Do Neuro ICU nurses get good cardiac experience?
- 1Mar 5, '09 by aCRNAhopefulHello all, I am going to be a new grad nurse this may and am applying to different critical care jobs in my area. I really wanted CVICU because I thought that area would give me the best knowledge of hemodynamics and allow me to think about physiology and the science part of nursing. That unit wasnt able to take any more new grads but I was offered an interview for the Neuro ICU. The facility is a level I trauma center. The breif description of the unit given to me by the HR person was that "Oh well they care for people with CVA's and things like that but they also handle the traumas." That's about all I got. Would a unit like this provide good cardiac experience as well? Do Neuro ICU's do swans, IABPs, etc? I am trying to research it the best I can to get a feel for what type of patients they would have but really dont get anything too direct. Besides the hemodynamic monitoring what else could you tell me about the care of patients in Neuro ICUs? Any info about what you do at your facility would be great. Thanks!
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- 0Mar 6, '09 by labmanI do work in a level one trauma center in there neuro ICU.
IABP- We never have to do any of that and that would be scary.
Hemodynamic wise we do not have too many people with swans. My year and a half in neuro we have only had 2 people I know of with swans.
The main hemodynamic montior we carry is ICP monitor (ventric) or a licox. Usually an ruptured cerebral aneurisms we do triple HHH therapy which requires CVP (but our unit rarely uses pressors)
When the brain herniates that is a hemodynamic game because they have no sympathetic tone and are ususally on 4-5 pressors.
I say if you want cardiac do cardiac go for another hospital or maybe a medical ICU because there is not too many hemodynamics involved with neuro. Don't want to be a troll but just my 2 cents.
- 0Mar 6, '09 by HouTx GuideI agree - Neuro ICU is mostly 'above the shoulders' stuff. I started out there as a new grad - got a wonderful orientation and loved it! However when I moved on to other ICU environments I felt like a new grad again. A lot of basic protocols were very different. For instance, the hemodynamics involved in maximizing cerebral perfusion are pretty unique and not at all like those you'd titrate for in an cardiac pt. It was a shock to have patients that actually ate - food. I really missed my Neuro pts - they were never messy, augumentative or demanding. I used to love getting the roto-rests all going in synch - ahh memories.
- 0Mar 7, '09 by labmanYa I remember calling the doctors about an issue. They would immediately go to so is the neuro status ok.
I also forgot to say neuro exam is probibly the most subjective compared to hemodynamics which is totally objective
I guess I agree with pts eating. we have spurts where everyone is eating then no one is...
Well good luck
- 0Mar 8, '09 by Christie RN2006Honestly, what you are exposed to depends on the hospital and the unit. The hospital I work in has 3 ICUs... CVICU, CCU and the SICU. I work in the SICU and our main patients are neuro, trauma, and critical surgical patients. We will occasionally get CCU type patients if they are full. We also will get transfers from CVICU if they have an infection. The CVICU at my hospital is a "clean" unit and they don't usually keep patients with anything transferable (flu, MRSA, C.diff, etc.)
We never have IABPs in my area and we rarely have swan lines. We do use a lot of drips for BP, HR, etc. We also have a lot of patients on CRRT, vents, and with monitors and drains such at Lycox, A-lines, CVP, Vigileo, ICP, ventric and lumbar drains.
The eating thing is something we joke about a lot. The SICU at my hospital rarely has people that can eat or use the call light. CCU generally has patients that are more active and can eat and use call lights. We also say that the patients in the SICU tend to be sicker and crash more often, but the CCU patients tend to crash a lot faster! Our SICU patients tend to have a lot more meds and our unit is generally busier than both the CVICU and the CCU.
If cardiac is something you are really looking into getting into, I would keep on looking, but if you are interested in giving neuro/trauma a try it could prove to be a huge learning experience for you! Would it be possible for you to shadow a nurse for a day to find out if you like the unit or not?
- 0Mar 8, '09 by Keysnurse2008Well...it depends on what you mean by good cardiac experience. In the Neuro ICU's I have worked at we had swans and really got alot of good education regarding PVR/SVR/pcwp/lvedp/ci etc etc. Think about it.....you ultimate goal in a neuro icu is to ensure you get good cerebral perfusion pressure. How do you get that? You get that by pressing that heart to ensure you keep the arterial pressure high enough to perfuse despite the elevated ICP. Will u get a IABP? I havent ever, but it is possible. You will occ get a pt in continous CVVHD and sick sick sick. But....there are things you will get in a neuro ICU that you might NOT get in a CVICU to give you that edge for CRNA school....like paralytic drips, monitoring To4, BIS monitoring, pts on multiple vasopressive and sedation drips. These pts can be much higer maintenance than CVICU and you learn alot about HOW to get that CPP, alot about swans, fine tune your neuro assessments, manage Level 1 patients, tons of procedures, and in my experience...if it is large neuro ICU ......you have just as strong of an edge with regards to competing for CRNA school. But...you arent going to get LVADS, IAOBPs, but what you will get is a fine appreciation of managing hemodynamics, swans, paralytics, sedation, etc etc.
- 0Mar 8, '09 by aCRNAhopefulWow there's been some great information shared here I really appreciate everyone's responses. I would be overjoyed to get offered a Neuro ICU or one of the cardiac icu's (CV or CCU) it sounds like theres tons to learn in each. HR interview went great now I'm holding out hope that I'm not too late. I'm getting my ADN from a rural area and am probably the most proactive as far as trying to find a job in my class but I didn't realize HOW soon I needed to get on the ball if I wanted to find a critical care position at a large teaching hospital. It seems like the wave of May new grads has swept through all the critical care units before I got on the scene. Thanks again everyone
- 0Mar 9, '09 by EasyatmidnightI started as a new grad in the NSICU in Detroit a year ago and I get pulled to other ICU's when they are short staffed. My best advise is...go to the source. Talk to the people on the neuro unit where you were offered a job. Find out more info before accepting this position, spend a few hours observing talking to other nurses there, etc. Just talking to an HR person? that would never be enough for me to accept a job on such a specialized unit.
- 0Mar 16, '09 by GrnHonu08I actually disagree. I was a new grad in the neuro ICU and I have had plenty of people with swans and one with an balloon..i'd say the balloon pump is pretty rare but we see hemod. unstable people all the time...I mean we HHH...run CVPS titrating vasoactive gtts...we don't see open hearts or anything but we do see rhythm stuff quite a bit. We have a huge unit though and we see quite a bit of everything...its not abnormal to see a swan (we used to use them all the time for HHH but now have gravitated to flotracs and such), dialysis..wounds...