RNpatterson

I'm a VAD coordinator at my hospital. No certification that I am aware of. Cardiac ICU background with VAD experience is quite common for coordinators. Once in the role, there are opportunities for formal training through Thoratec (HeartMate) and HeartWare, and of course opportunities for conferences. When I was in the ICU, the only training I received was through the hospital.

Ketamine isn't as scary as it sounds. I know our facility has a lower max dose on the floors compared to the ICU and it can really help with pain control (amio, cardizem, heparin all fair game on the floors here.). Levo and insulin gtts out of the ICU makes me raise an eyebrow though... interesting.

I started on a smaller CVICU first and I worked on the unit as a tech while in school which helped once I became a nurse. Being overwhelmed is good when you're new - it means you're learning. At that facility, we encouraged new nurses to take the sickest patients right from the start but we were surrounded by nurses who were available to help. Once I was comfortable there, I transferred to a larger facility where we do transplants and VADs and it's been a whole new learning curve. Here, new nurses take post-ops in orientation but then take stable patients when they are on their own and work their way into higher acuity over time (6mo-1yr). They all still have the same look of terror in their eyes when they take care of their first "really sick" or fresh post-op patient. The best advice I can offer is remember to breathe, help is there when you need it, and don't expect to know everything right away. You will learn with experience and you only do that by placing yourself in those uncomfortable positions (don't worry, it gets better!). Good luck!!!

The IABP only offloads the heart by about 15% which is often all is needed. The impella tends to offer more assistance and the newest model has the ability to offer full cardiac assistance. Balloon pumps are often used to assist in the recovery of cardiogenic shock or to optimize a pt's condition before a risky cardiac surgery since studies show a decrease in morbidity and mortality when a patient goes into surgery in their "peak" condition. Impellas are often used as a cardiac assist device in the cath lab and if a patient requires a little extra cardiac assistance for a day or two after the cath, it is easily left in place. Balloon pumps wouldn't be utilized during a cath given that it would be hard to thread anything up to the heart with that pesky balloon getting in the way with every heart beat. Of course these are not exclusive uses for these devices but certainly common uses. Perhaps someone can add on if I missed anything pertinent but for now I hope this helps.

I didn't mean to offend but I did start my post by saying I can only speak to my experience at my facility... hiccups? really?

Ask tons of questions! I always ask my orientees what their background is and what kind of patients they have taken so far in orientation, and what kinds of patients or skills they want to work on... it gives me a gauge of where they are on the learning curve. If they need to work on time management then we take stable doubles (a skill you probably already have coming from ICU). If they want more practice titrating gtts or learning hemodynamics, we'll take a post-op or a more unstable patient or even a stable double but we'll make sure one of the patients is there with a leave-in swan for monitoring. You won't learn it all at once so discuss with your preceptors what you feel comfortable with already and what you still need to work on and go from there... and ask lot of questions. If you have an "easy" assignment then ask to go over PA cath waveforms or the rationale for choosing certain vasoactive gtts... make a round on the unit and see what's going on with the more unstable patients or check out the chart or a patient who is now stable but coded or was a fresh post-op a couple days ago... or the patient who has been on the unit for three months. Be nosy. And did I mention ask a lot of questions? If your brain hurts when you go home from information overload, you did a good job. With time, more and more of it will stick as some of it repeats itself.

Oy... VAD coordinator from step-down? All of ours have at least a decade of CVICU experience on units utilizing VADs. I can't speak for the rest of the nation or for anyone else's experience (including yours) but that thought kind of terrifies me. Granted the majority of a coordinator's work with the pts is done when they are stable but they play a pivotal role in getting the pt to that point and keeping them there. They are there in the OR when they are placed, and on call for unstable patients. They also work with patients in the clinic and follow up and remain on call for patients to call from home. No doubt they all had their learning curve when moving into the coordinator position but they also had been a part of nearly every worst scenario possible from working in the ICU first. As soon as ANYTHING starts looking amiss on our step-down unit, the pt's come right back to us in the ICU for evaluation. It's very rare that those nurses have to trouble-shoot much with the VADs; definitely not enough to prepare them for a career as a coordinator. Just my two cents...

I haven't done any research on the topic but I can say our facility does them fairly quickly; we generally try to get it done before lifting sedation. It's rare, but sometimes they'll do it immediately post-op in the OR and also rare and far more unfavorable, the pt has it done the next day (but still within 24 hours).

