Cvicu

With any new environment it'll take a while to fit in; I felt comfortable in ICU almost straight away... you need to try and relax and enjoy the new challenge, try not to be too freaked out by all the equiptment etc. You should have a supernumery period where you should try to take as many new pumps as possible to get used to the routine. Try and familiarise yourself with the stock room and where the emergency equiptment is, and what it is for anything your not used to.

I think cardiothoracic ITU nurses get a bit of a rough deal, i think maybe theres a fair bit of jelousy because of the knowledge which we gain etc and the autonomy we gain; and the closeness we have with the medical staff. All units are different but my unit is very sociable and mainly fun and quite relaxed.

You shouldn't be given IABPs straight off until your comfortable, you need to read up on them, what they do etc, read the manual. Your unit may have a link nurse for the IABPs or there may be training available.

Good luck, they'll be lots to learn but I find it really enjoyable:)

The first thing I would do is purchase "Perioperative care in cardiac surgery" by Robert Bojar. It will tell you EVERYTHING you need to know and is extremely easy to read. One of the Surgeons I work with used it for his oral boards and gave it to me afterward. Its the best book I have ever read. It is very easy to read and explains the need to know high points of everything that goes on it the unit, drugs, procedures, ect. Do yourself a favor and find a way to buy it. You will not regret it. CVICU is a difficult place to work because the stakes are high. Keep your mouth shut, work hard and help your coworkers, LEARN-LEARN-LEARN, ask questions if you dont understand and study as much as you can and you will do great. The people in my unit that are hated are the ones who either are lazy, think they know it all AND DONT or the people who you have to explain the same thing to a hundred times. Dont get caught up in talking about other people or criticizing others. Thats the best advice I can give you. Good luck.

BTW.........make some sort of a notecard book with drugs and common dosages and constants and such as well as "need to know" info for the unit. It will save your A$$ in the long run.

I tell the nurses I orient to expect 6mos before they are not ready to quit every day, a year before they feel competent, and 2 years before they are competent.

It will vary greatly between hospitals and with different doctors but on average CVSICU nurses have a great deal more autonomy and are expected to trouble shoot the patients much more independently than in other critical care areas. I wish I could advise you on books and such but I've been doing this so long that books weren't invented when I started in CVSICU. We wrote our own book based on our docs expectations and unit protocals for our orientees.

CVSICU patient care is usualy goal oriented not task based. What problem you want to solve right now and what outcome you are trying for are more important than what tasks need to be done in the next half an hour.

The unit works best when people work as a team. Don't be afraid to ask questions ALL THE TIME. The newbie that tries to "wing it" the first 6mos is just asking for trouble. If there is an unstable patient try to get involved, even if you don't take them in your assignment, you can learn a lot from helping. The thing you will find most frustrating is you will never get the same answer from 2 different nurses with the same question. Low urine output-"give 10mg, lasix, "500cc NS", "bump up your pressors", "call the doc", "check some labs" are all possible answers. Find a nurse that has good outcomes and has the respect of the docs and follow thier lead until you can stand on your own. NEVER say to a doc "well, I did such and such because so-and so said I should" You are the RN and whatever action you take is your responsibility- when in doubt-call the doc. If it turns out the doc disagrees with your decision- so be it. Don't hang it on your mentors or soon you won't have any mentors. I will always be happy to offer advise to another nures but they are where the buck stops. If they try to hang the docs tantrum on me, the only answer they are going to get in the future is "call the doc". Good luck-CVSICU can be a great place to work. Sorry for the book- I passionate about CVSICU.

Thank you all for your input on this subject. It is good to see someone in CVICU that has some "miles" on them as well. I am about to be precepted for my reentry program in a very busy CVICU. I have always been in CCU and cath lab, but never on this side of the surgical fence. I have ordered the book refererenced earlier and will hit it tomorrow when it arrives so I am glad about that. Thank you all for the input on working in such a unit!!!:redbeathe