I started in a Level I Trauma Center CVICU at the end of last year, and it has proven to be the most challenging/rewarding thing I have ever done. I, too, transferred from a leadership, Charge Nurse role at a smaller hospital to a staff nurse at this teaching hospital. I was astounded at the level of expertise, skill, and knowledge every single nurse on the unit had, many of whom were younger than me. Not only that, but I felt from day one that I was a brand new nurse all over again, because Cardiac ICU is like nothing you have ever seen or done before. It is the exact opposite of everything you are taught in school. We even have our own ACLS (CALS), we do CPR and resuscitation different. CVICU is the top of the totem pole. I don't mean that other nurses are not as smart, or as skilled... I just mean that CVICU patients, open hearts, experience all co-morbidities under the sun while under your care. Strokes, GI bleeds, sepsis, shock, aneurysms, respiratory failure, kidney failure, shock liver... you see and treat it all. You fix it all. I do my own dialysis, neuro checks on a Neuro ICU nurse level, CRRT, we administer chemo to our patients who have cardiomyopathy secondary to their cancer, we do lumbar drains and bolts and pins, we do full C Spine precautions for the patients who have blunt force trauma from car wrecks, we do postpartum care for the mothers who have postpartum cardiomyopathy. Literally every kind of nursing you can think of will come into play in CVICU. Just be prepared to be challenged, to fail, to get back up and be better the next day. Your comfort zone no longer exists.