Transitioning from Med/Surg to CVICU

  1. Hello all,

    I am currently going through the orientation process at a CVICU. I have one year experience on a med-surg tele floor. I am absolutely terrified when I'm on the unit. So many different equipment, lines, diagnoses and a whole new way of doing things.
    I was wondering if anyone had any tips on how to organize your day when you have what it seems like endless charting to do.

    On my unit, you can have up to 2 "stable" ICU patients. You do vitals, check IVs, check the monitor hourly, assess every 4 hours including a head-toe, measure CVP, I/O (unless foley then its hourly) and pacer settings. Stable LVAD is every 2 hours.

    If you have a patient with ECMO, IABP, CRRT, fresh cardiac surgery or a fresh LVAD... you only have 1 patient since everything you do is hourly or less documentation.

    They also want you to do a CHG bath daily, lotion the patient down, etc. (we do not employ aides on this unit)

    Then of course I have medications to give, labs to draw, other care in between.

    I feel like no matter how I try to consolidate, I always have something to chart and I'm always behind. (And this is me coming from a med-surg unit with 6 patients and having everything done by 10am)

    Any recommendations? Advice? Support?
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  2. 5 Comments

  3. by   DesertSky
    Quote from Nurse_bre
    Hello all,

    I am currently going through the orientation process at a CVICU. I have one year experience on a med-surg tele floor. I am absolutely terrified when I'm on the unit. So many different equipment, lines, diagnoses and a whole new way of doing things.
    I was wondering if anyone had any tips on how to organize your day when you have what it seems like endless charting to do.

    On my unit, you can have up to 2 "stable" ICU patients. You do vitals, check IVs, check the monitor hourly, assess every 4 hours including a head-toe, measure CVP, I/O (unless foley then its hourly) and pacer settings. Stable LVAD is every 2 hours.

    If you have a patient with ECMO, IABP, CRRT, fresh cardiac surgery or a fresh LVAD... you only have 1 patient since everything you do is hourly or less documentation.

    They also want you to do a CHG bath daily, lotion the patient down, etc. (we do not employ aides on this unit)

    Then of course I have medications to give, labs to draw, other care in between.

    I feel like no matter how I try to consolidate, I always have something to chart and I'm always behind. (And this is me coming from a med-surg unit with 6 patients and having everything done by 10am)

    Any recommendations? Advice? Support?
    Take a deep breath and remember to be kind to yourself. You are still on orientation and are learning the flow of the unit on top of additional clinical skills specialized to ICU. Building your knowledge, confidence, and organization takes time.

    The best advice I have is to develop an organized approach to care. For example, after report assess both your patients before anything else. I always assess my more critical patient first.

    I always try to complete as much as I can as early as I can. Pass medications in the hour window before they are due. Stay on top of your charting! Of course this does not always happen in ICU when something emergent occurs, however if you can stay on top of your charting it will help. Realize that you will get faster as you gain experience and your comfort level will also increase.

    Always know who your resources are on the unit and do not be afraid to ask questions. You are a new ICU nurse and no one expects you to know all the answers. Write down concepts or topics that come up that you do not understand or do not know enough about and research them on your days off. Come to work with enthusiasm and a willingness to learn and you will do great!
  4. by   scheeh73
    You will get there but it's going to take time; give yourself at least a year! I started as a new grad. CVICU is a big deal! Ask questions constantly.. ask the "why" behind everything you do. Eventually hearts will start to feel routine and you will begin to notice patterns and anticipate orders and your time management will improve. Don't be too hard on yourself though. Learn which coworkers you can utilize as a mentor and seek their advice. Most of all, don't forget to enjoy every wild crazy minute of CVICU!
  5. by   cdibley
    Give yourself time, you will get there! My advice is to have a really good brain sheet, with hourly windows, I have an hourly chart on my report sheet and I put all my meds on there, anticipated PRN meds (pain) if a patient is getting each scheduled dose, baths, lab rechecks etc. This helps me look for things to combine and supplies to grab. I also do a lot of my charting while talking to patients. I used to just go in and check on them then sit at my desk and chart, but I find that I forget less and get to know my patients a little more if I just chart in their room.
  6. by   newmail445
    I'm transitioning, too! 3.25 years working M/S liver patients to the Coronary Care Unit. I have a 10 week orientation and my plan is to do basic book education for the next 3 weeks. And then when orientation starts to really be hands on and proactive because that's how I learn. (It's important to know ourselves!)
  7. by   RescueNinjaKy
    I second the brain sheet. It helps a lot to get organized. I like to show up a little earlier before work to research my patients. I have it labeled from 7-19. Then I circle each hour that I have meds. If it's something special that requires longer preparation then I will write it out. Then at another section I have the continuous meds/pressors written out with current titration and map goal. That way I know easily and can glance at it whenever. I have labs written in the back and then a to do list. Like if I have abg q4h then I'll write when it's due like 8, 12, 16. Group whatever you can. Typical blood sugar checks q4h for patients without insulin drip so I see which labs I can grab together (like get my abg while I'm at it) Of course you have to prioritize. Make sure you see your patient quickly and assess. As you get more comfortable with your rhythm and assessment things will go faster. If your patient load is heavy ask for help. The critical care setting is all about team work. Ask for help and help others.

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