Job Overview

The Post-Anesthesia Care Unit (PACU) Nurse manages patients during the critical transition period immediately following surgical anesthesia, reporting to the PACU Charge Nurse or Perianesthesia Services Manager. This is the window when patients are most physiologically unstable: airways can obstruct, blood pressure can crash, and pain can become unmanageable within minutes of arrival. PACU nurses must detect these shifts before they become crises. Success looks like a consistent Aldrete score reaching discharge threshold within the target recovery window for your unit, a complication rate below facility benchmark, and zero unplanned ICU transfers attributable to inadequate PACU assessment. This role demands acute clinical judgment, efficient communication, and the ability to manage two to three patients simultaneously.

Key Responsibilities

• Receive direct SBAR handoff from OR nurse and anesthesia provider, reviewing intraoperative events, medications administered, and patient-specific concerns.

• Assess and monitor airway patency, oxygen saturation, respiratory rate, blood pressure, heart rate, level of consciousness, and pain scores every 15 minutes or more frequently as clinically indicated.

• Administer Phase I and Phase II recovery medications per physician orders, including reversal agents, analgesics, and antiemetics.

• Apply Aldrete or Modified Aldrete scoring criteria consistently to determine readiness for Phase II recovery or discharge.

• Manage postoperative nausea and vomiting (PONV) using multimodal protocols, reducing PONV incidence to below unit-established targets.

• Recognize and respond to emergence delirium, laryngospasm, bronchospasm, and hemodynamic instability within immediate timeframes.

• Provide procedural sedation monitoring for Phase II-only procedures when applicable per facility protocol.

• Communicate postoperative instructions to patients and support persons clearly and at appropriate health literacy levels.

• Collaborate with anesthesia providers on complex or prolonged recoveries, escalating when clinical status fails to improve.

• Complete accurate, time-stamped electronic documentation of all assessments, interventions, and patient responses.

• Maintain PACU supply levels, emergency equipment readiness, and code cart checks per shift.

• Contribute to unit quality improvement by tracking complication metrics and participating in perianesthesia peer review.

Required Qualifications

• Active, unrestricted RN license in the state of practice; BSN preferred over ADN.

• Current ACLS (Advanced Cardiovascular Life Support) certification required; PALS preferred for pediatric surgical facilities.

• Current BLS certification.

• 2-5 years of acute care nursing experience with at least one year in PACU, ICU, or emergency nursing.

• Demonstrated proficiency in airway assessment and management, including supplemental oxygen delivery methods.

• Experience with pain assessment tools (NRS, CPOT, FLACC) and multimodal analgesia protocols.

• Ability to independently manage two to three patients during peak post-surgical volume.

• Familiarity with American Society of PeriAnesthesia Nurses (ASPAN) standards of practice.

Preferred Qualifications

• CPAN (Certified Post Anesthesia Nurse) or CAPA (Certified Ambulatory PeriAnesthesia Nurse) from ABPANC.

• ICU experience with arterial line, central line, or ventilator management.

• Experience in pediatric, cardiac, or neurosurgical post-anesthesia recovery settings.

• Moderate sedation certification or training in procedural sedation management.

Essential Skills and Competencies

Technical Skills

• Post-anesthesia patient assessment and hemodynamic monitoring

• Airway management: nasal/oral airways, BVM ventilation, supplemental O2 delivery systems

• Aldrete/Modified Aldrete scoring and phase transition criteria

• IV medication administration including opioids, reversal agents, and antiemetics

• EHR documentation in perioperative platforms (Epic, Cerner)

• Emergency response: code blue, malignant hyperthermia protocol activation

Soft Skills

• Rapid clinical pattern recognition under time pressure

• Clear, concise handoff communication with anesthesia and OR teams

• Patience and therapeutic communication with disoriented or distressed patients

• Multitasking across multiple patients without compromising assessment quality

• Collaborative relationship management with surgeons and anesthesiologists

Salary Range and Benefits

Salary Overview

PACU nurses earn $85,000 to $108,000 annually in most U.S. markets, anchored by the national RN median of $86,070 (BLS, May 2023). Specialty certification (CPAN) and experience in complex surgical recovery settings push compensation to the upper quartile. Facilities performing high volumes of cardiac or neurosurgical cases typically pay 10-15% above the median for experienced PACU staff. Source: U.S. Bureau of Labor Statistics, May 2023; PayScale, 2025.

Top-Paying Areas

• San Jose, CA ($118,000 - $140,000)

• Seattle-Tacoma, WA ($106,000 - $128,000)

• New York City, NY ($104,000 - $126,000)

• Los Angeles, CA ($100,000 - $122,000)

• Boston, MA ($98,000 - $120,000)

Benefits Package

Standard PACU nurse benefits include comprehensive health insurance (medical, dental, vision), 401(k) with 3-5% employer match, 3-4 weeks PTO, shift differentials for evenings, nights, and call-back pay. Most facilities reimburse CPAN and CAPA exam fees. Tuition assistance for advanced nursing degrees is common at academic medical centers.

Warning Signs When Evaluating
PACU Nurse Candidates

• Cannot explain how they would recognize and respond to laryngospasm: Laryngospasm is a true airway emergency. Any PACU nurse should be able to walk you through recognition and initial management without hesitation.

• Has never managed more than one patient simultaneously: PACU requires concurrent monitoring. Candidates who have only worked one-to-one care ratios may not adapt well to PACU volume.

• Expresses discomfort with frequent anesthesia provider interaction: PACU nurses work in near-constant collaboration with anesthesiologists and CRNAs. Poor rapport with this team creates communication failures.

• Cannot describe Aldrete scoring or lacks awareness of ASPAN standards: These are the foundational frameworks of perianesthesia practice. Ignorance of them signals a lack of specialty preparation.

• No experience managing acute pain in immediate postoperative patients: Pain assessment and titration is a core PACU function. Candidates who lack confidence here will struggle from day one.

Frequently Asked Questions