Change in Specialty to Cardiac Rehab??

  1. Hello!

    This is my first post at allnurses.com, so I apologize if it is in the wrong forum. I've been "lurking" on various forums for several weeks now and I must say I am very impressed with the professionalism and diversity represented here!

    I've been an RN for 13 years (in June) and most of my experience is in peds oncology. Prior to going to nursing school I earned a BS in Biology, and really considered getting a Master's in Exercise Physiology but for a number of reasons attended nursing school instead. About 5 yrs ago, though, I began to re-examine the Ex Phys thing and got really into fitness. I am certified as a personal trainer and have worked M-F attempting to build a training business out of my home while working weekends as an RN for the past year. Well, long story short I am now extremely burned out and have decided that my best option is to combine nursing and fitness/wellness into one career.

    The area I'm most interested in is cardiac rehab, but I have no nursing experience in cardiology. Given my background, is there any possibility I could find a job in cardiac rehab if I were to add ACLS and the ACSM Clinical Exercise Specialist cert (admittedly not a nursing cert, but very technical and geared to cardiopulmonary rehab pt's) to my credentials? The one thing I am not willing to do is go back to "square one" (i.e. night shift in the CCU, etc...), so if this is absolutely necessary I'd rather know now so I can continue looking for the right fit. Thanks so much for your thoughts!!

    FitnessRN
  2. Visit FitnessRN profile page

    About FitnessRN

    Joined: Feb '05; Posts: 1
    RN, Fitness Professional

    15 Comments

  3. by   joey442000
    i am also interested in the same thing does anyone have any info on cardiac rehab and exercise phys
  4. by   carachel2
    I have a BS in Exercise Phys. and a BSN. I worked for two years in CCU and then returned to my first love, cardiac rehab. for 8 years. Cardiac rehab is wonderful if you enjoy walky/talky type patients; are really good at teaching and reaching people where they are; and enjoy watching people gain small steps towards an improved quality of life. It is NOT a good job if you get bored easily and enjoy the constant thrill of living on the edge in a busy cardiac unit.

    As far as experience, our facility required cardiac rehab RN's to have some sort of tele/ICU or CCU experience. Even though the patients aren't as *sick* as hospital type patients, some of them are high risk (ejection fraction of 10%,etc.) and you will have up to ten of these types of patients at one time...experience in doing this will go a long way towards helping you do quick cardiac assessments. It was not unsual on any given day to have one patient having runs of ectopy, one who was hypoglycemic; one who was in new onset atrial fib with a rapid ventricular response and symptomatic and still another who had gained "just a few pounds" since his last visit and was a "little short of breath when walking on the track, but not really." You really need to know the acute side of cardiac care so you can recognize these symptoms, assess and treat appropriately. These patients are ambulatory, feeling SO much better and often do not want to admit to any problems they are having...so you really need to know the right questions to ask and how to aim your assessment. Without some cardiac care, you might find yourself overwhelmed.

    If you were to walk into our hospital based facility with your experience, ACLS and the ACSM certification, you would strongly be considered for a position, but would also be encouraged to get a little tele or cardiac experience. I would suggest for starters that you contact a nurse manager of a local facility and offer to do some type of internship. We've had more than one nurse rotate thru for a few mornings just to get an idea of what it was like and if it was for them.

    A lot of nurses think of cardiac rehab as the "country club" and think it is an easy job...and it is in a lot of ways. There are rarely any body fluids, rarely any Dr's barking orders and it is a fun environment: we regularly have Jimmy Buffett playing on the speaker system while patients are shouting out jokes and encouragement to one another. But it is very heavy on the paperwork part: each new patient had a full RN assessment, a teaching plan, team goals, a report to the referring physician at 6 weeks and then another at graduation. Each tele session must be reviewed for ectopy and ischemia and hemodynamic response to exercise, each teaching session documented,etc.etc.etc. I was also required to design and teach my own powerpoint lectures (and deliver them on a rotating basis ) on CHF; hypertension and my favorite..."Sex and Heart Disease."

    And don't even get me started on how much interaction I had to have on a daily basis with insurance companies. Each patient must be pre-approved and some companies allow only one initial visit and then you must contact them with a huge letter of goals, team treatment,etc. to obtain more visits. Some only grant 6 weeks and then require all of that. Medicare has tightened the restrictions too and only those patients who have had an MI, CABG or stable angina meet the requirements...leaving a whole population of post-stent and CHF patients with no reimbursed care and a string of cardiologists who don't know about these newer guidelines and still refer their bewildered patients to your front door for care.

