*New Cardiac RN Advice*

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Specializes in Alzheimer's Unit, Cardiac.

hi! i'm a new grad that just got my first job as a rn on a cardiac intensive care stepdown unit on night shift (7p-7a). they normally start new grads on night shift at my hospital. i will have about 10wks of training which also includes acls. also, my floor allows for self-scheduling. any advice on this floor, on working night shift, or about being a new rn? i'm very excited but i don't know many experienced nurses that i can get advice from. should i schedule my nights in a row? also, i plan to work some weekend nights too because of the pay. any tips? thanks in advance! :redbeathe

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Specializes in NICU, PICU, PCVICU and peds oncology.

I would suggest that you schedule your nights in blocks of three or four. Research has shown that for people working a permanent night shift that working two at a time is very disruptive to your sleep cycles and leads to severe fatigue and increased errors over time. (I can attest to that!) Two nights in a row isn't enough to allow your body clock to adjust to the new circadian rhythm you need it to, but three almost is. If possible try to maintain your nighttime schedule on your days off, staying up a bit later and sleeping later so that your body becomes accustomed to sleeping during the day. If you don't have a pressing reason to be up at 7 am (like I do) then you should feel quite fine about sleeping until 10 or 11. Make sure your family and friends understand your new lifestyle so they don't make unreasonable demands on you. When you're at work, try not to nap for more than about 20 minutes on your breaks because any longer and you'll be groggy and error-prone when you wake up and it will decrease the amount of sleep you get when you're home in bed. (More research!)

Work-wise, learn as much as you can about the drugs used on cardiac stepdown. Beta blockers, ACE inhibitors, ARBs, antiarhythmics, diuretics, digoxin and statins are examples. Do some reading on the psychological impact of cardiac illness. Look for opportunities to learn new skills. And enjoy your work!

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Specializes in Alzheimer's Unit, Cardiac.

wow! great advice! thank you for taking the time to send me that! i really appreciate it! :)

anyone else have any advice to offer?

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Specializes in Cardiac Telemetry.

Hi Southernbelle,

I am in the same boat as you! I just accepted a position in the cardiac medical floor yesterday. All the patients there are on some sort of cardiac drip. To be honest I am very nervous. I will have only 8 weeks of training....nearly two of which are not on the floor. My sister is a RN and suggested I read Cardiac Care Made Incredibly Easy. She is going to let me borrow her copy. On the positive side, the nurses on the floor seemed very cheerful and helpful. The nurse who gave me the tour of the floor said that everyone was more than happy to answer any questions she had as a newbie. Since we will be starting near the same time we might be able to be a resource for each other. I would love to bounce things off you if you are up for it. :D Contrats on the new job and keep me posted on how things are going!

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Specializes in Cardiac.
I would suggest that you schedule your nights in blocks of three or four. Research has shown that for people working a permanent night shift that working two at a time is very disruptive to your sleep cycles and leads to severe fatigue and increased errors over time. (I can attest to that!) Two nights in a row isn't enough to allow your body clock to adjust to the new circadian rhythm you need it to, but three almost is. If possible try to maintain your nighttime schedule on your days off, staying up a bit later and sleeping later so that your body becomes accustomed to sleeping during the day. If you don't have a pressing reason to be up at 7 am (like I do) then you should feel quite fine about sleeping until 10 or 11. Make sure your family and friends understand your new lifestyle so they don't make unreasonable demands on you. When you're at work, try not to nap for more than about 20 minutes on your breaks because any longer and you'll be groggy and error-prone when you wake up and it will decrease the amount of sleep you get when you're home in bed. (More research!)

Work-wise, learn as much as you can about the drugs used on cardiac stepdown. Beta blockers, ACE inhibitors, ARBs, antiarhythmics, diuretics, digoxin and statins are examples. Do some reading on the psychological impact of cardiac illness. Look for opportunities to learn new skills. And enjoy your work!

Janfrn-

Thanks for your post! It's really helpful. I began my Cardiac Internship one week ago and am looking for all the advice I can get...Tuesday will be my first day on the floor with my preceptor:)

Do you (or anyone else) have advice on how to organize my morning routine for 4 patients?

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Specializes in critical care, home health.

