How to become a post-anesthesia care unit nurse (PACU Nurse) in The USA?

By ShiftMed Team//Nursing Profession
PACU Nurses monitoring patients in a PACU

Surgical nursing isn’t the only job that helps patients undergoing procedures. After they’ve left the operating area, they are transferred to the post-anesthesia care unit, or PACU, where dedicated, skilled nurses monitor their vitals and ensure their immediate recovery goes smoothly. 

PACU nurses are registered nurses with specialized training in post-anesthesia and postoperative care.

If you want to become a certified PACU nurse, your career will start with becoming an RN. Then, you can gain the PACU experience and training necessary to sit for the CPAN (Certified Post-Anesthesia Nurse) exam.

Read more: What is a PACU nurse?

What are the steps to becoming a PACU nurse?

You can become a PACU nurse in 5 steps. Every nursing journey begins with an excellent educational foundation. Then, you can pursue jobs that provide the experience required to earn PACU certification.

Let’s take a closer look at each step.

1. Earn a nursing degree 

Every registered nurse needs a degree to be licensed in their state. Undergraduate nursing degrees can be either associate’s or bachelor’s degrees. An Associate of Nursing degree (ADN) prepares you for the NCLEX exam by introducing you to registered nurses' core skills and education. 

Your degree program covers all essential subjects a nurse needs to know, such as anatomy and physiology, pharmacology, behavioral health, and foundations in nursing.

You also develop various clinical nursing skills, such as physical assessment, central line care, intravenous therapy, and urinary catheterization. 

You’ll graduate fully equipped with the knowledge and skills you need to study and pass the NCLEX and work with patients.

A Bachelor of Science in Nursing (BSN) program covers all the same essential skills and coursework but includes additional classes not included in an ADN. These courses help you broaden your nursing education to include nursing theory, research, and management.

Students with a BSN generally have more career opportunities after graduation and can enter higher nursing roles with greater ease after gaining some clinical experience. That being said, an ADN is still a great start to a nursing career. You can always get your bachelor’s later through an accredited RN to BSN program.

2. Pass the NCLEX-RN exam

The NCLEX is the only nationally recognized exam for nurses in the United States. Every nursing school graduate who wants to work as a registered nurse has to pass the NCLEX. 

The school will prepare you for the exam, but some self-study is required. You can review the official NCLEX website for plenty of helpful resources. 

The NCLEX-RN exam questions vary based on a test taker's performance. Length can range between 75 to 145 questions, including 15 unscored pretest questions. 

Roughly 90% of the NCLEX questions are multiple-choice. Others are fill-in-the-blank, ordered responses, and identification questions using an image or diagram.

The NCLEX-RN is a pass-fail exam. The adaptive system will stop administering questions when it reaches 95% certainty that you have passed or failed. 

After passing the NCLEX-RN, your results are sent to your state board of nursing. Next, you must complete any additional application steps required to register and be given a license number.

3. Gain work experience in PACU

Once an RN, you must complete at least one year of clinical experience before taking on jobs in the post-anesthesia care unit. PACU nurses need at least a year of nursing experience on average to ensure they’re comfortable and confident enough in the PACU. 

Patients in PACU often recover from major invasive surgical procedures and need skilled nurses who recognize signs of complications and immediately intervene.

The average PACU stay is one-and-a-half to 4 hours. You’ll have to be comfortable with a high patient turnover rate and a demanding, fast-paced environment. All of this experience will prepare you to sit for the CPAN exam.

4. Earn your CPAN certification

To become a Certified Post-Anesthesia Care Nurse, you will have to sit for the CPAN exam offered by the ABPANC. The CPAN requires all applicants to hold a valid, unrestricted RN license and have at least 1,200 hours of post-anesthesia phase 1 experience.

Earning your CPAN marks you as a qualified specialty nurse who understands the unique continuum of care in the PACU environment—in addition, having your CPAN can qualify you for different career opportunities, including working with patients in post-anesthesia phase ii and extended recovery. 

5. Apply for PACU nurse jobs

You can apply for PACU nurse jobs with your CPAN credential. Employers often prefer candidates with several years of experience and certification. In addition, having your CPAN can boost your earning potential and qualify you for a higher salary, as well as more job opportunities in different healthcare environments. 

You can sign up for ShiftMed to start finding PACU nursing jobs near you.

Can you become a PACU nurse online?

You can take an online PACU course and complete continued education remotely. You can even complete all of your ADN or BSN coursework online. However, nursing students must all complete clinical rotations at approved healthcare facilities.

Clinicals are a crucial part of your nursing education. Your rotations give you direct patient care experience so you can enter the workforce confidently. 

