There is little in the literature to support one PACU management team structure over another; however, some principles should guide whatever structure is chosen in any given facility. Although titles vary greatly across the country, there is typically a nurse manager or patient care manager who covers the PACU. The patient care manager may cover a variety of perioperative areas, including preoperative and postoperative or procedural areas, and/or adult or pediatric areas. Patient care managers should be visible to staff to establish trust and to foster regular communication between the staff and the management team. Managers may have assistant nurse managers, and if so, this role may be more “frontline” than that of the patient care manager. Assistant nurse managers may still function as charge nurses, be counted into staffing on certain days, or provide break relief, as necessary, in addition to their administrative duties. The PACU needs a flexible staffing plan to accommodate patients when they are ready to arrive from the OR, and the assistant manager(s) may be a critical component in providing this flexibility and in enabling the unit to accommodate patients during peak times.
The patient care manager should foster a shared decision-making model to enable a horizontal power structure. In this complex setting, with differing patient populations and variable care needs, establishing a trusting and communicative environment is essential. In a shared decision-making environment, staff nurses are empowered to be active participants in many types of unit decisions, including policies, work-related rules and guidelines, and practice issues. Shared decision making can be facilitated through unit-level committees that focus on different topics, including quality, patient and family care, education, research, and recognition and retention, among others. These committees can be the driving force behind unit-level decisions, assuming the manager allows and encourages this from staff members. With shared decision making, the staff nurse will feel heard and respected by management and will embrace unit changes more readily (Timmins, 2010).