Updated: Feb 15, 2021
I am Toto. I am currently working as a Team Leader in the Recovery Unit in one of the NHS Trust in the East of England. I came to the United Kingdom from the Philippines in January 2002 and began as a staff nurse in one of the surgical wards of the hospital. After working for two and a half years in the surgical ward, I developed an interest for perioperative nursing when I experienced working as a bank escort nurse in the Recovery Unit. An opportunity arose that gave me the chance to work as a Recovery Practitioner in the Operating Theatres Department. 16 years later and I am still here, happy and passionate with my work.
This role comes with different titles. In the US, one is called a PACU (Post-Anaesthetic Care Unit) Nurse. In the UK, one can be called a Recovery Nurse if you are registered as a nurse, but the job title has changed to Recovery Practitioner because this role is no longer exclusive to nurses but is also open to Operating Department Practitioners (ODP) who are registered with the Health and Care Professions Council. So, I will call myself a Recovery Nurse because I am proud to be one.
As a recovery nurse, you become a part of a highly skilled and forward-thinking multidisciplinary team in the operating theatres department. You have a transformational impact on the lives of so many patients who undergo routine or life-saving surgery. A recovery nurse is the primary patient advocate following surgery. When patients recover from anaesthesia, we provide our utmost care to nurse them back to health. We provide our patients relief from surgical pain, from postoperative nausea and vomiting, and other complications that may arise. They expect you to provide them with a positive perioperative experience by competently providing safe and quality postoperative care. Our patients will never know what happened when they went under the knife, but they will surely remember what happened when they wake up in recovery.
What is your typical day like?
I usually do 12-hour shifts although at times we do 10-hour shifts. My typical day starts by doing our daily checks in the Recovery Unit. We check the monitoring, oxygen and suction equipment, our drugs and fluid stock levels and perishable supplies. I get hold of the Theatre lists and review the number of patients and the various cases in each Theatre. This gives me an idea which patient is considered a day case, and which one is staying in as an in-patient. I would then request for a bed for our in-patients through the Nerve Centre, a bed management software. I would also liaise with every Theatre team leader to find out any changes in the order of the operating list, any infection alerts, and post-operative care needs of the patient. After which, I would request the Theatre porters to get beds for our in-patients and other equipment we need.
The Recovery team would also have a regular team huddle. During the huddle, all will be briefed on the different theatre lists, discuss any plans and adjustments needed in terms of staffing and post-operative care needs of patients. After all the safety checks and getting the Recovery Unit ready, we wait for the first patient to be transferred from theatre.
Every theatre unit contacts the recovery unit to book a space for their patient before transferring the patient. This ensures that there is an available space for the patient in the Recovery Unit and for the Recovery nurse to be ready to receive the patient.
Upon receiving the postoperative patient, I receive a formal handover from the anaesthetist and the scrub practitioner. I provide supplementary oxygen to the patient and other clinical observations are supplemented by pulse oximetry and non-invasive blood pressure monitoring. When patients come to Recovery intubated or with a supraglottic airway device, I use capnography to help me detect early signs of airway obstruction. No fewer than two staff receive the patient and observed closely until they have regained control of their airway, achieved a stable cardiovascular and respiratory status, are awake and able to communicate.
I always make sure that the patient’s safety is our primary concern at the immediate postoperative period because they could quickly deteriorate or develop postoperative complications. After the patient have regained consciousness, I assess and manage postoperative nausea and vomiting, provide pain relief, correct hypothermia, and provide fluid therapy.
Since our theatre complex carry out a wide range of procedures for several surgical specialties, the variety of cases will certainly keep you on your toes. Each patient undergoing a surgical procedure may require a different postoperative care pathway. Thus, no two days are ever the same on the typical day of a recovery practitioner.
I liaise with the Surgical wards to check on the availability of beds for my patients. Once the patient is haemodynamically stable and met all discharge criteria, I transfer the patient to the ward and provide a handover to the surgical ward nurse. I continuously record and update our patient’s information on our electronic Theatre Management System.
At certain times, patients are kept longer than usual in Recovery because of there’s a lack of beds in the hospital. It causes undue pressure on the Recovery staff because of the need to transfer patients from Theatres. If they are not transferred, it delays the operating list and results in the cancellation of patients due to the lack of time. When the day surgery unit is transformed into a contingency ward, Recovery staff must provide food and drink to the day case patients and prepare them for discharge within the Recovery Unit.
Why did you choose this area of nursing?