We're pretty spoiled with our post-ops as well. We single our post-ops until extubated and dangled (mobility is HUGE in our ICU). If a pt is extubated toward the middle or end of the shift, they are usually left 1:1 for one more shift. My hospital is a large university hospital (and union) with very high acuity. The last CVICU I worked at was smaller and did more standard cases, mostly valves and CABGs. They were doubled as soon as they were extubated, sometimes sooner. Our balloon pumps are generally 1:2 but those are often some of our more stable patients - many of our IABP pts have them placed to optimize them for VAD surgery.

Our facility uses weight-based protocol but pharmacy uses the weight to determine a starting rate and bolus dose - that's the only time weight is factored into our use. The order set then shows the protocol for rate changes and bolus amount based on ptt, independent of weight. It sounds like your protocol is much different but just as anything else in critical care, when you are doing something out of the norm and you have that little voice in your head saying "is this right?," ALWAYS double-check. I'm not sure what a RNM is but I assume it's either your charge RN or manager which is a great place to start, but in this case, since it involves medication administration, my double-check would have been with a pharmacist and/or the physician. The problem with universal protocols is not everyone fits into the one-size-fits-all model and exceptions need to be made. It wouldn't be a bad idea to bring up a suggestion to your manager or the appropriate committee to add a BMI or weight range for your protocol. To answer your question, I couldn't tell you what we do at my current hospital does as I have not cared for a very heavy pt here, but the last hospital I worked at capped all weight-based infusions at 100kg, no matter how large the pt was.

Update --- I have seen many threads and posts about RNs wanting to leave their jobs and start a new field. I look back on this post and almost can't believe I wrote it. I really enjoy my job! While I do miss working with the underserved and the challenges of working with fewer resources, there is much to be said about having the ability to provide top notch medical and holistic care for my patients. I have seen a level of care I didn't know existed in today's health care and I can honestly say this new job has completely changed me as a nurse. I know I will one day move on to greener pastures but for now I'm enjoying the ride. When I am ready to leave, I will have many more options to consider as a result of taking this job and the team I work with is amazing. So, my advice to anyone who is considering leaving their unit or field in the first six months of employment is to stick it out a while and see where it takes you. You may find it's not so awful after all.

I was hired as a new grad into an inner-city ICU and absolutely loved my job and everyone I worked with. After a year, my husband and I had the opportunity to move out of state which I was quite happy about but of course that meant I had to put in my notice. While I was very happy to move, it broke my heart to leave that job. I quickly obtained a new job in the same field in the new city and I thought this would be my dream job; it's at a large university teaching hospital opening up many more opportunities for me when it comes to general knowledge, skills, and it's easy to get involved with research and/or join committees. And yet I'm finding that I'm miserable. It took moving for me to realize that it's not the rush of the cardiac ICU that I love so much, it was working with the underserved population and the challenge of trying to do more for my patients with less (money, resources, ancillary help). I am seeing numerous jobs posted that I wish I could interview for... Working with the homeless, HIV population, substance abuse, etc. But I have only been working in my new job for a few months and I don't want to burn bridges by leaving so soon. What's an RN to do?! Thoughts? Advice?

I'm moving to Seattle next month from Michigan. I applied to UW, VM, Northwest, and Swedish - within a week I had interviews lined up with all of them, last week I flew out and was offered jobs at all of the facilities (and accepted a position at UW). Part of it was luck I'm sure; all of these hospitals happened to be hiring for the ICU (I have a year of cardiac ICU experience). I also have my BSN and worked as a tech in the ICUs while in nursing school. I'm sure all of those were factors playing in my favor. What kind of units are you applying to? Just step down/PCU? How does your resume look (feel free to send it to me and I can look it over for you). Not having your BSN may be affecting your ability to get an interview at the larger facilities (esp if Magnet status is involved) but probably not as much at the smaller facilities. Try Northwest - their ICU is 15 beds and their nurses frequently float to the step-down unit and sometimes the floor when needed. Best of luck to you!!!!! Something will come along soon just don't give up!

Michigan - Cardiac ICU

Good point and that brings up another question I have. We're planning on living somewhere downtown (where I get a job will help guide where specifically)... Is public transportation a reliable resource to get to/from the hospitals i.e. UW, Harborview, Swedish, etc? We are only taking one car when we move and I'm hoping to either walk or use public transportation to get to and from work.