New grad starting in the CVICU

Posted

Specializes in Critical Care. Has 8 years experience.

Hey everyone. I have been accepted into a new grad residency in the CVICU in a large teaching hospital starting in July.

I'd like to ask for advice about working in this ICU, and how I can prepare myself before hand. What are some things that I should review? (so far I'm going through ICU Faqs and am contemplating getting a ECG workbook... also wondering about specific equipment most often seen here, regular drugs given, diseases/conditions). Have any tips for a new grad on how to succeed the CVICU? Can you share your experiences working with patients and their families in this environment?

Any comments would be very helpful and appreciated, thank you :)

sjalv

Specializes in CVICU. Has 1 years experience. 897 Posts

No tips, only that I too am a new grad RN starting in a CVICU and want to wish both of us luck! I dunno about your hospital but mine has me in classes for a good chunk of the first month of orientation (basic dysrhythmias, IABP management, hemodynamic monitoring, critical care 101, things like that) that are supposed to help prepare me for the floor. Since you are at a teaching hospital, I am assuming they'll be putting you in classes too to help merge the gap between what you learned in nursing school and the specific knowledge needed in a cardiac ICU.

thenightnurse456

324 Posts

My tips as an ICU nurse who has worked in CVICU:

Ask all the "stupid" questions you can think of during your preceptorship. Rather ask now then when your patient is crashing.

Customise a killer brain sheet specific to your unit.

Be crazy organized with your time.

Contact your manager or educator ahead of your start date and ask about the most common patient population and procedures they see on the unit. Ie: IABP? Transplants? STEMI? Review the things they tell you. No point studying IABP if your unit doesn't see them!

Definitely review your cardiac labs as well as anatomy and physiology. Those "lab note" note pads are a good idea to keep on you in the beginning.

Do an ECG course. This is really beneficial. I'm assuming the unit is providing you with ACLS training? If not, do this! Study your rhythms, this is a big part of the job.

Keep your rooms clean! Patients crash in CVICU. Nothing worse then trying to manoeuvre a crash cart into a room with chairs and junk all over the place!

Label your lines like a mad person. Your patient is crashing and you don't know which is your saline KVO line and which is your pressor line? That's gonna end badly.

Invest in a good stethoscope. Before CVICU I was one of those "any steth will do" kinda gal. But you need to hear EVERYTHING in CVICU and a good steth is worth its weight in gold.

Know that you're going to stress, maybe even cry and this is all perfectly normal. You're going into a very intense, critical care environment and you're going to be amazing. Remember to have a strong support system and a life outside of work or you will burn out very quickly.

Remember that Beyoncé wasn't built in a day. Good luck!

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SubSippi

Has 2 years experience. 907 Posts

Start with medications - epinephrine, levophed, neo-synephrine, amiodarone, cardizem, dobutamine, dopamine, nicardipene, propofol...those are the ones we use the most on my unit. You'll want to know their actions, how often to titrate each one, what to start the drips at, the maximum rate you can run each drip, etc. It's also helpful to have written down exactly how each one will affect hemodynamics. For example, neo is a pressor, it'll raise blood pressure. But in a CVICU, you need to know that it does this by stimulating alpha-1 receptors (in blood vessels), causing them to constrict - which will increase the patient's SVR. So, if the BP is low, but the SVR is high (the patient's blood vessels have clamped down), you're not going to need neo, you'll need volume (usually albumin or blood).

I know that might all be over your head right now, I just wanted to give an example of why you need to know how each medication will affect your hemos, and not just what the primary goal is when starting the drip!

Which leads me to the next part - start looking over hemodynamics! Preload (CVP), afterload (SVR and PVR), contractility, CO/CI. Have your numbers (what is within normal limits) readily available to you.

Vents! - Hopefully, most of your patients won't be vented for too long (you want to wake them up, get that tube out, and get them up in a chair asap!), but you still are going to want to know what everything means. Most of our patients come out of the OR in assist/control mode (AC). Look up the vent settings: tidal volume, PEEP, etc.

