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StevieRay BSN RN

StevieRay BSN RN

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  1. StevieRay BSN RN

    med surg RN to cardiac step-down

    I will try to help you the best I can with my under two years experience on a step-down telemetry/cardiothoracic unit. This is my first and only nursing position so I do not have experience on a general med-surg floor. I think you will make the transition just fine but that doesn't mean there won't be a learning curve for you. I'm not sure what your patient ratio is, or what it will be, but you probably already have your time management fine tuned. We typically have 4 patients on daylight and 5-6 on nightshift unfortunately. I would dive into studying all your cardiac drips. When are they used, the facility's protocol on titration, and most importantly, what you need to assess for and how often. On my unit, we most often see cardizem, nitro, amiodarone, and heparin gtts. We rarely ever have dopamine or epi unless they are started during a code and the patient will eventually be transferred to our ICU. Telemetry monitoring and EKG interpretation is also very important. You want to be able to quickly determine what's going on with your patient so that you can call the doc for orders if needed. Brush up on the electrophysiology of the heart. The MOA of drugs like tikosyn and fleccanide. Different treatments for rhythm issues like ablations, cardioversions, watchmen procedures, permanent/temporary pacemakers. Study the settings and what they mean on temporary pacers. Study and learn about cardiac caths and open heart surgeries. After open heart, your patients will have chest tubes in place. If you didn't work a lot with chest tubes on your med surg floor, I'd definitely go back and study that. Know how to identify an air leak, how to properly hook your patient up to suction etc. It's important to study the anatomy of the heart, the vessels, NSTEMI vs STEMI, cardiac stents, how to wean TR bands, and post cath site checks. And you definitely want to understand the pathophysiology of CHF, cardiomyopathy, cor pulmonale & left sided HF. We also deal a lot with valvular disease and receive patients s/p TAVR or valve replacements. If you already have the basic understanding of these subjects, the rest you will learn with experience and by asking a ton of questions. As you already know, you just need to know enough to be safe when starting a new speciality, you will certainly learn in time. I'm not sure if I answered your questions in the way you were hoping, but I hope this will help you somewhat. I just think it's important to show your potential manager that you have a genuine interest for cardiac nursing and your eager to learn along the way. Keep us updated & goodluck!
  2. StevieRay BSN RN

    Med-Surg v. Telemetry/Step-down

    I work on a med-surg/tele unit. Our ratio is 4:1 and seldom we get 5:1 but we try to do our best to coordinate this so the RN with the sickest patient doesn't have a 5 patient assignment. All of our patient's are monitored & we do have remote telemetry technicians (although a majority of the time we catch a dysrhythmia first anyway). Many of our patient's are 1st day post-op transfers from the ICU after open-heart surgery. We get TAVR's, VAT's, permanent pacers, new onset A fib w/ RVR. It's a lot of pre and post cardiothoracic surgery patients. We have heparin drips, tridil (only for chest pain since we don't have continuous BP monitoring), PCA pumps, epidurals, cardizem and Amiodarone drips that need to be titrated, blood administration, IVIG. A ton of cardiac caths. However we don't do insulin drips, venous sheaths or titrate cardiac drips for BP. Hope this helps!
  3. StevieRay BSN RN

    CNAs starting IVs

    To be honest, I don't really feel strongly on this topic either way. If I worked with a veteran CNA who was great at IV insertions, I would have absolutely no issue going up to them & asking if they'd be willing to get a stick for me while I got one of their patient's off the bedpan etc. However, I am wondering how you all feel with the assessment that goes along with IV insertions, or do most of you believe it's just a task that anyone can learn? When I'm starting IV's, I usually try to think about what the IV will be needed for. Does my patient need maintenance fluids, a bolus? Will they be receiving vasicant medications such as vancomycin, potassium? Do you think CNA's would think about gauge size, the best anatomical location, the property of the meds that will be administered? Or maybe the most important thing is that we're just able to get IV access in the first place? I'd be interested to hear what everyone thinks.
  4. StevieRay BSN RN

    New RN, how to save face

    A part of me thought your post was hilarious (mainly because it is something I can picture myself doing lol) and another part of me can empathize with your feelings. I have only been working for about a year on a cardiothoracic unit and I have did and said PLENTY of embarrassing things. I am a chronic over thinker and am very in tune with social cues and others' nonverbal body language. A few weeks ago I found myself in a situation with a surgeon who had just come up to our floor and stated he wanted to do "surgery" on my patient at the bedside. Pt was in for r/o sepsis and needed an abscess drained. He was unable to do it in the OR due to the influx of traumas we had that day and the patient had been NPO for the entire day. He wrote down a list of surgical supplies I needed to get and I called down to the OR to get the rest (which wasn't any easy feat). Long story short, we were in the pt's room & he had asked me to hand him an 18g needle. I handed him what I had grabbed earlier and he looked at me like I had 4 heads. He said "not this, I need an 18g needle!!" I ran out of the room, grabbed another 18g needle & went over to my coworkers. "Guys, wth am I supposed to do...he said this isn't an 18g needle! Is there something different?!" They also looked at me like I was crazy. I think I had us all in a panic hahaha I made the senior nurse go back into the room with me. I looked at the surgeon & said, "is this not what you need?" He looked at me & said "yeah...you handed me an 18 and 20 gauge accucath." I about died of embarassment. Then I laughed hysterically with my coworkers about my stupidity Point of my too long post is that, often times we overthink the mistakes we make when others may think about it for 2 seconds, then go back to their own tasks and thinking about themselves. Just think of how much time you spend thinking about others after they say something stupid or make a mistake...you most likely move on directly after it happens. Just forgive yourself and learn to laugh at yourself. We have all done it.
  5. StevieRay BSN RN

    Working smarter, not harder?

    The transition can be difficult, but isn't impossible. I work on a cardiothoracic/tele unit and some days are better than others. Some days I clock out with my head spinning and others, I leave feeling accomplished. We are severely under staffed currently but my manager does everything in her power to ensure that the daylight nurses only have 4 patient's each..and 5 if we are truly desperate & have exhausted other options. I agree w the other user who mentioned coming in early. That was one of the biggest things I did that seemed to help start my day off on a better foot. We make our own report sheets, but I usually come in at 06-0615 & begin looking up my patients. I write down all their med due times (and cross them off as I complete them later on). I write a few quick notes about who they are consulted to, who the attending is, what brought them in, any lab/testing results, any scheduled procedures, and whether they are accuchecks. I also write down on the back of my report sheets anything that I need to remember to do, any orders I need to obtain when the physicians start rounding, chest tube dressing changes, neurovascular checks etc. I then go to the omni to pull my morning meds. Then I prioritize care. If I have two patient's in the same room, I'll go in, take V/S, do my initial assessments, chart them (if I have time) then I'm usually able to begin passing meds. We get a lot of CABG/Cardiac cath/TAVR/VATS patients. As well as, Amiodarone, Tridil, heparin & cardizem gtts...so I always try to prioritize my day based on how stable my patients are. If I know that the ICU will be bringing me my post- CABG pt who was a difficult intubation, I may ask another RN or my charge to grab my accuchecks while I assess that pt. I'm super lucky to work on a floor where everyone works as a team. On nightshift, when one of us gets an admission, there is ALWAYS another RN in that room helping us with V/S, monitor placement, etc. I truly wouldn't be able to handle most days if it weren't for my charges, aides, and co-workers. Keep trying different methods and routines until you find one that works for you. You'll do great in no time!

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