A PACU nurse is a registered nurse who cares for patients in the post-anesthesia care unit (PACU), also called the recovery room, as they wake up from surgery and anesthesia. PACU nurses protect patients' airways, monitor breathing, heart rate and blood pressure, manage pain and nausea, watch for complications like bleeding and respond instantly when a patient's condition changes. Along with pre-op nurses, they are part of the specialty called perianesthesia nursing.
This guide covers what the PACU is, what PACU nurses do, the phases of post-anesthesia care, the Aldrete score, common PACU complications (including malignant hyperthermia), PACU vs ICU, how to become a PACU nurse, CPAN and CAPA certification, salary and how to celebrate PACU nurses during Perianesthesia Nurse Awareness Week.
In this guide
- What is the PACU?
- What is a PACU nurse?
- What does a PACU nurse do?
- Phases of post-anesthesia care
- What is the Aldrete score?
- Common PACU complications
- What is malignant hyperthermia?
- PACU vs ICU
- How to become a PACU nurse
- CPAN and CAPA certification
- How much do PACU nurses make?
- What is it like to be a PACU nurse?
- A short history of the recovery room
- When is Perianesthesia Nurse Awareness Week?
- Gifts for PACU nurses
- PACU nurse humor
- Frequently asked questions
What is the PACU?
PACU stands for post-anesthesia care unit. It is the area where patients go right after surgery or a procedure that required anesthesia or sedation. Most people know it as the recovery room. The PACU is usually right next to the operating rooms, so anesthesia providers and surgeons are close by if a patient needs them.
Patients stay in the PACU until they are awake, breathing well, stable and comfortable enough to move to a hospital room, go home or, for very sick patients, transfer to the ICU.
What is a PACU nurse?
A PACU nurse, also called a recovery room nurse or post-anesthesia nurse, is an RN who specializes in caring for patients during the most vulnerable period after surgery. Anesthesia affects breathing, heart rate, blood pressure and consciousness, so the first minutes and hours after surgery require very close watching.
PACU nurses are one type of perianesthesia nurse. Perianesthesia nursing covers the entire experience around anesthesia, including pre-op, PACU and the recovery phases before patients go home. Read about the surgical side in our OR nurse guide and the anesthesia side in our CRNA guide.
What does a PACU nurse do?
- Receive handoff: getting report from the anesthesia provider and OR nurse about the surgery, anesthesia, medications, fluids and any problems
- Airway management: protecting and supporting the airway as patients wake up, including repositioning, suctioning, oxygen and sometimes caring for patients who are still intubated
- Constant monitoring: watching oxygen levels, heart rhythm, blood pressure, temperature and level of consciousness
- Pain management: assessing pain and giving IV pain medications and other treatments
- Nausea control: preventing and treating post-operative nausea and vomiting (PONV)
- Surgical site checks: watching dressings, drains and incisions for bleeding
- Rapid response: recognizing and responding to complications like low oxygen, low blood pressure or airway obstruction
- Discharge and transfer: deciding when patients meet criteria to leave the PACU and giving report to the next nurse or teaching patients and families before they go home
PACU nurses usually care for one or two patients at a time, and one-to-one care is common for patients who are not yet awake or are unstable, following American Society of PeriAnesthesia Nurses (ASPAN) standards.
Phases of post-anesthesia care
ASPAN describes perianesthesia care in phases, and PACU nurses may work in one or several:
| Phase | What happens |
|---|---|
| Preanesthesia (pre-op) | Preparing patients before surgery: history, consent, IVs, medications and teaching |
| Phase I | The most intensive stage, right after surgery, focused on airway, breathing, circulation, pain and early complications |
| Phase II | Getting outpatients ready to go home: sitting up, drinking fluids, walking and discharge teaching |
| Extended care (sometimes called Phase III) | Ongoing observation for patients who need more time before discharge or a room |
Inpatients usually go from Phase I to a hospital room. Outpatients having same-day surgery usually move from Phase I to Phase II and then home.
What is the Aldrete score?
