Insight for a successful transition from CCU to CVSICU?

[Asherah, BSN, RN]

I've been working in a CCU (with heavy MICU overflow) since graduation, so approximately 3.5 years and am seeking a more challenging patient demographic and higher acuity environment. We get intermittent PACs, IABPs, large amounts of CRRT, moderate amounts of vents. The most critical cardiac patients end up being transferred to other institutions for cardiac surgical interventions, so they don't stay with us for long.

I have no terminal academic or professional end goal, but love and require continuous hands-on learning. Most of my nursing colleagues who have moved on from my CCU have transitioned to a CVISC/CTICU in about 2-3 years on my current unit as that has seemed the next logical step in terms of clinical environments for those who are seeking to grow their skill set at the bedside. I have interviews at both large academic institutions in my city within the week.

Thankfully I have good friends who work on both units and have given me at least one testimonial as to unit operations, morale, teamwork, etc. I have obtained CCRN and CMC certifications and although I know to some passing an exam is just symbolic, I'd hope to communicate to management that I'm committed to lifelong learning and growth in the profession.

In terms of preparing for these interviews, I'm trying to articulate and expand on why I'm choosing to pursue these busy and sometimes overwhelming environments, other than the general and oft used statement, "I want to work with really sick patients."

Can fellow nurses who work in these type of environments give me some further insight into the professional and personal benefits of working with the most complex patient populations, open hearts, etc? I'm not seeking easy answers to the question inevitably posed on the interview, but more of anecdotes that speak to a nurse's satisfaction to working in a CVSICU/CTICU and what nurses with experience feel are the keys to professional success within?

Thank you in advance, all comments much appreciated!

[Biffbradford]

I really don't know where to go with that, but with 12 years of CVICU under my belt, I'll give it a crack. You're looking for the next higher challenge. Working with potentially unstable patients right out of OR, perhaps (depending on where you work) utilizing state of the art, investigational meds and devices that are the cutting edge of today's medicine for heart care. You want to work closely with people in advanced heart failure including heart and/or lung transplant patients pre and post op. I think you're nuts. :) Good luck.

[CVmursenary]

Recovering open hearts is really fun because the patients usually do really well and are up in about in less than 24 hours. There is generally protocol for extubation and you will learn to know which patients will be easily extubated. Open hearts are rewarding because the patients are often grateful for keeping their pain down and also that they improve so rapidly after surgery. You will do well in this unit if you anticipate patient needs and have an eye for noticing minor trends. Extubate and mobilize your patients quickly as long as they are stable and the doctors will like you.

[stablesystole]

I have about a year and a half in a CTICU (3 years total experience as an RN). It's a high stress job and it takes a special combo of smart and adrenaline junkie to work there. That said I am glad that I made the change. You'll see some of the sickest patients that exist anywhere and you'll experience the rush of defying the grim reaper himself. Some highlights include packing open sternum wounds (try not to let the ribs bite you!), reopening chests emergently in the room, and ECMO.

One major benefit to this type of unit (at least in a well-run facility) is that you won't have to deal with all of the BS MICU overflow.

One major tip if you do go this route. Depending on your prior experience and types of MDs you worked with, CT surgeons may have very different communication expectations. I "grew up" with cardiologists and learned to call with a solution to my problem already in mind and having to pull teeth to get orders that I needed. CT surgeons on the other hand want you to speak to them in numbers. They rarely need your opinion and will come to their own conclusions. Just give them numbers and they'll give you orders.

[Biffbradford]

More like 'fight' the Grim Reaper, if he really want's 'em, he'll take 'em.