Any NPs in Cardiology out there??

Kristiern1 · Jun 10, 2007

Hi Charlsie,

I work in a cardiology practice that sounds a lot like the job you are considering.

Congratulations. To answer some of your questions. The best way to feel confident about murmurs comes with time. Start with a good stethescope, quiet environment, stethescope to skin only not through clothes. Then start listening to anyone you can get your hands on. Repetition. Always think of your murmurs in regards to flow....is it systole or diastole? Where do you hear it best....does it radiate? to axilla, precordium, carotids, to back? Try to visualize the dynamics of the murmur...(so i hear this loud swoosh at the rsb when I should be hearing S1. so aortic valve murmur during systole...maybe AS) I was also worried starting out but with doing it over and over it becomes easier.

Also, having a good rapport with your doc's and being able to say...."hey ...i hear something weird but not sure what it is. "

As far as devices go, that has been the most challenging of all aspects of my job. Most of my training is on the job. Yes sometimes the reps help come run the clinic, however if you are going to be making treatment decisions based on their findings you are going to have to be familiar with all the functions of the devices as well.

In my experience it was a whole new world. As a staff nurse I knew what to look for on EKG to assess capture and sensing. An could tell you what modes meant... VVI, DDD, DDIR etc.

I did a lot of on the job training. Additionally most of the companies Boston Scientific, Medtronic and St. Jude offer additional training classes.

We also do home monitoring of our CRT-D patients and also plain defibs.

Sorry this is so long, but I would also before jumping in that position get a specific idea of what your daily responsibilities will be. If that doctor is already that busy you want to make sure what your expected hours etc will be. Good luck! If you have any further questions let me know.

Kristie

DaisyRN, ACNP · Jun 10, 2007

hey kristie,

thanks for all your comments! i will keep them in mind... and dont be sorry that it was long; mine was longer! *haha* so how long have you been doing this? was this your first job after school? what do you enjoy most about it? least? do you make hospital rounds? the physician i was talking with the other day about the position was telling me about certifications you can get in cardiology... what are these? do you have them? are the benefits of having them worth the cost? which do you recommend? do you have any involvement with the cath lab?

the longer i think about hospital medicine, esp. where i'm located, the more frustrated i think i would be. the group i'd work for would be okay, but the hospital guides what i would and would not be able to do. since it is somewhat behind the times regarding use of nps, i would hit a lot of road barriers, and would not want to have gone to school to learn how to do all these things, and them shut me down every time. that is yet another reason i think working with a specialist group like the cardio would be better. also, i have the potential to be the first one working for the group, so i'd be in an influential position. and, although stressful i'm sure, it would be nice to be there when they start making these new plans... as i may have some input, and would be able to say, "oh, remember when...".

in terms of learning it, i probably just need to go back and re-read my cardio notes. :) i tell you what though, when i read the heart failure chapter in harrison's, i was just completely against cardio at that point. it is sooooooo involved and the book is so scientific.... its a med school book!

well, i'll just see how it goes and see about planning the clinical rotation with them next semester. if i'm able to set that up, i will concentrate on finding out what the expectations of me would be.

thanks so much for your words of wisdom! i look forward to hearing back from you again!! :)

hi charlsie,

i work in a cardiology practice that sounds a lot like the job you are considering.

congratulations. to answer some of your questions. the best way to feel confident about murmurs comes with time. start with a good stethescope, quiet environment, stethescope to skin only not through clothes. then start listening to anyone you can get your hands on. repetition. always think of your murmurs in regards to flow....is it systole or diastole? where do you hear it best....does it radiate? to axilla, precordium, carotids, to back? try to visualize the dynamics of the murmur...(so i hear this loud swoosh at the rsb when i should be hearing s1. so aortic valve murmur during systole...maybe as) i was also worried starting out but with doing it over and over it becomes easier.

also, having a good rapport with your doc's and being able to say...."hey ...i hear something weird but not sure what it is. "

as far as devices go, that has been the most challenging of all aspects of my job. most of my training is on the job. yes sometimes the reps help come run the clinic, however if you are going to be making treatment decisions based on their findings you are going to have to be familiar with all the functions of the devices as well.

in my experience it was a whole new world. as a staff nurse i knew what to look for on ekg to assess capture and sensing. an could tell you what modes meant... vvi, ddd, ddir etc.

i did a lot of on the job training. additionally most of the companies boston scientific, medtronic and st. jude offer additional training classes.

we also do home monitoring of our crt-d patients and also plain defibs.

sorry this is so long, but i would also before jumping in that position get a specific idea of what your daily responsibilities will be. if that doctor is already that busy you want to make sure what your expected hours etc will be. good luck! if you have any further questions let me know.
kristie

Rhfish2 · Jun 12, 2007

Kristie is correct. I learned the devices by attending the training programs by the big 3 and then doing hands on with the reps in the room. I currently work with 7 cardiologists and am the only NP, I do all of the device checks, the AV-opts with the CRT's as well as the stress tests and see patients. I have opted not to do hospital based care due to being so busy in the office and setting up many new programs. There is never a dull day in the office, as for murmurs, heart sounds etc, as Kristie said listen and learn and if your not sure let the patient have an echo and that will diagnosis the murmur for you.

Kristiern1 · Jun 13, 2007

Hey Charlsie,

This is my first and only job since graduating from my NP program. I graduated from an ACNP program with a subspecialty in cardiology. My national certification is for ACNP. I also have CCRN recognition and have taken the cardiac subspecialty exam as well. I do not possess any other specialty certifications. I do belong to AAHFN(Amer. Assoc. of heart failure nurses) and HRS (heart rhythm society). There is a certification exam you can take for specialty pacemaker/defib certification through HRS.

My week varies. Some days in office seeing patients, some days doing device clinic follow up, some days traveling to remote clinics, some days in the hospital rounding and seeing consults.

I think the heart failure patients I enjoy the most. We see them more frequently and you can really build a rapport with them. What do I like least?? I would probably answer differently everyday...but I cant say there is really anything im totally unhappy with.

I would recomend highly doing clinicals with these doctors to see how you like it and also feel out what they would expect from you. Good luck...Id be happy to chat more if you have more questions or need feedback.

Kristie