Cabg, Iabp, Crrt

I work in a CVICU which is primarily post-op hearts. I've had CVVH training and just had my 5th IABP patient last night (jeesh it sure is mentally rewarding to get pretty wave forms on that thing!). So, I've been trained in all of it.

I passed boards almost 5 months ago.

Are you waiting to get trained or are you actively pursuing it and asking your unit manager when you can train on these things? A good chunk of my learning comes as a result of proactive behavior on my part. i.e. "Hey, there's a balloon class on such-and-such date. I'd like to take it, Do you have to sign me up or do I do it myself?"

Good luck,

Alyssa

IMO, you should have been trained already. I can't believe you can't get your manager to tell you why. If there is some reason, you obviously have the right to know so you can correct it. I was taking fresh hearts and IABPs within my first year in ICU - my boss was eager to get people trained. Is it a staffing issue? Are there not enough people to have someone double up with you the first couple times?

Thanks for the encouragement, it's good to hear that my frustruation is not without reason. I think my lack of training is because of several factors. Mostly, I think it's because those in charge think that you have to have many years of experience before you're "ready" to take hearts. In fact, just before I came they changed the rule that said you had to work there a year before pulling a swan or sheath! It's a very old-school mentality, and they're very distrustful towards new nurses. There's this 'old hens' club of people who have worked there for 30 years, and they think that they're the only ones that have skills. It's very frustrating.

I think staffing is another issue, although I think they could work around that one if they really wanted to. They definetly don't like to give up a nurse to do a night of orientation.

As far as my motivation goes, I've been VERY active in voicing my desires and doing my own learning. In fact, I border on being a pest. I'm constantly hounding them about when I'll be trained, and most days I call the charge before my shift and ask for a hard assignment, or a certain type of patient.

I've decided that if they don't start me on this stuff by September, I'm going to the NICU or ER, since both would move me toward my eventual goal of working as a flight RN.

I agree that experience is very necessary before taking fresh hearts. There are too many variables involved in caring for them that go beyond basic skills. I'm not sure that "many years" is necessary. But this is something that you should be introduced to slowly, 1 step at a time. (At least that's the way I look at it) I don't know what kinds of experiences you have had during your year there, but hopefully you have been taking at least 12-24h hearts. Or been assisting with the fresh ones. I think your manager should at least be giving you a target date, and a plan to lead up to it. I wouldn't blame you for leaving if that doesn't happen. If your own personal and professional goals are not going to be attainable, you're just treading water.

I don't know if I was lucky or not, that my ICU was pretty short when I started there. I took a "class" on hearts, took lots of yesterday's hearts, then got thrown to the wolves (at around 6 months). Learned everything the hard way! I had lots of support, but no 1:1 support the first few times.

As far as IABP and CRRT, you should have been trained and handling those way before now. They're not the big deal that people make them out to be. Pt's are way more stable and easier to manage while on the pump than they were off. It's just a matter of managing the machines, and knowing how to handle the common problems.

I've worked in the ICU for one year this month. Have now been an RN for 6 years, so did have experience going in, but it was med/surg. Took the SLED/CVVH class in March and did it a couple times in May. Will be taking IABP in August, though we rarely get them in the MICU. It sure is an experience...

Missy

I am a new grad and new RN (passed boards July 2005). I have been training during my internship in the SICU and OHICU. As a new grad (and with preceptor assistance), Iam taking 12-24 hour post-op hearts (pretty much on my own) and assisting with fresh hearts. I am also taking IABP patients (without touching the machine, yet!) and plan to attend an IABP inservice through DataScope in September. I am also being trained in sheath and fem-line removals. The other day, I assisted with an IABP pump removal, as well. I have yet to be trained in CRRT, however, I am sure if the opportunity arises, my supervisor would be more than willing to train me.

Our ICU director and supervisor are both very willing to train their new grads in these skills, so I do not see why you are being denied the opportunity. It sounds like it may be time to have a serious talk with your supervisor - you are entitled to some answers!

Best of luck! -J

In our unit, new grads are trained to take our Open Hearts from the beginning. Because IABP/CRRT are not a daily occurance in our unit, we wait for a year to train our new grads in IABP/CRRT...I think that it is a good thing because it gives the new person a chance to acclimate to the unit, the routine, some intresting hemodynamics, etc before they throw the IABP into it.

i been an open heart and trauma icu rn for ten years, and i think the solution is to take ur own initiative, find a staff nurse from ur unit who can walk u through open heart recovery, iabp and cont renal therapy. ur manager is not with u at the bedside aat, i think the reason why ur not being trained is because maybe it's the unit is understaffed and putting u with a preceptor for about a week or so would put a burden on her precious schedule. if that is the case then take your load and learn from the other nurse who has the balloon. most heart nurses are willing to teach newer rn's you just have to pick the right one, finally if it continues to be a problem, there's alot more hospitals out there that would benefit from ur enthusiasm, we always need new great open heart nurses;)

Thanks for all the responses. It's good to know that there are places out there where I could receive training. I had a meeting with my unit director and nurse educator. After listening to her for about an hour, I still didn't have a clearer picuture of the situation, except that they're going to train me when they're good and ready. I do think staffing has a lot to do with it. I just don't think the education is very strong where I work, which is dissapointing. I've decided to give them until probably november, then I'll go to the ER if nothing changes. Maybe I'll learn something there...hehe.

Well... I have been an RN for about a year and a half. After graduation I applied for a critical care fellowship. It has been great and has been a great benefit as a new grad. I do work open heart recovery, do IABP, and CRRT. I had extra training in these areas and was lucky to have had preceptors that were great and a unit director who believed in my abilities even as a new nurse. I guess the best part about where I am working is I know if I have a question someone is there to help me out. Not all nights are like this granted there have been nights where I was the most experienced ICU nurse on the unit. But my advice to you is if you feel ready to take this training then take it! After the classes you will know if you are ready for it! When you do have a CRRT or IABP on the unit, stop in ask questions like crazy!! Thats what I did. Everyone in my unit knew I was interested and loved explaining things to me. Well I hope you get into your classes!! Good Luck!

I think it depends on the staffing and longevity of the nurses in your unit. If you have a stable staff and don't desperately need new open heart trained nurses I suppose the feeling is that they can wait till you have proved yourself with other hemodynamically unstable patients before training you. Other situations would demand you be trained as soon as you could be. In our unit we wait a year before open heart training the new grads, more experienced nurses much sooner. CRRT as soon as they take the class and the same with IABP's (on the non-surg pts).

Grace:rolleyes:

I started in CCU. Fresh caths/post MI. Pulling sheaths within 2 weeks. But my unit was 32 bed post intervention so sheathes were a dime a dozen. IABP within 6 monthes. Orienting to carge at 7 monthes. Prisma,CVVHD at 8 monthes. We got cabgs and valves 24-36 hrs out that were failure to thrive, failure to ween or bubble heads or strokes sooner. Stayed there for 2.5 years until management drove off there "seasoned" nurses. Started traveling, back to ER for a year, then started open heart as a traveler. Did it for 2 monthes, then ER for 8 monthes, then back to ICU for 3 monthes, then ER 8 monthes, then CVICU/transplant/VADS for last 1.5 years at a new heart hospital in Ohio. Love fresh hearts more than anything, the VADS have been a big bonus, nice padding for the resume. When I settle down should be able to walk in and say I want a job, and get it.

Secret to my success 1) excellent preceptors 2) aggressive by nature, always looking for the next challenge 3) hit the units when staffing sucked and was flexible and loved the OT.

If they won't give you the challenge someone else would be more than happy to.

Just my .02 cents