Do Neuro ICU nurses get good cardiac experience?

allnurses Guide · Mar 5, 2009

Neuro would not necessarily have swans and IABPs, but they would have many vasoactive infusions and invasive hemodynamic monitoring. I think you'd definitely learn a lot. I worked trauma ICU for a while after doing CTICU for years and still learned a lot.

labman · Mar 6, 2009

I 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.

HouTx, BSN, MSN, EdD · Mar 6, 2009

I 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.

labman · Mar 8, 2009

Ya 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

Christie RN2006 · Mar 8, 2009

Honestly, 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?

Keysnurse2008 · Mar 8, 2009

Well...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.

aCRNAhopeful · Mar 9, 2009

Wow 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

Easyatmidnight · Mar 9, 2009

I 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.

GrnHonu08 · Mar 17, 2009

I 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...

wanderlust99 · Mar 19, 2009

If you want to be a heart nurse, work in a busy CVICU if that is really your passion. Neuro is very interesting though and is a wonderful speciality to have. You will become familiar with all the vasoactive drips you will see on any cardiac unit (most of them anyway). I surely wouldn't expect you to see much balloon pumps though. If it's a strictly neuro icu and not a mix (like a sicu, etc..), then I don't think you'll see a balloon pump. Swans, we have a lot of them, but that depends where you are, as many docs are not using them so much anymore.

You can always transfer within your hospital. As a new grad, good luck. You will be getting the basics down that first year anyway.

You will be spending your time doing neuro exams, going for stat ct scans, helping with putting in evds, and more importantly managing them. It's a great knowledge to have, taking care & understanding neuro pts, as it can be complicated and serious. Good luck.

hassan ayache · Mar 26, 2011

can someone submit a competency checklist for hemodynamics in icu