Going from cardiac step-down to CVICU

[Fox_RuN, BSN]

Hey all,

Been a nurse straight out of school on a medically (rather than surgically) focused cardiac step-down unit for 14 months and just scored a position at my hospital's CVICU, which is supposedly according to those Newsweek articles, one of the best in the United States .

• I'm comfortable with all of the major IV/PO cardiac meds, including IV prostacyclins (i.e. Flolan).
  
• I'm surprisingly one of the few nurses in my current locations that is comfortable navigating a 12-lead and recognizing/explaining heart blocks and aberrancies.
  
• I can interpret ABGs quickly.
  
• I was never taught in school, but have started a few IVs on a generous (albeit healthy) co-worker.
  
• I've taken a leadership role in my share of codes this past year.
  
• My assessment skills/EKG interpretation is thorough and has helped prevent a patient from going into cardiac tamponade as well as getting others to a higher level of care so they didn't deteriorate further.
  

I've done very well as a new grad coming to that floor and believe I'm ready to take it to the next level (we'll see right?)

So, all you CVICU nurses, what gems/advice/quiz questions can you give me?

I've been studying intensely (I can tell you about normal ranges for CVP, wedge, MAP, CO/CI, facts about propofol, nipride, levo, etc...) I played a little with A-lines back in school during clinical rotations in SICU. Need to learn some more about vent settings/intubated patients, chest tubes, CRRT, IABPs and other surgical do-dads, so advice about these are especially appreciated

And all those damn stopcocks ...I always pushed adenosine straight in with someone else holding a flush in the port...

[RNpatterson]

As a new nurse nearing the end of orientation, I can speak from experience (for the first time in my nursing career) when I say "don't stress." You will learn everything you need to know (the basics and where to find help when needed) in orientation. I have been to class after class after class and so many skills labs since being hired... You will learn your resources (your coworkers and the manufacturing websites for equipment) and the rest you will learn with experience. I am in no way an expert in the cardiac ICU but I've gotten a proper foundation in the past three months and I am ready to fly solo. You will too.

The experienced nurses are concerned when there is a newbie who acts like a know-it-all or is too timid to ask questions. If you're not afraid to say "I don't know but I want to know..." you'll be fine. Good luck and congratulations!

[kuhRN]

It sounds like you have good baseline knowledge. I have been in CVICU since I became a nurse and when I was still in nursing school I precepted on the CV-step down. The cultures of the 2 units are completely different. CVICU is an ICU so obviously the patients are more critical than those on step down.

Even though it sounds like you know a lot the absolute best piece of advice I can give you is "do not act like you already know." Even if the RN you are working with is telling you something you already know just listen. First of all, you may not know and secondly, if you act like you already know then people won't want to take the time to teach you things. There was a new nurse in our unit and every time anyone tried to tell/teach him anything he acted like he already knew. He ended up loosing his job because of a very serious medication error. Show that you have a desire to learn and you'll do fine.