I start next week any advice for new grad

Jules Anne · Feb 29, 2008

I also am a new grad on a cardiac stepdown unit. My advice is to watch how your preceptor and other nurses organize their time, take on as much as your preceptor will let you so that you can work out your day with him/her watching over you to keep you out of trouble and ask tons of questions. GL!

TAB_RN · Mar 1, 2008

I also have started this past week on a cardiac/surgical step down unit. I will start precepting this week coming and start my telemetry certification classes next week. I am thrilled to be finally at this point. Good luck and best wishes to both of you!!!

surfer betty crocker · Mar 10, 2008

study, practice strips and be flexible. as a new nurse, many little things can throw a wrench into your night, things that a seasoned nurse wouldn't sweat. and on a cardiac floor add that patients are pretty ill and anxious. its very fast paced and overwhelming but then again, so are most areas of hospital nursing. be proactive and vigilant and most of all don't be hard on yerselves! good luck, it's a great specialty when you have managable pt. loads. :nurse: :typing

Miami NightNurse · Mar 10, 2008

Hello all I am so excited to 1) have a job and 2) for it to be a cardiac nursing job. I would like to know any suggestions you all may have for a new grad to survive this area and how to manage stress and time. Thanks I am so excited to be a RN

So did you start your new job? How is it going?

bluesnurse · Mar 13, 2008

Know your rhythms, know your patients, assess and re-assess frequently. Know your drugs, drips, and calculations. And don't ever, ever be afraid to ask questions. There are NO stupid questions, ever!!! Get to know the experienced nurses and pick their brains. Don't underestimate the docs, either -- many are great teachers and will trust your nursing judgment more and more as you gain experience.

Cardiac nursing is a challenge and the consequences of a bad decision are major. But it is also incredibly rewarding and endlessly interesting. I stumbled into cardiology 15 years ago and it's like a habit I can't kick -- every time I think about changing specialties, something pulls me back.

Good luck and let us know how your job is going!

Psqrd · May 26, 2008

I start June 16th on a CVIU floor...thanks to everyone for the advice even though I am not the OP I sure appreciate it.

P2

al7139, ASN, RN · May 30, 2008

Hi there!

I started one year ago fresh out of school on a telemetry unit. In school I never thought that I would want to do cardiac nursing (hated the subject in school), but my last semester, I did clinicals on the unit I work on now, and was amazed at how much I enjoyed it. The nurses were great, they really cared, and liked having the students around to teach (unlike other clincal sites where I felt like an inconvenience).

I chose this unit for those reasons, and I realized that the experience I get here will prepare me for any nursing job should I choose to try something different.

Be aware that real life nursing is very different from the controlled environment of school clinicals. It can be a very rude awakening for some people. Be prepared to have days when you question your decision to be a nurse, and cry on the way home, and think about quitting. Do NOT let this get you down!!!! Every new nurse experiences this and it is totally normal to feel this way.

The most important thing is to realize that school gives you a strong foundation to build on. You will be constantly challenged and constantly learning. At first you will be overwhelmed and feel like you didn't learn anything in school. Every new situation will be scary (the first time you have a pt with chest pain, the first code you call, the first death, etc.). You will need help at first for everything. After a while, you get a pt with the same problem as one you previously treated, and you think..."Iv'e done this before, I know what to do." and you do what needs to be done.

Some days I felt like a bother because I was constantly asking my preceptors what to do, but you can't learn if you don't ask.

I am still after a year asking questions, there are new learning experiences every time I work. It's OK not to know the answer to something you are asked by a pt or family. My standard reply is "I am not sure, let me check on that and then I will let you know."

For nursing care, get a system that works for you...don't let another nurse tell you that their way of organizing is how it should be done. It may not be right for you. I asked lots of nurses to show me how they organized and prioritized care, and I took what worked for me, so my system is based on several nurses advice. The unexpected happens, which can still throw me off, but that happens even with years of experience.

As for basics, these are what I feel was most important:

Know your ECG's especially the abnormal rhythms. When I look at telemetry strips or the monitor, if I have a question, I ask the tele techs since that is all they do, they know more than I do (get to know them, so you have a good working relationship), if you can get a chance to spend a shift with your techs. I loved it because the techs spent the shift quizzing me on different rhythms, which reinforced what I learned in the cert class.

Know your basic cardiac drug classes (beta blockers, ACE inhibitors, etc.), and what they do and side effects. If your unit has certain protocols for drips like integrilin, heparin, amio, etc, learn them so you know what you need to do.

If your unit has a code or a MRT (not quite a code, but the pt is in distress), try to at least be there to observe what to expect when you have to call one.

