Interviewing as a new grad for Cardiac/Stroke unit

CVCURN · Nov 3, 2012

I am a new RN on a cardiac/stroke unit. My manager didn't explicitly ask me medically-based questions. Now a days in nursing interviews they tend to be able to decide on your intelligence through the way you carry yourself. They are going to ask more questions related to the kind of person you are and your values. You're sure the get the common "tell me about a time you showed compassion to a pt" style question, and I find the answer to that one extremely important. That is a defining question on the amount of passion you have for the 'sport' that is nursing. As far as what to ask the manager...it might not be a bad idea to ask if they take surgical cardiac patients as well as medical. We take open heart patients day 1 post-CABG, and that's one of my biggest challenges at work. Also ask about continuing education opportunities within the facility. I found it to be daunting for my first position to be in a CV stepdown until I was informed about all the classes available at work to keep me up on cardiac/stroke-specific material. Good luck!

turnforthenurse, MSN, NP · Nov 3, 2012

As a new grad, they won't expect you to function at the level of an experienced nurse, so they won't really ask you questions regarding "medical knowledge." Be prepared for more situational questions...but they will probably be more generic. At least that's how my interview was. I interviewed as a new grad for a progressive care unit. We get a lot of chest pain/ACS/NSTEMI (STEMI's go straight to ICU or CCU), CHF and patients going for cardiac cath procedures or a stress test. We also get a lot of COPD exacerbation, acute respiratory failure, pneumonia, acute renal failure, electrolyte imbalances (usually hyper/hypokalemia as the admitting diagnosis), GI bleeds, strokes/seizures, altered mental status, overdoses (those patients need telemetry and more frequent monitoring)...a whole mix of things. The experience is invaluable.

Nurse Kyles, BSN, RN · Nov 5, 2012

I'm curious... How did the interview go?

Testa Rosa, RN · Nov 13, 2012

I work in a stoke/cardiac unit and we are heavy on the neuro assessment skills/frequent vitals and very proactive in making sure the pt gets a CT within the first half hour of coming in thru ER as well as the full stroke work up within 24 hours (follow up MRI, echo, carotid US, immediate neuro consult, standing orders for tele monitoring as well as anti platelets and anti coagulants, OT/PT and rehab evaluations, speech evaluation, swallow study, Lipid panels, etc). Our typical pts are ischemic stroke (where we allow for permissive HTN), hemoragic stroke (where we keep tight control over blood pressure), TIA's, Seizures, CHF, COPD, DKA.

We do a lot of PIV insertions, NG/Foley insertions and diabetic monitoring. Cardiac/Stroke floors get fast turnover -- many pts dropping down to a med surg floor once stable, so there will be a couple Transfers/Discharges and Admits in a 12 hour shift. Time management is more essential for me here than when I worked oncology--oncology was more intimate one-on-one care and less turnover. Here I am teaching to family more than the pt and there is quicker turn.

I find the Stroke admits are more labor intensive than in other units I've worked on because of the stroke protocol has a very tight time window and it's easy for a pt to get off track once they are not a good candidate for TPA. There is frequent vitals and BG checks and the nurse has to be the advocate for follow-up care. Also discharges are social service/rehab intensive so case managers get very involved from the get go.

This is just my view--your unit may vary. Hopes this helps anyone interviewing in a cardiac/stroke unit understand the lay of the land.

kaboo · Mar 5, 2013

Dear Testa Rosa,

I found your post helpful.I am a CCU RN with 5 yrs experience,earned outside US.I would have a interview this week in a Cardiac step down unit/telemetry.I would like to know what the nurse manager would probably ask...any guidance/tips would be grateful

Testa Rosa, RN · Mar 5, 2013

First thing: Every pt suspected of stroke must have a head CT before leaving ER and coming up to the floor--I sometimes come down and make sure this is happening the minute I get wind of a new stroke pt coming my way. It's nice to get a verbal report and calm the family down in the hallway too.

Even in a certified stroke center you would be surprised at what can happen with a busy CT room and demanding MD's who want to have their pt scaned STAT. Strokes always go first--Tele pt always go first--law of the land! Every minute off monitor places that pt at risk for being in a bad rhythm that we could have prevented had we seen it on the monitor.

Once you have that initial CT--and sometimes it doesn't tell you much at first but it's a start--you have a treatment plan. Hopefully you have an answer to the big question? Is it Ischemic or is it a Hemorrhagic. Then following your decision tree quickly becomes essential. Every moment wasted is potential for brain cell loss. Hopefully your other pts are stable so you can focus in on the admit because the faster admitted the faster you can get all the anticoag/antithrombotic goodies on board. I spend a lot of time on the phone lighting fires under the hospitalists to keep the pts on schedule with the decision tree. The neurologists are usually on board and work closely with us but our hospitalizes--like all of us at bedside these days--are just overwhelmed at times so taking telephone orders to keep a pt on schedule with the decision tree can be important.

Second: Frequent neuro checks and communicating what you have assessed to the treatment team. We do stroke rounds to make sure this happens and we are all on the same page. I find working well at coordinating with other staff--respiratory, speech therapy (for swallow eval), transport techs (because the pt needs lots of tests yet needs to come back between tests to let me set eyes on them and do a quick set of vitals--I've had a stroke evolve from when a pt left to do a Carotid and return 15 minutes later), case management (lots of communicating with them), rehab staff, PT/OT--essential and would imagine it would be a focus of a hiring manager.

Tele/Stroke step downs are turn over heavy. There are many types of Tele/step down combo's ranging from post cath lab overnight stay to those that can become dumping zones for those difficult to place pts--you know the ones--too stable for ICU but on bedside dialysis and permanent vents. In those long range pts, I would imagine while care coordination is still important, a more intimate relationship develops and family care becomes more the issue.

Stroke Step downs are working against the clock--every second that pt is not on anti coagulation, not on SCD's not being worked up, not working with PT/OT, not being evaluated for swallow to prevent sepsis, can work against salvaging brain time/quality of life and so advocating for the pt, and having a sense of restrained urgency.

kaboo · May 22, 2014

I found your post helpful.