    An exercise phys background would be MOST helpful and might balance out your lack of cardiac care experience. More than a few of our RN's are great at managing the tele part, but were unsure how to progress the post MI/ EF 10% patient on his program and how to return the truckdriver (who had to lift a 50 lb weight load on a daily basis ) back to work. I found my Ex. phys background VERY useful in this aspect and found it made me a much better cardiac rehab nurse.

    I LOVED my cardiac rehab job and my patients. They truly appreciated all you did for them...we gave them their life back after bypass or MI at a time when they never thought they would have the energy to travel again or play with the grandkids. I loved teaching the busy young executive how to balance out his/her life and watch them learn to slow down. I loved cheering on the 300 lb woman as she lost a pound a week. I went to more funerals than I could count and I regularly ate breakfast with the group of old guys who have been doing rehab together for 20+ years. I LOVED my 4 day a week, no weekends and no holiday job and my coworkers were fun and helpful as well.

    I left my job because I was getting a little stagnant and needed a more flexible job as I return to school. I now work PRN in the ER. I should also add that in a lot of areas the pay for cardiac rehab nurses is not as nice as for typical 'bedside' care nurses and there is no shift diff,etc. However, it is a LOT less stressful and like I said...SO fullfilling and fun.

    I am rambling now, but left me know if you have any further questions. I am more than happy to help !
  5. by   carachel2
    I just re-read my post to you and realized I gave you a lot of insight into the job itself, but didn't really answer your question ! I think based on your health and fitness experience you would have a good chance of crossing over. Do you have any adult nursing experience at all ?

    I've met lots of nurses in the cardiac rehab industry who had NO fitness expertise at all....no real understanding of the physiological responses to exercise for special health populations. If you do the ACSM test, you will have proven that you do understand these basics.

    Again, I would just start calling up some local programs, tell them about yourself, arrange to come in and meet the nurse manager and spend some time just observing. Your biggest challenge will be the tele part of the job, but I think your willingness to learn and your interest in health and wellness may just over ride the lack of cardiac experience. I would also supplement your ACLS and ACSM with a solid 12 lead EKG course and any other cardiac courses you could get your hands on like CHF and Acute MI.
  6. by   Smilez06
    Hello Room, I really like this site and that was a really good insight about Cardiac Rehab. I am currently in Nursing School and I believe Cardiac Rehab is where I would like to work. I have a degree in Exersice & Sport Science and I always wanted to combine my degrees. So you are suggesting that I should start out in CCU and Cardiac instead of jumping right into Cardiac Rehab? I just don't think Med Surg is where I want to be when I graduate? Anymore good advice for the future?
  7. by   carachel2
    Smilez...I definitely think you should work in either CCU, telemetry or CVICU after you graduate. As I mentioned in my longer post before, you will be faced with many similar issues in cardiac rehab and experience in managing them is invaluable...especially ischemia and chest pain. On my first day in cardiac rehab we had a full cardiac arrest ! Everyone else freaked out and for me it was just like another day in CCU, LOL.

    My nurse manager required some sort of ICU,CCU or tele experience. Good luck to you and let me know how everything turns out. I also have a degree in Exercise Science and returned to nursing school.
  8. by   cardiacrehab
    Hi all I have enjoyed reading the responses in this forum. I am a CNS in cardiology and the Manager of a cardiac rehab program. I hire nurses who can read a monitor, 12 lead, and have ACLS. Myself I spent many years in the CCU, have a Masters in nursing, have ACLS, and am an exercise specialist with the ACSM. The exercise specialists I hire are ususally purely physio or Kinesiology with their personal trainer. Having said all this, the best exercise person I ever hired was a nurse with a very strong exercise background, but no cardiac experience. She was awesome. Being fond of patient teaching on a one-to-one and group sessions is a great attribute. I'm thrilled that there is so much interest in CR, it is my passion.
  9. by   Smilez06
    hello cardiac rehab, I have a degree in Exersicse & Sport Science, but didn't get certified as an AT, because my passion was stronger in the Nursing field. I am truly interested in this area and would like to combine both my degrees. I would like to know if the ACLS is the personal trainers license? Also is the ACLS needed to become a cardiac rehab nurse? Since you are already in this field would you suggest that I start out in the ICU or CCU before going right into CR? By the way I am still in nursing school. Thank you in advance
  10. by   Smilez06
    thanks to you as well carachel2 for the info, I am trying to get as much info about this field as possible.
  11. by   carachel2
    Quote from Smilez06
    hello cardiac rehab, I have a degree in Exersicse & Sport Science, but didn't get certified as an AT, because my passion was stronger in the Nursing field. I am truly interested in this area and would like to combine both my degrees. I would like to know if the ACLS is the personal trainers license? Also is the ACLS needed to become a cardiac rehab nurse? Since you are already in this field would you suggest that I start out in the ICU or CCU before going right into CR? By the way I am still in nursing school. Thank you in advance

    ACLS = Advanced Cardiac Life Support
    ACSM= American College of Sports Medicine...they have different levels of certification for Exercise Science/Technology.

