Help fellow Nurse Educators! When are new nurses ready for IABP, CRRT, etc.?

[CindydH]

I've been a staff nurse for 26 years and an ICU nurse for 19 of those years. I've been a staff member in the 24-bed cardiac surgery ICU for 13 years prior to starting this job in January of this year. Now I'm the clinical educator for both my cardiac surgery unit and a medical cardiac unit.

Here's the issue: we have incredibly high acuity in both units but especially the Cardiac surgery ICU. We not only have very sick patients but they come with a myriad of devices - Impella, CRRT, VAD, IABP and recently our ECMO program has taken off.

We've had nurses leave because they're going off to CRNA school, because they've had a baby, because their spouse was transferred, and other reasons.

So we've recently had an influx of a lot of new staff which is great for our numbers, but as we all know - it's not enough to have a "warm body" to make sure your staffing is okay. We need "warm bodies" who know what they're doing. The staff we've hired our excited, ready to learn, and willing to work hard but they're also really green and it's going to take time to get them up to speed.

So, my question is - how do you figure out when they're ready to take the IABP, CRRT and VAD classes that we require before they take care of the patients with those devices? In the past - we arbitrarily decided to send them at 6 months (IABP), 9 months(CRRT) and 12 months (VAD) after they completed their orientation.

Recently with a skill mix severely lacking in nurses prepared to take care of patients with these advanced therapies - our administration has mandated that we send the nurses who have finished orientation a couple months ago to these classes now. None of these nurses have previous ICU experience and although they're doing well I'm concerned.

I'm trying to figure out a more meaningful and objective way of assessing when each nurse is ready to take on the challenges of caring for these complex patients.

[FutureCruzanRN]

I started taking CRRT patients after two years of ICU experience. I took the class after a year and a half of working in the icu though.. I think that was sufficient. CRRT patients are often unstable ICU patients requiring dialysis. They are often not ready to be on HD due to hemodynamic instability. So far I've had two patients try to die on me on CRRT. In addition to knowing how to work the machine, it's imperative the nurse can spot the signs of a declining patient and intervene. Our intensivists often due not have a clue about how we use the CRRT machine and our nephrologists would be on call. The nurse at times is very alone and independent when caring for these patients. I don't think I would have been able to just off of orientation.

[PaSSiNGaS, MSN]

Waiting 2 years for CRRT is laughable. No reason you need to wait that long. Talk to your staff, see what they feel comfortable with. I understand nurses are on their own for a lot of daily care but that is just simply not the case and there is always backup. People aren't going to be comfortable with stuff initially no matter what it is. If they seem like they're doing a good job after the ICU orientation and are handling their current workload without much assistance then let them have some sicker patients. No need to wait a certain period of time.

If I was told I would need to wait 12 months before being able to care of a VAD patient I would have left that unit.

[FutureCruzanRN]

Like, I said this is my experience. My unit does not teach RNs with less than a year of nursing experience to do CRRT ( just asked the educator). Every unit is different. What's laughable is that you think all units are equivalent. I'm often the only CRRT nurse working on my unit or the most experienced with the machine.

[PaSSiNGaS, MSN]

You're the only one on the unit that knows the machine because your managers and leaders refuse to train others because of an arbitrary time period.

[RescueNinjaKy]

I think the norm in my cicu is that they train for crrt at around 1 and 1/2 year

[kalycat, BSN, RN]

Our timeline is sort of the opposite of this. We have a pretty active VAD and transplant program though. So, VAD and impella at about 6 months if the nurse is brand new to cardiac, usually balloon pumps about the same time or shortly thereafter (9 months) CRRT is last and usually around the one year mark but is occasionally pushed. There is some flexibility depending on the nurse's previous experience, so there's no hard and fast timeline that must be adhered to no matter what, but the scheduling of the classes is set up to support this basic structure. Sometimes people are trained sooner if the nurse is progressing and a class has openings.

For the record, I'm not an educator. I'm a cardiac transplant and mechanical heart RN (formerly came from the open heart OR) who cross trained to cvicu to help with some significant staffing demands. Hope that helps a little. :)