I work on a very similar floor (not all of our patients are cardiac, but most are) and I love it! I hope you do too. I also work nights, and I wouldn't work day shift again even if days paid more.

My night shift tricks: well, I confess, my sleep schedule is completely messed up. I do take a nap every day on my days off from about noon to three or four. If you don't have black-out curtains, buy an eye mask to keep out the light. If you still have trouble sleeping during the day, try benadryl PRN.

At work, don't be afraid to ask questions. By now, you'd think I wouldn't have to ask questions, but not a night goes by that I don't ask another nurse's advice. If you act like you know what you're doing when you really don't, people won't appreciate it. If you admit, "I don't know what to do about this", then they'll be very happy to help you. If ever you reach a point where you don't have to ask questions, you should retire.

It can be difficult to learn your drips- there are so many of them. Make yourself a cheat sheet to keep in your pocket with amiodarone, cardizem, dobutamine, dopamine, etc. on it. You want to know the loading dose (if applicable) the action, the usual rate, minimum and max doses, and things to watch out for. Until these things become a permanent part of your brain, you want to have this information handy.

Study your rhythms. They're fun if you think of them that way. One way I like to teach new nurses the rhythms is to sit down in front of the main monitor and go through the actual patients' rhythms as they're happening in real time. (Feel free to print off actual rhythms and keep them for future study.) I also teach rhythms using interpretive dance, but I doubt your preceptor will be as fun as me. :smokin:

As far as organizing the care for four patients, everyone develops a personal system. Some people never get organized this way; these are the people who routinely have to stay late to chart. Observe your preceptor's system and the systems used by other nurses on your unit. Ask them how they do it, and pick out the parts that work for you.

If you do charting by exception, that means charting by exception. When reading other nurses' notes, I'm always amazed at how much time they waste charting a head to toe assessment: pages and pages, and you can hardly find the abnormal or important bits mixed in there. Then, when something happens that really is important, you can't find it in the notes. I prefer to concentrate on the real issues at hand, and make sure to chart the important stuff. When you read my notes, you can clearly see what's WRONG, and what was DONE about it, and when. Follow your hospital's policy here.

I'm a very visual person, so for each patient I write the times 19 20 21 etc in a line. I circle all the hours when I have meds due. I put a little line under the hours when I have to do blood sugars. Any time when I have to do something at a certain time, that hour gets circled. Pretty much anything that needs to be done gets put in a circle: rotating IV's, changing central line dressings, changing tubing, anything. As I work, I cross out the circles as something gets done, so at the end of the night there are no circles left. I also jot little notes to myself on the side with the time so when I go to chart, I know what I did when. If I didn't have this visual reminder, I'd go crazy wondering what I forgot to do.

There are often things I need to remember to pass on the the next shift. I jot these down in a designated place on my paper. Otherwise I would totally forget to mention them.

Read your patients' H&Ps. There is no better way to get a clear picture of what's happening with your patient. It will help you to see the Big Picture and pull it all together. Also, time spent talking to the patient and family is time well spent. It will help you to figure out what concerns this patient, what he needs, and you can work to make that happen.

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Specializes in NICU, PICU, PCVICU and peds oncology.

Great reply, HollyHobby. Since I work on a pediatric ICU that is primarily cardiac, I typically have only 1 patient and couldn't help with the 4 patient - time management piece.

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Specializes in Cardiac.

Thanks Holly!

That's really helpful advice:) I did my preceptorship in an ICU and was responsible for 2 pts. I was told I had good time management skills but in the Heart Hospital, I'll be working with at least 4 pts...time management is going to be imperative.

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H!!!:clown:

