Cardiac unit for the new grad.. good idea?

[NurseKey622]

Hey guys,

I have been working in LTC as an LPN for about 3 years now and I just graduated with my RN in August. I stayed at the LTC facility for another month but they moved me to the rehab unit which I absolutely hate. Nurse to patient ratio is 1:20 and it's just too much. I was not trained on this unit so I'm still learning but every night I come home and just want to cry.

I had an interview today for a rather large hospital in my area, and it's on the cardiac unit. They told me the ratio is 1:5 or 1:6, however I realize that they are more critical. And eventually I can cross-train in CICU. I just found out that I got the job, and I am very nervous. I feel like this is a huge stepping stone in my career but I think it's for the best. While I'm working out my two week notice, I want to go back and review all things cardiac. Any other suggestions on how to be prepared for this major transition?? I want to feel at least somewhat prepared when I start orientation!

Thanks in advance for any advice for this baby RN!

[Ruby Vee, BSN]

I'm normally against ICUs for new grads (although I know that it's a thing now to hire new grads into the ICU and those new grads claim they do just great) but you're not really a new grad. You're a nurse with three years of experience. Your RN license is brand new, but you've already had experience as a nurse.

My best advice is to buy an ACLS manual and study it. You'll learn basic rhythms, which ones to treat (and not to treat) and why, the basic drugs and doses and what an "ideal code" looks like. Also study the basic anatomy of the heart -- you ought to be able to trace the blood flow through the system. Doing that will enable you to understand what to watch out for in a patient with an anterior MI vs. and inferior MI and what signs might alert you that a patient who just had an RCA occlusion opened is now occluding it again. Two weeks isn't a lot of time -- start with the ACLS manual and learn the coronary circulation while you're on orientation. You'll probably have a class on that in orientation, but if you've at least glanced at it ahead of time you'll pick up more in the class.

[Heartnurse24]

Are you working for a teaching hospital? My very first RN position was in a large teaching hospital on a combination med/surg and telemetry unit and as a part of their orientation they included EKG strips and interpretations w/ caliper measuring. We also were required to attend a 2 day course on cardiac rhythms and arrythmias, causes, treatements etc. Ask your nurse manager what they provide if anything. I think it's great experience to have that specialty. Not sure about your hospital, but mine sent you to ACLS classes after at least 6 months working on the floor and we were also cross trained into charge nursing on the unit. Good luck!

[Stella_Blue]

I too was a LPN for about 3 years before I started out on a cardiac critical care unit. I have been there for about 10 months now and so far I am really liking it. When I first left nursing school I loathed cardiac, but now Im in love. My question though is this more of a critical floor or a tele floor? That is a very high ratio. My floor is 3:1 on days and 4:1 on nights. We manage things such as many types of drips and pressers, we are the only floor other than ICU that gets anything post cath lab, STEMI & NSTEMI, CABGs after a few days post op, and so on. I would be a bit scared to titrate a neo drip, hang blood, and receive a fresh post cath all at once and still have 1 or 2 more patients to manage.

[RN_Vinny]

First off, Congratulations. I worked in LTC before going to my Cardiac floor so I feel your pain. The ratios in those rehab facilities are absolutely ridiculous. Once you finish once med pass, its time for another one. Any, I worked as a Rehab Director in a SNF, and worked on the floor when they were short at times, then worked in Rehab before finally making the transition to my current position on a Cardiac/ Neuro PCU. I was so nervous about the transition and trying to study up on everything but I am here to tell you that it is ok. It will all come back to you. You will have to take ACLS, and EKG classes so you will be fine. I didnt buy anything, just brushed up on a few things and so far, All is going well. Ive been on the unit now for about four months now and I love every minute of it. The EKG class will more than prepare you to know all the rhythms that you will need and ACLS will fill in medication gaps. The hardest part for me was figuring out the charting system, that's always the hardest. Use the nurses on the unit as your resource as well, you're never alone. I have nurses on my unit that have been there since I was born, that's a wealth of knowledge right there and they help calm me when I'm freaking out about a septic pt Im getting coming up on a cardizem and heparin gtt, because they had afib with rvr, didnt know and had a stroke.. EEKK. And of course an untreated UTI that has now made them septic. There's too much to cram in all at once so take it one shift at a time, and use your time at home to rest and sleep, lol. I promise, it will all fall into place sooner than you expect. Good luck, I love being a tele nurse though. I work nights and our ratios are usually 4:1 but if a tele bed is needed we can go to 5, but thats usually if we have med/surg overflow pts