    ACLS is required for most cardiac rehab facilities (I wouldn't work at one that doesn't require it, LOL). IF you really love hearts and all things cardiac, I would shoot for telemetry, cardiovascular recovery or CCU. I did two years before going back to cardiac rehab as an RN and I am very glad I did. As I mentioned, we had a full cardiac arrest on my first day in rehab.

    Be aware that cardiac rehab nursing pay is a little less than floor nursing. There are no weekends, holidays ,etc. required (a good thing !) and no shift differential. The $$ is still good, but a lot of nurses are shocked by the pay difference. But when you keep in mind that you are not dealing with body fluids, 12 hour shifts, working on weekends and holidays.....it comes up pretty even. PLUS...a lot of places offer flexibile scheduling which is great when you have kids. Have fun !
  12. by   RN12345656
    FitnessRN--
    Please keep in mind that many facilities/hospitals CR nurses work in different capacities.
    The hospital I work for, the CR nurses exercise "well" patients with cardiac hxs or post cardiac surgery and/or post cardiac interventions. The CR nurses also round on inpatients which includes walking, talking, and teaching the patients. I personally feel the CR nurses are a valuable part of our "team" :redpinkhe , however I find it not to be challenging for me as a nurse. If you prefer to work at a faster pace--I wouldn't reccommend CR nursing. CR nursing does have bonuses like no weekends/no holidays (in most hospitals) and really getting to know the patients on a personal level.
    If you have not work with adults and especially in cardiac, you definitely need to brush up and take ACLS. You will have an occasion code with your outpts.
    I believe you have all the requirements to be a CR nurse..but only you know if it would make a right fit for yourself. Speak with a nurse manager..find out exactly first hand what capacity the CR nurses work in the facility of your choice. Shadow them for an entire day. Only then will you be able to decide.
    Good luck to you!!
  13. by   carachel2
    Quote from heartnurseinva
    FitnessRN--
    Please keep in mind that many facilities/hospitals CR nurses work in different capacities.
    The hospital I work for, the CR nurses exercise "well" patients with cardiac hxs or post cardiac surgery and/or post cardiac interventions. The CR nurses also round on inpatients which includes walking, talking, and teaching the patients. I personally feel the CR nurses are a valuable part of our "team" :redpinkhe , however I find it not to be challenging for me as a nurse. If you prefer to work at a faster pace--I wouldn't reccommend CR nursing. CR nursing does have bonuses like no weekends/no holidays (in most hospitals) and really getting to know the patients on a personal level.
    If you have not work with adults and especially in cardiac, you definitely need to brush up and take ACLS. You will have an occasion code with your outpts.
    I believe you have all the requirements to be a CR nurse..but only you know if it would make a right fit for yourself. Speak with a nurse manager..find out exactly first hand what capacity the CR nurses work in the facility of your choice. Shadow them for an entire day. Only then will you be able to decide.
    Good luck to you!!
    You bring up very good points....if you are a nurse who thrives on the thrill of an exciting coronary unit with new admissions, people crashing and all that good stuff...you will be desperately unhappy in cardiac rehab for the most part. I find that the nurses who do best in CR are the ones who enjoy a somewhat predictable environment, enjoy long term relationships with patients (i.e. if they are annoying, you cannot sedate them OR discharge them...they are there to stay, LOL !) and also really enjoy the essence of patient education and teaching.
  14. by   lee1
    I am a full time cardiac rehab nurse. To be honest I would not reccomend any nurse for this job UNLESS they had cardiac CCU or cardiac telemetry experience. Most of these patients are on Cardiac medications which you need to understand, plus the anatomy/physiology of what happens with cardiac patients. You may or may not be working with other nurses. 1 day out of the week, I am NOT with another RN but with the exercise physiologist, who granted, does have a good understanding of cardiac disease as he many years of experience. My other nurses are all either former CCU or telemtry nurses.
    Just today, I had 3 almost incidents this morning during our exercise session. An anxiety attack, post exercise hypotension, during exercise angina attack. I have sent 14 patients to the hospital ER over the last year, most were admitted and treated-----restent, new stent, medication adjustment. Since our hopsital is hi acuity we also have heart transplant patients, we see LVAD inpatients also.

Must Read Topics


close