Don't expect to be able to remember all of this off the top of your head! When I was new to the CVICU, having all of these things written down helped me keep my head straight. It saved me time from having to search med books and the internet for information, AND from having to ask my preceptor the same questions over and over. Also, write down random things you need to remember for charting. For example, our art-lines are always a 20g...you'll be expected to have those sorts of things (size of art-line, cords, swan...) charted in your head to toe assessment, and if you're the nurse getting the patient straight from the OR (SO much fun!), you won't be able to look and see what other people have down.

These are some things you can look up in advanced. Other things (LVADs, IABPs, 12-leads, etc.) don't really make much sense until you've had some exposure to them (in my opinion). But having yourself a little cheat sheet (or big cheat notebook) is a good way to start getting ready, for those of us who over-prepare.

Ask questions, and try to write down the answer so you can find it later. I'm warning you now, preceptors start to get agitated with people who keep asking the same things. Find out where your protocols are, print out the ones you use, and keep them close.

As far as I'm concerned, CVICU is as good as it gets. Good luck, and have fun!

BeatsPerMinute, BSN, RN

Specializes in Critical Care. Has 8 years experience. 277 Posts

No tips, only that I too am a new grad RN starting in a CVICU and want to wish both of us luck! I dunno about your hospital but mine has me in classes for a good chunk of the first month of orientation (basic dysrhythmias, IABP management, hemodynamic monitoring, critical care 101, things like that) that are supposed to help prepare me for the floor. Since you are at a teaching hospital, I am assuming they'll be putting you in classes too to help merge the gap between what you learned in nursing school and the specific knowledge needed in a cardiac ICU.

Good luck to you as well!! I am sure there is some classwork, just not sure when or how much!

BeatsPerMinute, BSN, RN

Specializes in Critical Care. Has 8 years experience. 277 Posts

Thank you everyone for your input!! I'm so excited about starting in this unit. Your tips are very helpful and I will definitely be spending time reviewing the information.

ChickaBoom

28 Posts

Remember that Beyoncé wasn't built in a day. Good luck!

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I love this and I can't even express why.

DarkEyed

Specializes in Cardiac ICU, ER, PICU, Corrections. 46 Posts

I recommend a good cardiac stethoscope. I thank my lucky stars I invested in a cardiac stethoscope that I had only seen doctors have. Prepare yourself, it will be stressful at times and you will lose patients. Soon, you'll be USED to codes. It's perfectly okay to cry. (I cried my first code on CICU) really familiarize yourself with your medications. I agree with the brain sheet idea and really study the cardiac assessment. Know your EKGs!!! I cannot stress that enough.

Nursejal

2 Posts

I, too, was hired straight out of school into a CVICU (I did have my clinical preceptorship there during the final months of school). I have been in the unit for a little over 2 years now.

There is a very steep learning curve in a CVICU. There were some days during my training period that I went home and sobbed like a baby thinking "what have I gotten myself into?!?" I now understand that it's pretty typical to feel that way at first.

My biggest piece of advice is to absorb everything you can during the day with your preceptor, but don't beat yourself up if you don't quittttte understand it all at first. Invest in a good reference book, read everything you can about the procedure/med etc that night (if you're not too tired, or as soon as you can, if you are). It will help solidify what you learned.

There is a podcast from a few years back (still available on iTunes) called The New Nurse Podcast and it focuses solely on being a new nurse in the ICU. It's pretty good and free.

Also, learn everything you can about drips you use. I STILL read up on them and learn something new each time.

And most of all, know that it just takes time. Every shift brings you closer to being that competent, confident CVICU nurse. I still have days where I feel overwhelmed. But the "I've got this" days outweigh the not so great days. Good luck!

SororAKS, ADN, RN

Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc. Has 12 years experience. 1 Article; 720 Posts

Learn your hemodynamics, drugs,labs/diagnostic tests, emergency equipment, ventilators, pacemakers and protocols. Read, read, read. Really think about why your are doing what you are doing. If you have an unusual case, research that. Get a membership in AACN, they have a lot of continuing ed resources, some of which deal with CVICU.

SororAKS, ADN, RN

Specializes in ER, ICU/CCU, Open Heart OR Recovery, Etc. Has 12 years experience. 1 Article; 720 Posts

PS: Definitely get a good stethoscope, not the cheapies. I had a Littman Cardiology II for the first 12 years in nursing, and just got a new one for my return to the field after years away.

Good luck to you!