The Aldrete score is one of the most common tools PACU nurses use to decide when a patient is ready to leave Phase I recovery. The modified version scores five areas from 0 to 2, for a total of 0 to 10:
| Category | 2 points | 1 point | 0 points |
|---|---|---|---|
| Activity | Moves all four limbs on command | Moves two limbs | Cannot move limbs |
| Respiration | Breathes deeply and coughs freely | Short or limited breathing | Not breathing on own |
| Circulation | Blood pressure within 20% of pre-op level | Within 20% to 50% | More than 50% off pre-op level |
| Consciousness | Fully awake | Wakes when called | Not responding |
| Oxygen saturation | Above 92% on room air | Needs oxygen to stay above 90% | Below 90% even with oxygen |
Many facilities look for a score of about 9 or 10 before discharge from Phase I, but each facility sets its own discharge criteria, and PACU nurses also consider pain, nausea, bleeding and the patient's overall condition.
Common PACU complications
- Airway obstruction and low oxygen: often from the tongue relaxing backward or leftover anesthesia effects
- Post-operative nausea and vomiting (PONV): one of the most common problems after anesthesia
- Pain: which has to be controlled without over-sedating the patient
- Low or high blood pressure and heart rhythm changes
- Hypothermia and shivering: operating rooms are cold, and anesthesia affects temperature control
- Bleeding at the surgical site
- Emergence delirium: confusion, agitation or thrashing while waking up, especially common in young children
- Urinary retention after spinal anesthesia or certain surgeries
What is malignant hyperthermia?
Malignant hyperthermia (MH) is a rare but life-threatening inherited reaction to certain anesthesia medications, including some inhaled anesthetic gases and the muscle relaxant succinylcholine. It causes a rapid rise in carbon dioxide levels, muscle rigidity, a fast heart rate and, often later, a dangerously high temperature.
MH is an emergency that requires immediate treatment with the medication dantrolene, cooling and intensive support. Operating rooms and PACUs keep MH carts stocked and run drills so the whole team is ready. The Malignant Hyperthermia Association of the United States (MHAUS) runs a 24-hour hotline for clinicians managing an MH crisis.
PACU vs ICU
| PACU | ICU | |
|---|---|---|
| Length of stay | Usually one to a few hours | Days to weeks |
| Patients | Anyone recovering from anesthesia, from healthy outpatients to very sick patients | Critically ill patients with medical or surgical problems |
| Focus | Safe emergence from anesthesia, airway, pain and nausea | Organ support, ventilators, drips and long-term critical care |
| Pace | Fast turnover, many patients in a shift | Fewer patients, longer relationships |
Many PACU nurses come from the ICU because the airway and critical care skills transfer so well. Explore our ICU collection too.
How to become a PACU nurse
- Earn a nursing degree (ADN or BSN) and pass the NCLEX-RN.
- Get acute care experience. Most PACUs want at least one to two years of ICU, ER or other critical care experience because PACU nurses must manage airways and respond quickly to emergencies. Some hospitals hire experienced med-surg or step-down nurses. (See our ER nurse guide and med-surg nurse guide.)
- Get BLS, ACLS and PALS certified. PALS is especially important in PACUs that care for children.
- Complete PACU orientation, including airway management, anesthesia medications and ASPAN standards.
- Earn the CPAN or CAPA after gaining perianesthesia experience.
CPAN and CAPA certification
The American Board of Perianesthesia Nursing Certification (ABPANC) offers two certifications:
- CPAN (Certified Post Anesthesia Nurse): for nurses who care for patients in Phase I recovery
- CAPA (Certified Ambulatory Perianesthesia Nurse): for nurses working in pre-op, Phase II and extended care, often in ambulatory surgery centers
Eligibility for either exam generally requires a current RN license and 1,200 hours of direct clinical practice in perianesthesia nursing within the past two years. Check ABPANC for current requirements. Some nurses hold both credentials.
How much do PACU nurses make?
The U.S. Bureau of Labor Statistics does not publish a separate salary for PACU nurses, because it groups them with all registered nurses. The median annual wage for registered nurses was $97,550 in May 2025, according to the BLS.
PACU nurse pay depends on location, experience, certification, setting (hospital PACUs often include call pay, while surgery centers usually do not) and shift. Many hospital PACU nurses take call for emergency surgeries at night and on weekends, which adds on-call and callback pay.
What is it like to be a PACU nurse?
- Schedule: many PACU nurses work daytime hours on weekdays, with rotating call for nights, weekends and holidays. Surgery center PACUs often have no call at all.
- Pace: the day can go from calm to many patients arriving at once when several surgeries finish together.
- Short relationships: PACU nurses may care for many patients in one shift, often for an hour or two each.
- Critical thinking: patients can change fast while waking up, so PACU nurses need strong assessment and airway skills.
- Funny moments: patients waking from anesthesia say some truly memorable things.