Get a chance to spend a shift in the cath lab to observe the procedure, post care, etc.

You will have patients with multiple problems...esp diabetics. Know your insulins, parameters, blood sugars, etc. Expect to be treating lots of different problems, not just heart related.

Try to use your critical thinking skills to work through a problem first, get to a decision, then run it by another nurse FIRST to make sure you are on the right track. It's ok to ask and be wrong, you will learn, it's not ok to do something if you are unsure.

Expect to at some point make a mistake. It's not the end of the world, learn from it and move on. Don't beat yourself up over it.

Have fun, and laugh at yourself. A sense of humor is important to get you through the rough spots. Nurses joke about things most people would not find funny.

Have a good bedside manner. The pt who was a pain in the rear to the last nurse may just need someone to listen and acknowledge their feelings. Get to know them and talk to them, don't just be the person who gives them meds, and never ever show that you don't agree with their lifestyle, or treat them as anything less than human. Even if they are a homeless crack addict, they deserve our respect and the best care possible.

Sorry this is so long, hope it helps!

Amy

jjjoy, LPN · Jun 6, 2008

Amy - I bet you'd make a great preceptor/clinical instructor!!!!!

Morettia2, BSN, RN · Jun 10, 2008

1.ALWAYS ASK QUESTIONS

2. Know your rhythms( I can't stress this enough look any any EKG or tele monitor you can to make your self familiar with the rhythms)

3.Introduce your self to the cardiac MD's and make sure you talk to them on a regular basis as an orientee and est. a relationship with the cardiologists,(believe me it's less stressful to call a cardiologist at 1am when they know who you are, they may still get annoyed, and be aggressive ,but at least they know who you are)

4.Know your cardiac drugs (ACE, B-Blockers, Inotropes, ARB's, dieuritecs, thinners, ect..), and drug-drug, drug-food interactions. Ex: ACE's can cause the ACE cough, or angioedema, B-Blockers check for a BP or Pluse perameter in the medex Usually is 'Hold for SBP

5.keep your ACLS pocket guide with you at all times (believe me, it will save your life as a new RN and possibly your patients life during a code or a RRT, all the cardiac algorhythms(I can't spell) are in it plus all the cardiac drugs are in the ACLS pocket guide)

6.Know your lab values, Low K+ or High K+=bad shift, Low Mg or high Mg=bad shift, Elevated BNP=possible CHF, Elevated CK and trop with a normal 12 lead EKG=possible NSTEMI, Elevated CK and trop with a abnormal 12 lead with a S-T elevation=STEMI, Both NSTEMI and STEMI are immediate Codes at my hosp.AND ALWAYS REMEMBER M.O.N.A.....

7.Always do a through assessment. If your pt. is having a 'strange' feeling in their chest, pay attention. If a pt. says they are having CP s/p cardiac cath, call the MD who preformed the cath or the cardiac fellow, If the pt. is female and feels a heaviness, and like some one is sitting on their chest, and with a radiating 'sensation' to both upper limbs along with a anxious feeling you better notifly the MD ASAP, and if the MD is not at the Hosp. call the House MD or Tele Resident to eval the pt. and make note of the curent EKG on the monitor. If the pt. is male, and they have been exp. 'heartburn' more than they usually do, with GI upset and sleeping sitting up x's 1 or 2 nights, and a feeling they just can't shake, you better be calling the MD ASAP and if the MD isn''t at the hosp. cal the house MD or the tele resident, and get a STAT EKG and labs. It may be nothing or it maybe something. ALWAYS think with cardiac pt's, when they say, "Well my GERD is acting up more then usual, or I have this weight on my chest..I just think it's stress, or I have been sleeping sitting upright in a chair for the last 2 nights, or IT only gets worse at night, or I have angina but it's unbearable right now and Nitro dosen't relieve it" you better be prepared to do a full work up. When you see that your pt. has a run of V-Tach, say 8 beats on the tele monitor, at say 0100(b/c I work nights hehe), ALWAYS check the pt. FIRST, even if in the long run you look at the strip and it's just artifact or non-sustained V-tach. YOu can't judge a pt. by the rhythm strip. The first thing I learned in cardiac nursing is, your pt. may be dead and still have an EKG on the tele monitor or PEA(Pulseless Electrical Activity)...Scary I know..but true.