I have never worked in the Operating Theatre Department before, more so in its Recovery Unit. As a registered nurse with a broad range of knowledge, I decided to work in the Recovery Unit to experience working in a highly specialized area of nursing. It is like going into the unknown which makes it incredibly challenging for me. In the Operating Theatres Department, where the Recovery Unit is part of it, I have the opportunity of working with a remarkably diverse and highly skilled group of scrub practitioners, operating department practitioners, anaesthetists, surgeons and theatre support workers. The theatre complex provides you with a wide range of experiences in caring for postoperative patients who have undergone surgery. This area of nursing also provided me with a clear understanding of the whole perioperative environment, thus helping me comprehend my role as a recovery practitioner more effectively.
What qualities and skills do a recovery nurse should possess and acquire in the process?
The first thing I noticed when I started in the Recovery Unit was how skilled recovery practitioners are in airway management. When patients arrive in the unit, we immediately assess the airway to see if an airway device is in place before we proceed to assess the patient’s breathing and circulatory condition. Managing the airway of an unconscious patient is a particularly important skill that a recovery nurse must possess. I also had little understanding of the different anaesthetic drugs used in the operating theatre when I started here. It is crucial to have a sound knowledge of these drugs because it enables a recovery nurse to anticipate the duration of unconsciousness, the likelihood of emerging post-anaesthetic problems, the risks of hypotension and respiratory depression, and management of pain and other complications that may arise. Recovery nurses must never assume that patients respond the same way to anaesthesia.
Recovery nurses must also have excellent observation skills, be able to think critically, and be able to make quick and effective decisions. A patient’s condition could change rapidly and without warning.
Also, considering that this role will be working within a multi-disciplinary team, a recovery nurse should also possess excellent communication and interpersonal skills. Multi-skilling is also encouraged within our recovery unit.
Finally, as we are working in a fast-paced environment, having the ability to plan, organise and prioritise your work and being flexible are essential to this role.
Do you think you are making a difference as a nurse in this field? How?
Nursing a patient back from the effects of anaesthesia and the trauma following an elective or life-saving emergency surgery is a big difference I make as a nurse. Providing my patients with a positive and satisfactory perioperative experience has always been my ultimate end goal. As I gained confidence and experience as a recovery nurse, I started to look for ways to improve and change the way we work. After working for more than a decade in the recovery unit, I started to notice that old ways of working still exist despite changes in standards of care. In my own little way, I have made some contributions to change our practice.
Since our patients do not stay with us for a longer period, you cannot always expect to get recognition and appreciation for the job you have done. But any feedback from my patients says a lot about the difference I make as a recovery nurse.
As one of the senior recovery nurses, I also make a difference by being a role model to my junior colleagues by teaching them and by being supportive when they first started in the recovery unit. As a mentor to students, I teach them the skills they need to learn in providing postoperative care and sell the idea that recovery practice is an area of nursing they should consider.
What are the challenges of a recovery nurse?
One of the challenges I have faced as a recovery nurse is dealing with a patient with an obstructed airway especially if it is a child. The child deteriorates rapidly in just a few seconds. I will never forgive myself if I ever lose a child in my care. It is so important that recovery nurses must have the expertise in dealing with emergency situations like this and act accordingly.
With the COVID-19 pandemic, all elective lists in the operating theatres were cancelled except cancer patients who need surgery. This simply means one thing for us working in the operating theatres: deployment to the critical care areas of the trust to help the overstretched and outnumbered critical care nurses. This is another challenge that we are facing as we have the most skills that could be immensely helpful in looking after HDU or ITU patients.
What are the benefits of working as a recovery nurse?
Working in this role is extremely rewarding because, first and foremost, I love and enjoy what I am doing. I was introduced to the immense world of the perioperative environment. My learning was not limited to post-anaesthetic but was extended to learning about what is happening during the pre-operative and intra-operative period of the patient’s journey. There is just so much to learn if you have the interest and inclination towards learning new things. Some of my colleagues in Recovery have even decided to move to anaesthetics and scrub practice because they want to learn and develop a new skill and gain a new experience.
We also have opportunities both for internal and external trainings and study days relevant to our role although at times external learning opportunities comes far and between due to budget restraints. Financially, we get special rates for extra shifts that we do which are paid as overtime rates. We also do private cases outside our NHS hours and get paid a generous rate per hour for this from our patients who pay for their surgery through their private health insurance.
Working in the operating theatres department is a benefit as well. You meet and work with a remarkably diverse group of people with different culture and skill set. A patient at one time woke up from anaesthesia in the Recovery Unit thinking he was in a different country.
Advice to Other Nurses
Recovery practice or post-anaesthetic care is a specialised area of practice in the operating theatre department. This is a good step-up for nurses who have previous work experience in other areas of the hospital. If you feel the burn-out or the stagnation in your nursing career, a role in recovery could kickstart your career because of its dynamic and busy environment.
I am not dissuading newly qualified nurses from working in recovery but if you are highly motivated to learn and acquire new skills and knowledge, then, this is the field of practice for you. We have experienced mentors who will provide new members of staff in recovery with support.