A short history of the recovery room
- 1863: Florence Nightingale writes about the value of small rooms near the operating theater where patients can recover from surgery under close watch.
- 1940s: studies of deaths after surgery find that many could have been prevented with better observation right after anesthesia, and hospitals begin opening dedicated recovery rooms.
- 1950s and 1960s: recovery rooms become standard in American hospitals and help inspire the first intensive care units.
- 1980: the American Society of PeriAnesthesia Nurses (ASPAN) is founded, originally as the American Society of Post Anesthesia Nurses.
- Today: PACU nurses care for patients after millions of surgeries and procedures every year in hospitals and ambulatory surgery centers.
When is Perianesthesia Nurse Awareness Week?
Perianesthesia Nurse Awareness Week (PANAW) is celebrated every year during the first full week of February. ASPAN leads the celebration, which honors PACU, pre-op and ambulatory surgery nurses. It falls in American Heart Month, just before Valentine's Day, so many units use heart themes.
PANAW ideas
- Bring in breakfast before the first cases arrive from the OR.
- Give awards like "Best Airway Save," "Nausea Ninja" and "Warmest Blankets in the Building."
- Share the funniest (anonymous and appropriate) things patients have said while waking up.
- Sponsor CPAN or CAPA exam fees or ASPAN memberships.
- Recognize the anesthesia techs, OR team and unit secretaries who keep patients moving.
Gifts for PACU nurses
For the coffee that gets finished before the first patient rolls out of the OR. An easy PANAW gift. $15.99
Shop now →
Every recovery room nurse's job description in one sticker. Perfect for badge reels and water bottles. $3.99
Shop now →PACU nurse humor
- "I wake the dead gently."
- "Take a deep breath. No, a real one. Okay, one more."
- "Yes, you already asked if the surgery is over. Yes, it is. Yes, you can ask me again in two minutes."
- "I've been proposed to by more patients coming out of anesthesia than I can count."
- "Warm blankets: the most powerful medication in the PACU."
- "What happens in the PACU stays in the PACU. You won't remember it anyway."
Frequently asked questions
What does PACU stand for?
PACU stands for post-anesthesia care unit, the area where patients recover right after surgery or a procedure with anesthesia. It is often called the recovery room.
What does a PACU nurse do?
PACU nurses care for patients waking up from anesthesia. They protect the airway, monitor vital signs and oxygen levels, manage pain and nausea, watch for bleeding and complications and decide when patients are ready to leave the PACU.
What is the Aldrete score?
The modified Aldrete score rates activity, respiration, circulation, consciousness and oxygen saturation from 0 to 2 each, for a total of 0 to 10. PACU nurses use it to help decide when patients are ready to leave Phase I recovery.
What is the difference between CPAN and CAPA?
Both are perianesthesia certifications from ABPANC. The CPAN is for nurses working in Phase I post-anesthesia care, and the CAPA is for nurses working in pre-op, Phase II and extended care, often in ambulatory surgery.
How do you become a PACU nurse?
Become a registered nurse, gain one to two years of acute or critical care experience (often ICU or ER), earn BLS, ACLS and often PALS, complete PACU orientation and then earn the CPAN or CAPA.
How much do PACU nurses make?
BLS does not report PACU nurse pay separately. Registered nurses overall earned a median of $97,550 in May 2025. PACU nurse pay varies by location, experience, certification, setting and call pay.
Do PACU nurses take call?
Many hospital PACU nurses take call for emergency surgeries on nights, weekends and holidays. PACU nurses at ambulatory surgery centers usually do not take call.
When is Perianesthesia Nurse Awareness Week?
Perianesthesia Nurse Awareness Week is celebrated during the first full week of February each year, led by the American Society of PeriAnesthesia Nurses.
Exploring other specialties? See our full guide to nurse specialties and the types of nurses.
Celebrate the PACU nurses in your life
For PANAW, a new CPAN or the nurse who was there when you woke up: gifts for the recovery room crew.
Shop the PACU Collection →Sources
- U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Registered Nurses
- American Society of PeriAnesthesia Nurses (ASPAN), Perianesthesia Nursing Standards and Perianesthesia Nurse Awareness Week
- American Board of Perianesthesia Nursing Certification (ABPANC), CPAN and CAPA Certification Candidate Handbook
- Aldrete JA, The Post-Anesthesia Recovery Score Revisited, Journal of Clinical Anesthesia (1995)
- Malignant Hyperthermia Association of the United States (MHAUS)