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Open Heart ICU

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How is it looked upon for new graduates to apply for work in an Open heart unit? Did any of you go directly into an open heart ICU after graduation? Do you know of a new grad who did?

I'm a senior and I have a teacher who believes that nobody should even work in the ICU without years of med-surg experience. She said, "Back in my day, open heart nurses were the cream of the crop." I think she may just be bitter that things have changed, but I would like a fair view of how you see this issue in your workplace.

How is it looked upon for new graduates to apply for work in an Open heart unit? Did any of you go directly into an open heart ICU after graduation? Do you know of a new grad who did?

I'm a senior and I have a teacher who believes that nobody should even work in the ICU without years of med-surg experience. She said, "Back in my day, open heart nurses were the cream of the crop." I think she may just be bitter that things have changed, but I would like a fair view of how you see this issue in your workplace.

I participated in a critical care intership which offered 3 months of c.c. training. We had classes coordinated with working on the floor. Many hospitals offers these types of programs. I participated in one in TX. It takes the right fit for that person to succeed. I worked vey hard to absorb every experience and learn as much as possible. I performed rotations in NICU and CVICU. When the intership was over there was a position in CVICU and the offered it to me. It was challenging learn basic RN skills as well caring for cardiovascular surgeries. The nurses in the unit expect allot from you (as they should) and they cut you no slack. It made me a better nurse but it was not easy. If you get this type of opportunity I recommend you work the day shift and not night but cause you experience and see more to shaping your basic RN skills as well as your c.c. skills. If you need any advice feel free to contact me. I've been there and done that. Good luck!

How is it looked upon for new graduates to apply for work in an Open heart unit? Did any of you go directly into an open heart ICU after graduation? Do you know of a new grad who did?

I'm a senior and I have a teacher who believes that nobody should even work in the ICU without years of med-surg experience. She said, "Back in my day, open heart nurses were the cream of the crop." I think she may just be bitter that things have changed, but I would like a fair view of how you see this issue in your workplace.

I went straight from nursing school to splitting time in an ICU & CVRU. I did also have experience as an EMT (Basic) and I worked as an ER tech and ICU internship 6mo prior to graduation. It is very challenging and you need to absorb as much as possible. ICU nurses are a different crowd so you need to be a little tough-skinned. They do expect a lot, because they know after you are done with orientation that you will be a person backing them up as a member of the team.

Floor and ICU experience are 2 totally different areas and I don't really think that one prepares you for the other. I had my nursing instructors tell me the same thing....that I needed med surg experience before I should go to ICU, but it has been a great fit for me. Try to get some intern experience with a unit that you may like to work in. It will help you to decide what you should do. Good Luck!

Dinith88

Specializes in CCU/CVU/ICU. Has 15 years experience.

With the nursing 'shortage', icu's are taking more and more new grads. New grads can be successful ICU nurses, it just takes them longer. The better 'new' ICU nurses are those who've spent time on the floor (step-down, med-surge, whatever) as they're used-to being a nurse and have a 'handle' on the profession and all it entails. Because of this, the 'transferring' nurse has a distinct edge over a new grad who has to learn from scratch. A nurse with experience on the floor has a narrower 'focus' when learning icu stuff so they almost invariably have a smoother transition.

In my opinion, the 'ideal' icu nurse has spent time on a step-down as they're exposed to various 'critical care'-type patients, drips, monitors, etc. Also, if a nurse comes to icu right out of school, they're usually the nurses who fail miserably when floated out of the unit. They're so in tune with having 1-2 patients that they drown when given 5 (or more!). (whereas a nurse with floor experience is better well rounded and knows what to expect and how to function when faced with 5 pt's). (also, pt's usually dont get discharged home from icu's, so when floated and faced with discharging a patient..or two..or three...they struggle with this otherwise routine procedure)

Anyway, yes new grads get hired in icu's. Yes they can excel. Yes, they have a harder time than nurses with experience in other areas.

begalli

Specializes in Critical Care/ICU.

Yes, they have a harder time than nurses with experience in other areas.
I completely disagree with this blanket statement. I have percepted/oriented both new grads and "new to icu" experienced floor nurses and have found that it takes about the same time for each to acclimate to the unit.

The experienced floor nurse does have an edge, I think, in that they have experience interacting with other members of the health care team and they have some organizational/prioritizing skills (which will change in the icu, which is very similar to the new grad establishing these same traits).

I love nothing more than precepting a bright, motivated, and excited new grad. They are a very special breed in an area of nursing that's a very unique beast.

(also, pt's usually dont get discharged home from icu's, so when floated and faced with discharging a patient..or two..or three...they struggle with this otherwise routine procedure)
We occasionally discharge patients home from our ICU. Discharging and admitting patients is very routine on our unit, and I'm sure this is true on most ICU's.

The most in discharges/admits I've experienced during one shift was a total of 5--more than once. The most one RN can be assigned at a time on our unit, by law, is 2 patients. My most recent experience went like this:

I started out my night with two walkie-talkies.

Discharged #1 to the floor whose spot was filled immediately by #3 (an admit from Life Flight--a dissecting ao aneurysm who we lined and sent off to the OR); shortly after sending out #3 to the OR, #2 transferred out to the floor and #4 (a room transfer from within the unit-a stable post-op day one) transferred into #3's spot. #5 (a fresh post-op MVR-CABG) arrived with a bang a short while later with bleeding and after a couple of hours of giving blood...sent him back to the OR as well. He returned just before change of shift (so technically, same person but that's another admit).