I'm also a new nurse who started on a telemetry unit (step-down unit,taking care of STABLE patients who underwent open heart surgeries,cath lab patients,MI,pacemakers and a whole lot of more)...I got hired on a pretty decent floor that hasnt had any new grads in a long time..Right now I'm two weeks into training and tommorow I'm starting orienting with my preceptor..the first two weeks I had spent on just meeting the unit people,reading on protocols/order sets,unit policies,also I have watched videos regarding cardiac care,was given a lot of sheets about cardiac procedures to get a general ideas and then had to take few post tests of what I learned (nothing major,the tests are not scored),spend some time on observing cardiac catherization procedure,cardioversion,and an open heart surgery.Basically I'm being introduced to the unit gradually and very slowly.Of course I'm very overwhelmed,and anxious and scared but I think it is normal to feel this way when you know that you are the only new grad on your floor and everyone else is a nursing wizard...I'm pretty nervous right now since I will be starting with an preceptor from now on but instead getting stressed out over it the whole weekend and I totally relaxed and went outside the town.Happy I did...I think this trip helped me to calm my nerves and go in tommorow with a fresh attitude..I figure we are there for the learning experience and that we must always tell remind ourselves that rome wasnt build in one day and the begginings are always ucertain,stressful and worrysome..well I just wanted to let you know that I'm sure you will get a fair orientation with a lot of support and you will be provided with all the material that you will need..keep on marching,trust me I'm in your schoes and know that you are not alone! Let us know how it goes for you,good luck!!

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Specializes in Cardiac.
H!!!:clown:

I'm also a new nurse who started on a telemetry unit (step-down unit,taking care of STABLE patients who underwent open heart surgeries,cath lab patients,MI,pacemakers and a whole lot of more)...I got hired on a pretty decent floor that hasnt had any new grads in a long time..Right now I'm two weeks into training and tommorow I'm starting orienting with my preceptor..the first two weeks I had spent on just meeting the unit people,reading on protocols/order sets,unit policies,also I have watched videos regarding cardiac care,was given a lot of sheets about cardiac procedures to get a general ideas and then had to take few post tests of what I learned (nothing major,the tests are not scored),spend some time on observing cardiac catherization procedure,cardioversion,and an open heart surgery.Basically I'm being introduced to the unit gradually and very slowly.Of course I'm very overwhelmed,and anxious and scared but I think it is normal to feel this way when you know that you are the only new grad on your floor and everyone else is a nursing wizard...I'm pretty nervous right now since I will be starting with an preceptor from now on but instead getting stressed out over it the whole weekend and I totally relaxed and went outside the town.Happy I did...I think this trip helped me to calm my nerves and go in tommorow with a fresh attitude..I figure we are there for the learning experience and that we must always tell remind ourselves that rome wasnt build in one day and the begginings are always ucertain,stressful and worrysome..well I just wanted to let you know that I'm sure you will get a fair orientation with a lot of support and you will be provided with all the material that you will need..keep on marching,trust me I'm in your schoes and know that you are not alone! Let us know how it goes for you,good luck!!

Thanks for your reply! Like you, I'm nervous but I know that being nervous is all apart of being brand-spanking new. I just want to take it all in stride and soak up as much knowledge as possible!

Good luck to us all!:)

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Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

welcome. i can't add much to what everyone else has said -- you've gotten some good advice.

about working night shift -- you'll figure out how your body best tolerates nights, although it may take you a few months to do it. working 3 or 4 nights in a row helps the circadian rhythms, i guess, but the most i can tolerate is two in a row. (back and knee issues). figure out what works best for you and don't apologize for doing it that way.

unplug, silence, bury under down pillows or do whatever you need to do to not be disturbed by the telephone when you're trying to sleep. you'd be surprised how many telemarketers, charities, and well-meaning family and friends call during the day. even if you explain it to them several times, some family and friends just don't get it unless you call them at 0200 "just to chat." if that's what it takes, do so. an old boyfriend of mine used to let himself into my house (i should never have given him the key!) eat everything in my refrigerator and then lay down in bed with me to "take a nap." once i showed up at his house at 0200 and did the exact same thing, he got it.

treat your sleep time seriously. don't be up all day being "productive" and then go to work at night without sleeping.

bring healthy meals to work and eat them in the middle of the night. it's when you're up.

never be afraid to ask questions, never pretend that you know something you don't and never try to hide an error.

the rest will come. you're going to feel stupid and incompetent for the first year or so; that's normal. and you will make mistakes. anyone who says they haven't is either lying or too stupid to realize they've made one.

good luck -- i hope you have a marvelous preceptor.

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Specializes in ICU, MedSurg, Medical Telemetry.

Hmmm. I'll have to see if that works for me. I haven't really worked three in a row. I'm working two nights, then one off, then three on. I'll have to see how I am at the end of that. Maybe I'll start scheduling myself for three in a row if I like it.

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