New Nurse in Peri-Anaesthesia? Check out these TIPS!

by | Sunday, March 13, 2022

Hey Friends,

Today’s blog is for new graduates and new nurses who have landed a position in peri-anaesthesia, or you are a nurse who is interested to give this fantastic clinical area a go. As many of you know, I am not only a peri-anaesthesia nurse specialist; I also completed my new graduate year in anaesthetics and recovery! This blog post is sure to provide you with plenty of value as you learn the clinical specifics and progress with your journey in peri-anaesthesia nursing.

I wanted to share the key areas in peri-anaesthesia nursing with you and what I found helpful to learn as I progressed in the area. We will look at what I found helpful starting as a grad, including the knowledge, skills, hints, tips and more!

Let’s have a look!

Important Aspects of Peri-Anaesthesia Nursing

  • A breakdown of the important aspects of peri-anaesthesia nursing for new nurses – a FREE guide for YOU!

The Role of the Peri-anaesthesia Nurse

Anaesthesia Nurse

The anaesthetic nurse is the assistant to the anaesthetist. They:

  • prepare the environment and equipment for the patient
  • prepare equipment for administering the anaesthetic
  • receive the patient into the operating room, establish rapport by asking and answering any questions, and check identification and consent
  • communicate relevant patient information to the other members of the intra-operative team, both nurses and doctors
  • assist with intra-operative patient monitoring and ensure the patient’s safety, comfort and warmth
  • assist the anaesthetist at the end of the procedure as the patient emerges from the effects of anaesthesia.

Position statement on the assistant for the anaesthetist – CLICK HERE

Knowledge and skills

The anaesthetic nurse 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
  • knowledge of airway anatomy and physiology, airway management strategies and anaesthetic complications.

Becoming an Anaesthesia Nurse – Education pathway

This role is suitable for both registered and enrolled nurses. Registered nurses need to complete a Bachelor of Nursing degree and a postgraduate degree that focuses on anaesthetic nursing. Enrolled nurses need to complete a Diploma of Nursing that includes medication administration and a Diploma of Anaesthetic Technology.

Post-Anaesthesia Care Nurse

The Post Anaesthesia Care Unit (PACU) nurse receives the patient into the PACU (also known as the recovery unit). They:

  • undertake respiratory, cardiovascular and neurological assessment and monitoring as the patient recovers from the effects of anaesthesia and surgery
  • monitor emergence from anaesthesia, dressings, intravenous lines and drainage tubes
  • implement and document post-operative treatment regimes including pain management.

Knowledge and skills

The PACU nurse requires:

  • strong knowledge of and ability to manage post-operative complications and respond to patient deterioration quickly and efficiently
  • advanced airway management skills
  • the ability to quickly recognise respiratory compromise and take necessary action
  • excellent assessment skills
  • strong knowledge of pain management methods and medications
  • excellent communication skills
  • the ability to work as an effective member of a multidisciplinary team.

Becoming a Recovery or Post-Anaesthesia Care Nurse – Education pathway

This role is suitable for registered nurses who have completed a Bachelor of Nursing degree and a postgraduate degree that focuses on post-anaesthetic care.

Enrolled nurses who have completed a Diploma of Nursing that includes medication administration may work in second-level recovery care where patients require a period of supervised monitoring, privacy for the discussion of procedural outcomes and discharge instructions, bathroom facilities and provision of food and fluids. Criteria for discharge from second stage recovery include pain and nausea control manageable with oral medications, return of cognition to pre-procedure levels, and the ability to be mobile safely.

Pharmacology (including GA + Muscle Relaxants & Reversal) used in Anaesthesia & Post-Anaesthesia Care

Different types of anaesthesia – General, sedation, local, regional, combination

Main anaesthesia medications

Muscle relaxants – depolarising and non-depolarising

Patient Monitoring

Invasive monitoring – CVL, ART

5 Lead cardiac monitoring

Capnography

Common Respiratory Complications

Recognising & managing these complications

Acute Pain Management

Comprehensive pain assessment

PQRST pain assessment

Multimodal Pain Management

Emergencies in the Peri-operative Environment

Look at the management of these emergencies:

  • Anaphylaxis
  • Local anaesthetic toxicity
  • Malignant Hyperthermia
  • Difficult Airways – Cannot Intubate, cannot oxygenate
  • Laryngospasm

Patient Assessment

  • Respiratory
  • Cardiovascular
  • Neurological
  • Neuro-vascular
  • Circulatory
  • Fluid Balance

Caring for the Patient having Regional Anaesthesia

  • What are they?
  • Why are they used?
  • What are the benefits?
  • How do they differ from GA & sedation?
  • Can you have a GA &/or sedation with regional anaesthesia?
  • What are the differences between these types of regional anaesthesia?
    • Epidural
    • Spinal
    • Major joint
    • Extremity

Study Guide for your Journey in Peri-Anaesthesia

Knowledge Areas

Foundational knowledge to brush up on prior to starting or to reflect upon along the journey within the first few weeks to build confidence and nail your skills!