Now this doesn't happen all the time but it does happen. Our unit is a large and very supportive one. We thrive and absolutely shine when we're slammed.

Also - I think it's tragic that ICU nurses float to non-ICU floors. That's just wrong. Do the floor nurses float to the ICU?

begalli

Specializes in Critical Care/ICU.

I just want to add that I have the utmost respect for nurses no matter what area of nursing they partake, but everyone is unique. Each individual learns at their own pace in their own distinct style and perceptors need to recognize and capture that style and run with it whether it's a new grad or a new to the ICU RN.

If a motivated new grad wants into the ICU, I happily say, boy do I have some incredible things to show and teach you!!

Come on! Let's go!

Kinda corny eh? I love my job...we do some things that are beyond a verbal description.

I am also suprised that ICU nurses float to the floor. We float to other ICU's or our step-down unit only (and that is rare). I agree that floor nurses should not float to the ICU and ICU nurses should not float to the floor...it is an entirely different field of nursing.

New grads can absolutely thrive in the ICU! I started in an open heart ICU as a new grad in a hospital with 55 open heart beds, and I absolutely loved it. Our unit hired many new grads, and provided them with a 16 week orientation. Others who posted on this thread about ICU nurses being a different breed are correct - you will develop a thick skin (if you don't have one already). The other nurses in your unit will expect a lot from you when orientation is finished - and rightfully so. These patients require a lot of time, knowledge, and care - often more than one person alone can provide. You will come to rely on them as much as they will come to rely on you as a solid member of a team. ICU nursing is definitely not an individual sport - teamwork is the name of the game.

There are a couple of things you can do to help yourself be successful in this environment.

1. Get yourself a good textbook or two, (I recommend Finkelmeier's Cardiothoracic Surgical Nursing and Woods et al Cardiac Nursing) and do your homework! When you get home at night after work, read about what you saw that day. Get to know the types of surgery your institution does (CABG, valve repairs/replacements, surgery for atrial fib, DOR, Batista, Acorn, Myosplint, VADs, transplants, aneurysms, esophageal procedures, thoracic procedures, etc). Get to know patients underlying pathophysiology, especially the cardiac abnormalities (CAD, CHF, ICM, DCM, RCM, etc). Make sure you know normal lab value and ABG ranges and what abnormal values mean to your patient's status - you will become intimately involved with lab values as an ICU nurse!

2. If you have a chance before you start orientation, begin to study the pharmacokinetics and pharmacodynamics of different vasoactive meds your patient may be on. Things like epinephrine, levophed, neosynephrine, nipride, nitroglycerin, dopamine, dobutamine, natrecor, milrinone, vasopressin, amiodarone, lidocaine, etc are important meds to know. Pharmacology is a huge part of ICU nursing, and you will need to know what the drugs do to the body both alone and in combination with each other. If you can get a head start and at least get the basics down, you will be ahead of the game.

3. When you have spare time in the unit (your patient(s) is/are stable, not requiring much), offer help to other RNs who may have a busier assignment. Once other members of the team come to see you as someone who is willing to help, they will most definitely be willing to help you when you need it.

4. During your orientation, make sure you find time to do things for yourself after work. Your job will be very stressful, especially for the first few months when the learning curve is steepest, and to avoid burnout, make sure you get some "me time." Exercise, take naps, read, whatever it is you do in your spare time, make sure you do it. While your new career as an ICU nurse will be hard, it is important that you not let it consume you.

5. Finally, enjoy your new role as you transition from student nurse to RN! It is a great feeling to say to your patient, Hi, my name is ABC, and I will be your NURSE today!:-)

Good luck!

begalli

Specializes in Critical Care/ICU.

Beautiful post hearticu!

Gosh! That totally inspired me. Thank you all for your thoughts for new grads working in open heart ICU.

Dinith88

Specializes in CCU/CVU/ICU. Has 15 years experience.

The experienced floor nurse does have an edge, I think, in that they have experience interacting with other members of the health care team and...?

I'm guessing you went straight to ICU as a new grad as you're obviously very passionate about this issue...

If you think a nurse with a few years on a step-down does NOT have an overwhelming edge over new-grads, i think you're on crack.

And just a clarification...our nurses dont go to the 'floors' but we do float to step-down where unfortunately the load is sometimes 5 patients...

And i find it odd that your unit(it was your unit, right?) does discharges home from ICU. One minute critically sick and the next ok to go home?? Does this unit double as step-down, or maybe overflow???

Our unit also occasionally will send patients home. Now, this is a very rare happening, but sometimes we'll get a 'level I' trauma that had to be intubated for CT, but had no 'real' injuries, and we will discharge them to home when they're ready.

RE: New Grads in the Unit

I think it depends on the individual person, just like anything. Some new grads have no business in the unit, and some experienced med/surg nurses also have no business in the unit, no matter how much training you provide.

As far as orienting new grads compared to experienced med/surg nurses.....aside from a little bit of organization edge, and more experience with assessments, it still seems to take them just as much time as a new grad (most of them), to pick up the new skills needed to work in an ICU.

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