8. Always get a PMH from the pt. If the pt. is a smoker 20+ years, who drinks ETOH occasionally, and has a strong family Hx of heart disease, and depending on the ethnicity(which can play a huge role along with family Hx) and this is their first hosp. for cardiac problems should raise a GREAT BIG RED FLAG. Even if the pt. is a non-smoker, dosen;t drink ETOH with a unknown family Hx, and you know the ethnicity(just by asking questions) can also raise a GREAT BIG RED FLAG. The best you can do as a nurse is, ASK QUESTIONS (which can be the rosetta stone for determining care for many pt's), EDUCATE the pt (which is KEY for the pt.), and be the pt's SUPPORT system.

9. When ever you can, participate in RRT's and Codes(cardiac arrest in particular), and pay attention. Believe me, the first few RRT's or Codes you feel like you are hindering insted of helping, but offer help in what ever you can do, be a runner for IVF, MEDS that the code cart ran out of, enter critical labs, pay attention to the RN doing the Code Count, call what ever MD's need to be called, call the lab for the lab results, even take the regular calls on the floor(phone calls, call bells, ect..) YOU WILL LEARN. And when you are able to handle a CODE, make sure that there is one voice in the sea of voices that is heard, so the MD or who ever running the CODE knows they have some one who can repeat the orders LOUD. It gets crazy during a CODE, RN's ,MD's, MD Residents, Respiratory, Med Students ect crowded in a small space all shouting and saying multiple things at once ...I have learned to give a sheet of paper to another RN to do the count, and I have the loudest voice on my floor (literally) and I ALWAYS say to the masses, WHO IS RUNNING THIS CODE. When ever the MD says push this, do that, we need this, ok all clear shocking, I repeat what the MD said in a loud voice to make sure all parties are listening and hopefully paying attention. And the RN doing the CODE count need to be able to hear what Meds or interventions are being done at specific times, so when the MD asks, "When was the last round of EPI given, or Atropine, or NAHC03 given", the RN doing the code count can ans. the MD with the right time and med. and the MD can determine if another round of MEDS is needed. I also tell ALL of the MD's and RN's after they give a MED during a CODE to save the vial and make sure the Code Count RN is aware that the Med was given by saying, "1 amp NAHC03 given", shows the vial to the Code count RN. Since I started doing this during our CODES, we have had less confusion as to what MEDS were administered or when was the last time a MED was given. I also make sure that the Newer Cardiac Residents, who are great, and I love them, don't crack all the pt.'s ribs while doing CPR, so the pt. ends up with a flail chest and a possible pneumo, b/c the residents just wanna DO IT and begin whailing on the pt. like a rag doll. I know they are excited, and ready to pump n' shock, but on the 97 y.o. grandma, who is all of 80lbs, I make sure they are in the right spot for CPR. I saw one new resident begin compressions in the wrong spot and well it didn't go so well,I have also seen brand NEW SPANKING residents begin compression on a morbidly obese pt, and the pt. aspirated b/c they didn't take the 1 second to feel the chest. That time I just jumped on top of the 300+lb pt and said, "I wil do compressions and you help run the code". The Resident MD asked me afterward how did I know where to push, I said "Look, and feel, obese people have a xyphoid process, but you may not be able to feel it, just look and feel, and you will get it, if it's soft it's a bad place to be." ALSO KNOW IF YOUR PT. HAS AN ICD or a DUAL PM/ICD, and if there is a magnet on the code cart, or a magnet near by. Always think 'ICD=Magnet near me' during a code. B/c the EPS MD may ask for a magnet to deactivate the ICD to see the pt's underlying rhythm during a code.

10. Be proud that you are a cardiac RN. I am one month shy of my first year as a Cardiac RN or being a RN period I should say. Good luck, it's exciting, heart pounding at time (literally, both you and your pt's), and you learn so much. And with such a huge spike in people with cardiac problems, you will always learn something new. Just keep your mind open, try and learn as much as you can (but not all at once b/c it toooo much), remember your basic Maslow, and your ABC's, and people are only human, always ask questions and never feel like you are bothering a fellow healthcare proessional for asking questions. No matter how healthy a person is, no matter how much they eat right, exercise, and par-take in a healthy lifestyle, they may end up on your floor with a cardiac condition. I have seen it, and I see it, and even from personal family exp.. I educate on all levels, and try for the pt. to make sense of the situation. I draw pic's, I make analogies to the heart with sports, court cases, politics, tv shows, movies, historical people, cartoons, different types of beer, even types of dogs what ever it takes for the pt. to understand. Rememeber, after the pt. leaves you, some may seek Cardiac Rehab. The educators are RN's, not MD's but RN's.

GOOD CHOICE!!! Sorry for the long post! Just wanted to share, I wish one year ago some would shared this info with me.!! We are here for you!