New to Cardiac Surgery ICU and need guidance

joeyzstj, LPN · Aug 16, 2008

Hi Everyone,
Ok, please bear with me with this long post.
I just started working in the brand new Cardiac Surgery ICU at a large Boston hospital. I worked in another ICU for about 5 years. I have been a nurse about 10 yrs.
Now, this is only my first week in the unit, but I am already overwhelmed by these nurses. They are brilliant !! - I mean, when I listen to them precepting me, I feel like I don't belong here.
I am an experienced icu nurse, but I feel like a kindergarten child. I read, and reread and reread all the stuff they gave me. But it feels like as soon as I read it, it's gone. i can't recall what I've read.
Putting it all into focus and being able to really comprehend how it all works is really difficult for me. I miss stuff that I feel like I should have caught and then there are things that get said by another nurse, just in conversation and I am like "I should have known that !" - No one wants to feel incompetent in this career, but I am starting to really feel that way. I want to do really well, improve as a nurse and improve the care I give.
So, how does one make sense of it ? - How do these nurses really retain all this information and spit it out the way they do ? -
Basically, how can I improve my understanding of this complicated profession, raise my confidence and become a better nurse ?

Hello. I want to thank you for this post. I personally appreciate that fact that although you are having a difficult time, you are still able to recognize the ability it requires to work in a CVICU environment. From my experience, Cardiovascular ICU's are a little different both in the environment, and the way people learn. In my opinion it is a little like a military teaching style. Most of the Heart Surgeons wont tolerate telling you something twice and if you were to ask most of them they would tell you that they believe their CVI nurses to be the cream of the crop. This might make some people upset, however its been this way in many of the places Ive traveled to. I suggest buying a book by Robert Bojar called "Perioperative Care in Cardiac Sugery". It explains everything you will need to know. Additionally, take notes and carry note cards or some type of reference book. They are probably being a little harder on you due to your 10 years of nursing and your 5 years of ICU background. Typically ICU's see a minimal amount of swans in comparison to a CVICU, and when you have a patient in multisystem failure with multiple arrthythmias and hemodynamic compromise, its something you need experience with to treat properly. You are going to get really familar with a lot of drugs you probably didnt see that much in ICU and have to learn everything about them very quickly. A bad AVR, MVR, ACB that comes out bleeding with multiple blood products running on a balloon pump that is going in and out of V-Tach will make most anyone wonder what the H3LL they are doing there. A fresh post op heart is basically a dead person that you are trying to keep alive for next 12 hours with drugs and fluid. The steaks are higher as you will soon realize, however the rewards are amazing and the experience you are going to be force fed is unparalled. Talk to the RT, the dialysis nurse, the surgeons, the attending physicians and find the oldest nurses in there and learn from their mistakes. The way that I always look at it is that I have the opportunity to learn from 5-10 of the best nurses I have ever had the pleasure of working with. Just think...........you have all of the coaches around to give you their combined knowledge and share their mistakes. Take it all in and learn from it.

-Buy the book I mentioned. Its definately the best book I have ever owned. Also, get your CCRN or at least review the material. THe AACN makes some great videos that explain hemodynamics and Drug Receptro sites in depts which you absolutely need to know to understand your drugs. Google Alpha-1, Alpha-2, Beta-1 and Beta-2 receptors and what happens when each of these are stimulated, and become very familiary with adrenergic, agonist, antagonist termonology. Good luck.

suanna · Aug 16, 2008

Welcome aboard! I've been a CVSICU nurse for over 20years. It is very different from other ICUs. I HATE MICU, SICU is only a little better , but CVSICU is my home.

1) Look at your patient and say "what's his most pressing problem"

2) Decide what you need to do to identify the source of the problem-labs, x-ray, hemoodynamic profile , physical assessment...

3) Ask what intervention do I have ordered/ need to get ordered that could solve this problem and improve my patients status RIGHT NOW.

4) Set short term goals for long term gains. What do you need to get done in the next 15min to improve your patients condition?

5) Ask for input from other staff. If a CVSICU nursing team isn't working collaboratively then it probably isn't a place you want to work. Along with that, know when you are in over your head. Don't wait until your patient is coding before you ask someone else to come in your room.- Winging it won't win you any brownie points with your peers.

6) Pick one or two nurses that seem to have the respect of the docs and good patient outcomes and try to emulate them-there are any number of ways to approach any patient problem but if you try to see it from too many perspectives it just becomes a blurr.-One nurse may give lasix, another will try a fluid challange first, another will turn up the inotropes-all may be ordered as standing orders- all may be good interventions for low urine output, but why and when you use each one are answers you will have to get a feel for with time.

Post-op heart patient care is process based. What is most wrong and how am I going to make it better is your approach to recovery.

It takes about six mos to get comfortable with managing post-op open heart patients- one year before you feel you can handle the sick ones. Whenever there is a sicker patient try to take it, or at least be next door. Help out with other patients whenever you can. This can be a very satisfying unit. You can take a patient from cold, bleeding, on a vent, unresponsive with a struggling cardiac function and have them ready to go for a walk in 12 hours!