Changing from ER to CSICU

NorfolkRN · Apr 1, 2007

I started taking care of open heart pts about 2 years ago after 3 years of general ICU nursing. I enjoy it because I get to see very sick people get better quickly (usually). They come out on all these gtts and you're giving all this volume getting them stabilized. The focus then turns to getting them extubated ASAP then hopefully by the next morning they're up in the chair having breakfast. I find it extremely rewarding. However sometimes they become chronic pts with multiple organ system dysfunction and you're stuck with them for weeks then it becomes more like regular ICU care. Surgeons are are taking sicker and sicker patients now so you get folks with 10% EFs with alot of comorbidities.

I have only worked in the ER once in my entire career so it is hard for me to say whether you would find CSICU enjoyable. I found the ER somewhat frustrating because of how unpredictable it was not knowing what would roll through the door next but a little bit exhilirating because of the fast pace and pt variety. The CSICU is pretty predictable "cookbook" nursing. There are very bad crashing pts sometimes but they are variations on the same theme. Make sure the unit functions well as a team so you know you'll always have help which I find is essential in dealing with these types of pts.

Hope that helps.

Best of luck to you

incublissRN, BSN, RN · Apr 1, 2007

I started taking care of open heart pts about 2 years ago after 3 years of general ICU nursing. I enjoy it because I get to see very sick people get better quickly (usually). They come out on all these gtts and you're giving all this volume getting them stabilized. The focus then turns to getting them extubated ASAP then hopefully by the next morning they're up in the chair having breakfast. I find it extremely rewarding. However sometimes they become chronic pts with multiple organ system dysfunction and you're stuck with them for weeks then it becomes more like regular ICU care. Surgeons are are taking sicker and sicker patients now so you get folks with 10% EFs with alot of comorbidities.
I have only worked in the ER once in my entire career so it is hard for me to say whether you would find CSICU enjoyable. I found the ER somewhat frustrating because of how unpredictable it was not knowing what would roll through the door next but a little bit exhilirating because of the fast pace and pt variety. The CSICU is pretty predictable "cookbook" nursing. There are very bad crashing pts sometimes but they are variations on the same theme. Make sure the unit functions well as a team so you know you'll always have help which I find is essential in dealing with these types of pts.
Hope that helps.
Best of luck to you

:yeahthat:

I just transferred to cardio vascular thoracic recovery in November. It can be predictable but has variations. I like the predictability and the variations keep it interesting. Like the other poster said, things can go well or they become ICU patients. It seems to go in waves in my unit. I really enjoy it because when things go well it is very rewarding to see my patient sitting up in the chair POD 1 but I also get to learn a lot by taking care of ICU patients. It's a nice mix of patients that talk and vented/sedated patients

clarkheart · Apr 1, 2007

I've worked in CVICU for 5 years now and I've learned that is there is no such thing as a "rountine" CABG--and that's what keep things interesting for me. Just when you think you've seen it all, new scenarios arise and you find yourself learning all over again. Because of all the systems that are involved in taking care of these CABG's, I am always on the alert and not allowed to get complacent at all. In our CVICU we are allowed a great deal of autonomy with regards to starting meds and extubation. I find the work very satisfying and challenging.

cardsRN · Apr 4, 2007

just when you get complacent, the pt exsanguinates and you have OR in your room. it is very serious business, and i would strongly suggest visiting the unit before accepting any offer to shadow and pay close attention to the group dynamics. it is very possible that as an experienced but new to ct surg nurse you will not be within arms length of anything interesting for some time. it all depends on how "stratified" your staff is. unless you are willing to do a certain amount of "dues paying" all over again, i might look into sicu first. just my experience, every place is different. shadow first and talk to other recent hires.

incublissRN, BSN, RN · Apr 4, 2007

Yeah, group dynamics are important. My unit is good about letting me receive patients at night whenever possible so that I get the experience. Find out when they expect you to take classes for VADs and balloon pumps.

BBFRN, BSN, PhD · Apr 6, 2007

I went to the CCU with a background in trauma ER (different hospital than the one I'm in now), and although the two are vastly different, I am making a good transition- in fact, I am being trained to take fresh hearts. I absolutely love learning about heart patients, and it is never boring on my unit- just like the ED.

I had a lot to learn about heart patients, cardiac numbers, and maintenance drips. Most of the meds given on my unit, I had initiated in the ED, but did not really have to titrate the patients off of them, or maintain them for very long. I had helped intubate and vent patients many times in the ED, but didn't really have to maintain those things. Maintenance of most of the things I have initiated in the ED has been my focus of learning- as well as pathophysiology of the heart.

The ED did prepare me to be quick on my feet when I see a problem arising, though. This is invaluable with these patients who can go downhill very quickly.

The ED experience also comes into play when dealing with stressed out family members, and in being proactive in predicting what things need to be done before calling the doc. I find a lot of autonomy on the unit, and if you're a strong nurse, you'll enjoy that as well.

I have found CCU to be quite task-oriented at times, just like the ED, because these patients do move in either direction pretty fast. If you're an adrenaline junkie still, you might just find yourself at home.

I told my coworkers that I have never felt more at home than on my unit, because they are anal nerds, just like me. I should have done this years ago. The funny thing is, when I applied for the transfer to this unit, I was told it was a neuro ICU by the retention specialist. I had thought I would be a better fit in neuro, because of my trauma background. 2 days into orientation, I asked why we didn't have any brain drains on our unit. My coworkers still laugh about that one...lol.

healingtouchRN · Apr 9, 2007

congrats! I went the reverse route, CCU then ER. But I think if you can endure the pace change. You think less of tasks from ER to CCU & more of longer term (greater than 12 hours) planning for the inpatient. In ER your planning so often centered on discharge home & follow up with consultant or wound care or home health. Your CCU plan will be ongoing & changing, a challenge to get it all done. Often when my paramedic or nursing students rotated in CCU, they would say to me "it's so quiet, nothing is happening". I reminded them in that this show ignorance of a cardiac patient. they can be considered the calm before the storm. the silent MI's, The R-on-T, the pulmonary edema at 4am....all require the RN alert & accurate assessment skills. this assessment ongoing makes for a "quiet night" heading off any untoward emergencies. I believe this is what early intervention means! To quote Dr. Laura Gasparis-VonFrollio, "you need a nurse to save your life!"

Indy, LPN, LVN · Apr 15, 2007

You know, I really do think pulmonary edema is fond of 4 am for some reason.