New Grad- advice!!

[Beau&B]

Hi everyone!

I am a new grad starting next month on a cardiovascular surgical unit. I wanted to pick your brains!

*I currently have a littmann lightweight. Will this work for a cardiac floor, or should I buy a classic or a cardiology?

*What education/resource material should I buy? I am already looking through cardiovascular care made incredibly easy.

*Time management tips? Brain sheets?

*What NOT to do as a new grad in general?

My unit does 6 weeks of orientation on the floor, plus a basic dysrhythmia class. Thankfully I know some of the nurses there, so I feel like I will have a couple of support people.

Thank you!

[Purple_roses]

Following. I received a job offer for a cardiac stepdown unit last week. I'm meeting with the manager again on Tuesday and have decided to accept the offer. I have a million questions as well.

Personally, I'm going to compare different stethoscopes at a store. I very well may stick with my Classic III.

I have Cardiovascular Care Made Incredibly Easy in my Amazon wish list. What do you think of it so far? I'm also rereading notes from ECG interpretation lectures.

Good luck to you!

[kalycat, BSN, RN]

Congrats to you both! Nice to hear this, Miss Purple! :)

So...

Pump stuff: Review your basic rhythms. Don't get cardiologist crazy but know how to eyeball a strip and recognize Afib, flutter, VT and Vfib, PVCs, Torsades. The heart blocks are helpful also but the main one I would focus on is a 3rd degree, since that can go bad quickly. Review basic info on pacemakers. You will probably get the meat of this info in your class but it's best not to go in blind. 12 lead interpretation may come later so just start with the basics of your day to day population.

Meds: review your common cardiac meds and drips. Be prepared to ask questions regarding things like heparin protocol, the procedure for titrating nitro (BP frequency, etc), and insulin drip protocol. Amiodarone is another one to know, as well as parameters for cardizem drip use - some units can't titrate this med.

Speaking of which, depending on your unit's designation and population, you may be titrating other vasoactive meds, so be prepared to read up on those as you progress through orientation. Understand what you CAN and CANT do/titrate and know where to access your policies.

Labs: Get familiar with your unit's electrolyte replacemt protocol; sometimes we replace K+ pretty aggressively, so a K+ of 3.4 may not look too weird at first glance, but may require replacement in certain patients. Be be prepared for common labs: if you are seeing heart failure patients, review cardiac/renal syndrome, your kidney function labs, and your basic cardiac labs like Troponin, BNP, and electrolytes.

Assessment: I listened to some heart/lung sounds online to refresh myself before transferring from the OR. I do prefer my cardiac scopes (Master cardiology III) over my Littman classic, however, my basic scope is actually better for manual BPs, especially on people who are hard to hear. Be prepared to see BPs and pulses lower than you might expect, and be aware that even if a patient is running a little soft, it may still be best practice to give their beta blocker or whatever. Your unit should have some clear info on this, but it may also depend on the patient's hx, how low they really are, and what the underlying issue is, as well as provider preference.

Organization: I like to use a simple blank sheet of paper for notes and a to do list. I fold it in thirds. If I have a critical patient or am in ICU, I use a systems based critical care brain sheet that has each body system, skin, and LDAs. On the back it has a box for each hour of the shift, 07 - 1930. I will try to upload a copy.

Last but not least, know how to manage a stable post cardiac cath patient. Review how you will assess groin or radial sites for issues. Know the procedure for managing re-bleeds and hematomas cold, and know the key assessment points for early identification of a retroperitoneal bleed.

As as far as what *not* to do, be prepared to manage your PO and IV fluids much more closely than you might be used to. Don't bring beverages and whatnot to another nurse's patient without checking first. Sometimes fluid restriction patients don't have printed signage in the room. If you are diuresing someone, stay right on top of your output and electrolytes.

I cant emphasize enough how important it is to know what your resources are and how to access them. Have a good drug guide or app if that is allowed. I use Medscape because it also has data sheets on common procedures (and uncommon ones) as well as extensive info on a vast number of medical conditions. It is detailed but concise. Never heard of a surgical procedure? You've got it in your pocket.

I find that that the most successful oroentees are the ones able to put in work reading and preparing outside of their shift. Sometimes it is not possible to do a ton of education during a shift. Think through your questions before asking them - and communicate with your preceptor by talking through a process or procedure ahead of time, particularly for the first time. Gather your supplies in advance.

Good prep breeds confidence and proficiency. Expect to debrief after performing a skill for the first time, and be receptive to feedback. Invite it. "Is there anything I could do differently that we haven't already discussed?" I personally prefer to give feedback right after a procedure but away from the patient if possible. (Safety concerns notwithstanding; then we stop mid stream) Be comfortable saying "I don't know, but I know where I can find out. OR "I don't know, can you tell me more?" If feedback is delivered harshly or you make a mistake, focus on WHAT the feedback means and apply that. Shake off the delivery method as much as possible, and focus on how that feedback will help improve your practice. Communicate with your manager and educator on how you're progressing; be honest.

I love being a cardiac nurse. I will try to think of more. Best wishes to you both!

[Purple_roses]

kalycat, thank you so much for such a detailed response! I'm going to make some cheat sheets for myself based off of this information. The job offer is contingent upon passing NCLEX, which I'll be eligible to take after graduation in May. I'm glad that I have time to review in the meantime!

Again, thank you so much for the advice!

[pmabraham, BSN, RN]

Good day Beau&B:

I started on as CTU RN in early February. I use a MDF Sprague Rappaport Dual Head Stethoscope I got on sale for $19.99 on Amazon.com, and find it works better than my two Littman's (one's a light, the other a cardiology).

Most of the staff on my unit customized their own brain sheets. I use a WhiteCoat folding Clipboard, and created my own brain sheet (using several experienced staff's sheets as guides for what data to collect -- not the formatting, just the data collection) that takes advantage of the clipboards ease of use in landscape mode for data collection. I print on both sides of the page (flipping on the short edge) so that when I turn the page halfway over, I have a nice section to take report along with reminders for rounds with the doctor as well as giving report. Turn the page completely over, and on the farside I have reminders for RRT, medication notes, and what needs to be charted.

I'm still working on my time management skills; and, that's the area where I currently need to focus on. I do recommend asking everyone you precept with as well as your coworkers how they best manage their time during their shift.

Thank you.