If you want to complete nursing school online, you can find programs that remotely include all courses and lab simulations. But you’ll always have to attend in-person clinicals to gain the experience required to become a skilled entry-level nurse.

What is the difference between a PACU nurse and a registered nurse?

PACU nurses are post-anesthesia nursing specialists. Registered nurses hold additional experience and likely certification in post-anesthesia care. A PACU nurse also performs more specific tasks related to post-anesthesia recovery than RNs.

Typically, a PACU nurse works with patients on an extremely short-term basis. Patients can enter PACU and be out within an hour in outpatient settings. You can treat more than a dozen a day, and you have to move quickly to ensure each one meets the appropriate recovery benchmarks before they’re discharged or transferred to another recovery area. 

Post-anesthesia care nurses must also be skilled in airway management and life support interventions. Not all patients can breathe independently following a surgical procedure, especially in critical care situations and trauma hospitals. 

If you decide to become a PACU nurse, you will need to:

  • Monitor patients immediately following surgical procedures

  • Closely examine patients’ end-tidal CO2 or capnography to prevent complications

  • Provide Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) if necessary

  • Regularly assess vital signs and notify the operative team of any unusual patterns

  • Administer medication and maintain IV and catheter lines

  • Help patients manage post-anesthesia side effects, like nausea and dizziness

  • Ensure that bandages are clean, sterile, and properly applied 

  • Educate patients and caregivers about their condition, and provide tips for post-operative care

What positions can you progress to from being a PACU nurse?

If you love working in PACU or want to further your knowledge of anesthesia care, you could look into becoming a family nurse practitioner (FNP) who specializes in PACU care. You could also consider becoming a Certified Registered Nurse Anesthetist (CRNA), who works directly with patients during surgeries and administers various anesthesia.

To become a nurse practitioner or CRNA, you must earn a master’s or doctorate in nursing, then complete additional hours of training in your specialty. These jobs are pretty different from PACU nursing, but they are exciting roles to explore if you want to broaden your career horizons and explore new responsibilities.

Does CPAN expire?

PACU nurse qualifications must be renewed every three years. In addition, you must renew your CPAN certification and your RN license, which may require renewal every 3 to 4 years, depending on where you live.

CPAN recertification requires at least 900 hours of direct post-anesthesia experience during a 3-year period and successfully passing the certifying exam. If you want an alternative to taking the exam, you can demonstrate at least 90 contact hours of continued qualified education based on the CPAN Recertification Handbook

How much do PACU nurses make?

The typical PACU nurse earns between $51,500 to $156,000 annually. According to the latest data on ZipRecruiter, the average PACU nurse salary is $92,199 (October 2022). While the lowest salary reported is $51,500, the average earnings for PACU nurses tend to range between  $71,500 to $104,000. 

Read more about how much PACU nurses make in our salary guide.

How long does it take to become a PACU nurse?

PACU nurses need an undergraduate degree and 1,200 hours of peri-anesthesia care to become a CPAN. This means you’ll have to spend 2 to 4 years earning a degree plus an additional year working in PACU. 

In total, expect to commit at least 4 to 5 years to become a certified PACU nurse with CPAN certification.

Read more: How long does it take to become a nurse?

FAQs about becoming a PACU nurse

What experience do you need for PACU?

To get your first job in the PACU, you’ll need to hold a valid RN license and likely have at least one year of nursing experience. Because PACU requires intensive, specialized care, most employers want new nurses to have a minimum of 12 months of nursing experience. 

Many hospitals will require you to have ICU nursing experience before letting you work in the PACU. However, some offer the option to complete a special orientation program that prepares them to transfer from non-ICU settings to PACU care.

Can new grads work in PACU?

No. New nursing graduates are not considered skilled enough to work in the PACU. PACU requires a confident nurse who is comfortable working with patients in intensive care. You will need to develop your resume more and gain experience with patients before you’re eligible to work in PACU.

Does PACU count for CRNA school?

If you want to become a Certified Registered Nurse Anesthetist, PACU may not count toward your experience. Generally, CRNA programs accept students who have direct critical care experience in ICU, PICU (Pediatric Intensive Care Unit), MICU (Medical Intensive Care Unit), SICU (Surgical Intensive Care Unit), CCU (Coronary Care Unit), and CTICU (Cardiothoracic Intensive Care Unit).

PACU often doesn’t count for CRNA school because the programs want nurses who have performed a wider range of critical care procedures, such as intubation, chest drainage tube insertion, central line placement, vasopressor therapy, and advanced ventilator management (HFOV).