I am new to CVICU and have been taking step down patients, trying to get my feet wet. It is coming up on 6 months, and I am supposed to start taking fresh hearts soon. I have tried studying meds, machines, intrepretations, etc. I feel overwhelmed. I would like to know how you guys got your training. Were you just thrown in and told "ask me if you have questions" or was there a formal training opportunity.
Jun 6, '13
I started out my internship in the CVICU, and as much as they would give you the "less sick" CVICU patients they just sort of threw you in there to sink or swim kind of deal. You always had someone around but at the same time there were multiple sick patients all at once. I just really, really studied up on my gtts so I didn't have to ask too many questions and learned to watch for specific s/s of patients and eventually with enough practice it got to be where people were asking me for advice. I was one of the first ones out on my own in my internship but it was pretty scary at first. I kept thinking I was going to kill someone.
Jun 6, '13
I work in a mixed medical/surgical ICU, but we do a lot of hearts. People usually don't get to take care of them until after being there for at least two years, and then not till after taking a formal class. We are then precepted on six fresh open hearts by our cardio-thoracic nurse educator before being able to take one on our own.
Maybe you can ask if they can precept you on at least one or two fresh open hearts? If they are not amenable to that, use your more experienced colleagues as resources. Just try to stay calm and learn as much as you can, you'd feel more confident in no time at all. Good luck!
Jun 9, '13
I started on a smaller CVICU first and I worked on the unit as a tech while in school which helped once I became a nurse. Being overwhelmed is good when you're new - it means you're learning. At that facility, we encouraged new nurses to take the sickest patients right from the start but we were surrounded by nurses who were available to help.
Once I was comfortable there, I transferred to a larger facility where we do transplants and VADs and it's been a whole new learning curve. Here, new nurses take post-ops in orientation but then take stable patients when they are on their own and work their way into higher acuity over time (6mo-1yr). They all still have the same look of terror in their eyes when they take care of their first "really sick" or fresh post-op patient.
The best advice I can offer is remember to breathe, help is there when you need it, and don't expect to know everything right away. You will learn with experience and you only do that by placing yourself in those uncomfortable positions (don't worry, it gets better!). Good luck!!!
Jun 10, '13
I started on a VERY busy and well known and sought after CVICU about 4 months ago...and got a fresh heart my 3rd day on my own haha.
Thats crazy that they wait that long for you!
Help is always there, and Ive learned to really turn to my senior co workers.
Jun 10, '13
My facility has ICU nurses take two day post op cases, then hearts that were extubated overnight, then precept 7 fresh cases before taking the first one solo. If they aren't giving you learning opportunities, I would ask for them, even if you have to shadow an experienced heart nurse on your day off. I think it shows responsibility that you want to be well prepared. Good luck!
Jun 12, '13
There is no excuse for making new nurses "sink or swim." You and your preceptor should get the first heart of the day. To help learn swan numbers and use critical thinking, try pacep.org. Just register, it's free. Ask tons of questions. Hope it helps
Jun 12, '13
We take post-ops on orientation but then generally have the more stable kiddos for the first few months to a year. That being said on my unit (a peds cicu) the most "stable" kid at the start of the shift (walking, talking, transfer orders in) can end the shift with an open chest on ecmo...and I've seen it happen more than once (to myself included) so I always teach my orientees to never trust a sick heart no matter how good they look on the outside.
No matter what that first time is always terrifying, hopefully you have a solid unit that is able to support you.
Jun 12, '13
There is a very much sink or swim attitude on my unit.
I started on the unit in March, got a 6 week induction & I've been taking level 3 & open hearts for the past 3weeks now. In fact today I had to settle a pt in from the theatre on my own, while the surgeon was barking the handover at me. I just said to him, you'll have to wait while I sort this pt out before you do that, & if you want it done quicker you can help me!
I think that's the key, ask people to help you & let the surgeons know you are new so they can take there time. Hopefully you'll have nice doctors like on our unit, and ask the Doctors questions too...we all know how they like to show off!
Jun 14, '13
You need to have some experienced CV nurses orient you to fresh hearts. That is a very special pt population and if you miss something important, their condition can turn on you like a F5 tornado!
Yes, you need to know the meds and labs, but you also need a solid routine to follow to help you be diligent about keeping up with all the vitals, outputs, and labs so you can nip trends in the butt so they don't get out of hand. Should I call on this? Would just some volume fix it? Do I need a drip? Should we really extubate? Is this chest tube clotting off? You think you've got crabby surgeons now, try it when you've got your best buds coding your fresh heart. No lunch break for you!
Jun 16, '13
No such thing with on the job training with this population. My facility had a program specifically for fresh hearts. Its not only about meds it's about the equipment & the situations you can be in with these very ill pt. Agree learning the routine & the procedures to handle any thing that can happen. It was a very strong, educated structured 6 program for me. When i was on my own. I was ready. I was in a heavy CVICU they do these surgeries like an assembly line.
Last edit by Bronx1560 on Jun 16, '13
Jun 18, '13
I work in a CVICU and I'm so thankful that where I work, we were not just thrown into the fire, we had like a few months of orientation with another nurse. I feel so lucky that the nurse I was put with was so knowlegable and open to teaching (I was a new grad at the time) I think what helped me was whatever I saw at work, like drips I went home and looked up so when I came into work next time I would have an idea. You will do just fine.
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