CV ICU new grad job question

Ruby Vee, BSN · Jan 14, 2017

I've never heard of orienting to all of the ICUs, unless it's a new thing. I don't think it's a bad idea, though. You'll be exposed to all of the different ICUs and the people who work there, and it is never a bad idea to have friends all over the hospital. Nor is it a bad idea to know how to take care of a neuro patient, for example, if your aortic dissection patient in the CVSICU would stroke. Or if you have to monitor a lumbar drain. Or if you have to float.

Each ICU has their own area of expertise -- you know that. But it's a great idea to learn something about the other areas of critical care nursing because patients don't come in perfect health except for the heart you're fixing. I worked with hearts for 30 years . . . and during that time, I've had two patients give birth, a few require traction (MVA either caused a cardiac event or was caused by one), one kid whose "aortic dissection" turned out to be a huge freaking tumor and we had to learn to give chemo, several patients who stroked and were on neuro protocols in the CVSICU (it would help to know what a neurologist means when he orders a "neuro check q 1 h" because what they thought they were ordering and what WE thought they were ordering were vastly different). I took care of a kid who went through a threshing machine before he was impaled on the pitchfork that his Dad thought they would jam the thrashing machine with to free him . . . after his heart got stitched back together, we had all these OTHER injuries to take care of as well. We've had numerous patients on long term vents, and MICU experience would have been invaluable.

Basically, I think it's a fantastic idea to orient to all of the ICUs. You'll learn tons, you'll meet people who will be resources and may even become friends, and you may discover you're more interested in Neuro than in cardiac. You just never know. Good luck!

Burks21 · Jan 14, 2017

The system I work for does something similar. As a new hire into the ICU world you "follow" a seasoned nurse in each of the ICU environments (SICU, CCU, CVICU). It's kind of neat, in my opinion, as you get to see a little bit of everything. Who is to say your recent CABG patient doesn't start presenting CVA like symptoms? That would be on of our SICU main admissions. How about an IABP or CRRT? That would be our CCU and CCU/SICU areas. Our CVICU rarely has an IABP or CRRT but sometimes they do.

It's a fantastic learning experience and I highly recommend you take the time to learn all you can in each area. This is a new program to us and from my experience, the new ICU nurses are doing much better than they previously were. Also, as Ruby pointed out, you may have to float to another ICU. Now they won't give you patients you are unfamiliar with but I'm sure they'd give you cardiac related patients or maybe some septic patients and expect you to manage fluids, labs, and possible pressors. The nice thing is, during your rotation, you'll also learn which nurses you can lean on and feel comfortable asking "stupid" questions (remember there are no stupid questions in nursing).

Good luck to you.

SDSUBSN · Jan 15, 2017

Thank you both for sharing your insights and thoughts.

OllieW, DNP, PhD, NP · Jan 16, 2017

You orient in all ICUs in case you are required to float there.. Always inquire where you float as a nurse. Some facilities require just to float to the ICU clusters while others will have you in step-downs as well. Other facilities will make you even float to med-surg. It makes ICU nurses crazy to float out of their clusters and especially to med-surg areas as they manage time differently.

Just because you like or desire one area better there is much to be learned in other areas and there is a lot of crossover as far as patient care. Your patients in CVICU will no doubt have conditions that are not only cardiac related.

Good Luck

WestCoastSunRN, MSN, CNS · Jan 16, 2017

What's going to kill em first? That decides which ICU they go to. Other than that you can expect a lot of cross-over in co-morbidities. My hospital has the same policy as ICU nurses will float to any of the ICU's. So they orient you in those as well as on your own so that you'll feel comfortable floating there. I WISH my previous institutions had done that. Would have taken some of the anxiety out of floating, as well as had given me exposure to stuff I didn't see in my unit.