of a maximum of 2 patients per 1 RN at one time. We all volunteer to cover nights and weekends as call. I take 2-3 nights shifts per month and 1 48-hour weekend every 5 weeks, or so. Flexibility is a must. If patients are still coming in when it's your time to go home, you may have to stay (in all likelihood our PACU RNs wouldn't think of leaving until the busyness was over). Fortunately, flexibility goes both ways here. When I need to adjust my schedule, my management goes out of their way to help me out.  

Training here is great. It has to be. We have to know what to expect from various types of surgeries. We must be fully proficient in managing respiratory instability, cardiac, and neuro issues and all the complexities of pain remediation. Sometimes we have to deal with confused and even combative patients.

Career advancement is important to me. Highland's administration is serious about retaining good nurses, so they give it a lot of attention. They've developed a culture of performance improvement and corresponding rewards. I recently served on the revamped clinical ladder task force. 

I think PACU nursing has a lot to offer. It's a stimulating environment. You get to use all of your diverse nursing skills. It's like an ICU but without the more depressing parts. People rarely die in a PACU. The relationships with your patients are short but intense. The "my patient/your patient" concept doesn't exist the way it does on a floor. We work as an integrated team. The patient turnover rate is too high to do otherwise. We respect and trust each other.