  • Specific Roles of the anaesthetic and post anaesthetic care unit nurse
  • Pharmacology utilised for general anaesthesia, sedation, local and regional blocks
  • Monitoring a patient before, during and after anaesthesia
  • Respiratory complications
  • Airway anatomy + physiology
  • Airway assessment + management
  • Acute pain management
  • Peri-operative emergencies
  • Patient Assessment
  • Caring for patients who have had regional anaesthesia
  • Devices and equipment utilised in peri-operative and peri-anaesthesia clinical practice
  • Medications:
    • Propofol
    • Midazolam
    • Opiates: Fentanyl, Morphine, Hydromorphone, Alfentanil, Remifentanil, Buprenorphine
    • Ketamine
    • Droperidol
    • Dexamethasone
    • Ondansetron
    • Parecoxib
    • Paracetamol
    • Atropine
    • Ephedrine
    • Metaraminol
    • Rocuronium
    • Suxamethonium
    • Clonidine
    • Epinephrine
    • Neostigmine
    • Sugammadex
    • Desflurane
    • Sevoflurane
    • Isoflurane
    • Oxycodone
    • Targin
    • Tramadol
    • Ropivacaine

Skills

You will be exposed to, practice and develop advanced nursing skills surrounding airway, breathing, circulation, disability, pain and exposure. Familiarise yourself with these clinical skills in peri-anaesthesia and identify your roles as an anaesthetic or recovery nurse.

Airway Skills

Basic airway management skills for Nurse’s video

CLICK HERE

Skills covered include:

  • Chin lift, jaw support, head tilt and jaw thrust
  • Non-invasive airway management devices – oropharyngeal and nasopharyngeal airways
  • Differences with Adults vs children & infants

Airway Management

  • Suctioning
  • Airway cart and equipment
  • Suction airway
  • Assist ETT Intubation with manual and video laryngoscopes
  • Cricoid pressure
  • Verification of ETT placement: CO2 detector, auscultation, CXR
  • Use of bag-valve-mask
  • Assist with tapes
  • Insertion LMA

Clinical Competencies

The required clinical competencies ranges and depends on the specific clinical area you are in and the type of peri-operative services the hospital provides.

Common competencies include:

Anaesthesia & Post Anaesthesia Care Nurses:

  • Patient Assessment
  • Patient Monitoring
  • Management of the unconscious and semi-conscious patient
  • Airway management including the removal of LMA upon the emergence of GA
  • Assisting anaesthetists
  • A-G patient assessment
  • Manage pain and primary assessment complications in the immediate post-operative stage
  • Manage the thermic state of the patient
  • Use various pieces of equipment for the care of the patient including:
    • Use of doppler
    • PCA
    • Transducers
    • Chest drains

Non Clinical Skills

Communication Teamwork Time Management

Resources for the Anaesthetic Nurse

  • Emergency Department Notes
  • Handover from Emergency Team
  • Pre-operative Assessment
  • Progress Notes
  • The patient

Resources for the PACU Nurse

  • All of the above
  • The patient (sometimes)
  • Anaesthetic Record
  • Anaesthetic Handover
  • Scrub Nurse Handover

Getting prepared

I was always searching for the best and up to date information. Along the journey, I found and developed some great resources. I decided to collate them all together here in one place for us all to enjoy!

Check it 👇🏼

🔥 The Ultimate Resource List 🆓

HERE

Rory’s experience as a Grad in Peri-anaesthesia

I was a New Graduate in Peri-anaesthesia straight out of University. Now, I am a Clinical Nurse Specialist & Clinical Nurse Educator. I have previously worked as a peri-operative Clinical Nurse Educator.

CLICK HERE to hear about my journey, from a University Student Registered Nurse to New Graduate Registered Nurse.