[Sonya G]

I am considering a job in a post CABAG unit. I have had ER experience. I am not familiar with art. lines and pressures. How much orientation is needed before someone is comfortable in this setting?

[New CCU RN]

Whatever facility you apply to should have a decent orientation to catch you up with those skills. With your ER experience you are ahead of the game. Definitely go for it. Ask during your interview what the orientation process is for an experienced RN. I was a new grad starting out in CCU, but everyone regardless of experience went to CC classes which helped reinforce what already was being taught on the unit. I think everyone is different as far as how much orientation is needed. I am five months into it now, and while there is still plenty to learn, I can at least say I take on my assignments with confidence. Good luck to you.

[whipping girl in 07]

In our mixed ICU, we orient to the unit for 12 weeks, then after one year out of orientation we orient to fresh hearts. During this year I have gotten quite a bit of experience with titrating drips, Swans and a-lines. I feel that next April when I've been out of orientation for a year (or maybe even a little sooner), I'll be ready for my heart orientation.

[martabee]

Go for the gold. I have been in our Open Heart unit for almost 2 years . I came to the unit after working with CHF pts in the home with a wonderful program. I was so nervous but I really like cardiac nursing so when I was given the opportunity I jumped at the chance. I was oriented to our unit on the day shift for 3-4 weeks then another 3-4 weeks on nights. Then a 10 day CC course. All of our nurses start on the night shift. It's a little slower paced and there is ample opportunity for a Fresh heart" especially for the nurses able to come in for a 16 hour shift occasionally. When I was orienting on the day shift, I thought Oh my gosh if I am ever as good as some of these nurses I will be able to go anywhere and do anything. I am so fortunate to work with some of the best I have ever seen and they are wonderful mentors. Really stretching me but always right there to help or give advice when I need it. Our docs take their time getting the trust factor up so if they have a question they will often ask the charge and rarely do the docs learn your name for about a year, waiting to see if you are going to handle their patients well. I have been on the day shift now for about 9 months and will be leaving the unit to take a 9 mo cruise to the Bahama;s with my hubby. I will miss the unit believe it or not, and will be nervous again when I re=-enter the work force. I think orientations vary just don't be afraid to ask questions and admit that you don't know everything. No one in a heart unit will expect you to know everything. We all started day one somewhere and remember the fears. It takes time to get comfortable with the hearts. Lots of time. I love it. Go for it.

[mikebike]

I started working on a cardiac surgical unit a month after graduating from nursing school. After going through a little over a month of general nursing and critical care nursing orientation, I spent about 3 1/2 months orientating on the cardiac surgical unit. Our cardiac surgical ICU and stepdown are on the same unit and the RNs work in both areas, so I oriented to both. I have now been out of orientation and on my own for about a year. It is very important to get with a good preceptor during your orientation period. You need someone who can bring you along according to your pace and learning needs, and is willing to teach you everything they know about the post op management of cardiac surgical pts. Cardiac surgical nursing is a very specialized area of nursing. There is a lot to learn, and you need time to learn it. The longer your orientation time is the better because this will give you more time to experience and learn how to manage all the problems particular to post cardiac surgical pts like post op bleeding, cardiac tamponade, HTN, hypotension, low CO, electrolyte imbalance, resp problems,etc. I would also reccomend that you read as much as you can on the management of these pts. I bought a few books on cardiac surgical nursing from Amazon and BN, and have found it very beneficial to read and reread some of the info in these books. This has really helped me to understand the "big picture", and also understand what is going on with these pts physiologically. For example, it is very important to understand the physiological effects of the cardiopulmonary bypass machine. As far as the hemodynamic monitoring lines you mentioned, you will learn all about this in orientation. I think cardiac surgical nursing is probably one of the most stressful areas in nursing. I have got to the point where I am pretty comfortable, but still get anxious when admitting post op pts. Looking back over my first year, I am very thankful to get some of the experiences I have had behind me. These have made me into a much better nurse. I really think experience is key in nursing. This is the reason I said the longer your orientation the better. The more situations you can experience with your precepting nurse the better off you will be. Always try to get the most challenging pts during your orientation, and if another nurse on your unit is having some problems with their pt, try to get in on the action. One more thing, most of the nurses you work with will hopefully be more than willing to help you after your orientation is over. Cardiac surgical nursing is a team effort. One nurse cannot do it all when problems occur, or when admitting a fresh heart. It really helps take away a lot of stress, and makes your work much more comfortable if the unit you are going to work on has a "team mentality". Try to make sure this is true of the unit before you decide to work there and make sure you have this attitude also.

[lever5]

Do all CVICU nurses aggressively strip or milk all CT's? I realize the heart drains need to be cleared of clots, but it is my understanding that ct aggressive milking can cause more damage than not? What is the current opinion on this. Thanks.

[ufmatt]

First thing is you should find out if the xrays have shown anything (sometimes they will). And usually, if the patient is fresh out of the OR, they are still slightly coagulopathic and you won't even need to worry about stripping the chest tubes. and by the time they do clot, there is little incidence of causing more damage/bleeding. obviously, this weighs more heavily than fluid building up to the point of tamponade! The majority of my attendings agree to stripping.

[austin heart]

there is no stripping in my unit! strictly prohibited by our cv surgeons.
as for orientation, when i first started out in cvicu i got a 12 week orientation, included was the open hearts. at the facility i am currently at, i was more experianced than some of the other people already working there. so, i just jumped write in.
good luck to you!

[zambezi]

There is no stripping of CTs by RNs in our CCU either, if the doc is there he does strip or suction if he feels it necessary...i also started as a new grad in our ccu...have been there for about 6 months now and i love it...i was in the unit for six months as a student, had a critical care class, oriented on days for one month, oriented on nights for two months, and now work on my own but have lots of buddies when i need support. i am oriented to art line removal, fresh hearts, etc and have been able to admit a few of "my own" even on nights, I can not get certified for IABP until i have been there for at least one year. I am lucky and work in a unit that really does work as a team...when i have questions or need some help, my coworkers are excellent and always willing to assist me...I enjoy working there and can't imagine working anywhere else for the time being.

[Pete495]

Any critical care unit in my facility for new graduates requires a critical care fellowship. It is a 20 week orientation to critical care including clinical and didactic education on a cardiac tele unit, ICU, and CVSU. It is a very good educational experience, and after going through this, I entered the CVSU as a nurse, and then had to go through 5 weeks of orientation. I actually asked for the 5th week, but they told me I was ready after 4. The fellowship though was a very valuable experience, and I wouldn't have done it any other way. I've also had good preceptors, and it has made the difference. Well, I took open hearts after I was oriented for 5 weeks. They try to give you easy cases at first, and then let you take on the hard ones as time goes on. Right now, I've been there about a year, not counting my fellowship, and I'm taking everything. I've even had an LVAD patient. It was a great experience.

Pete495