1smartrn

I will never forget the first day on my unit! I had been there maybe an hour and we had a code blue. It was a fresh open heart surgery pt, and she was very young (early twenties). She'd had a severe reaction to the protamine that was given to her, and they ended up taking her back down to the OR after 30 minutes of coding her. I will forever remember watching them whisk her towards the elevator, one of my coworkers stradled over her on the bed doing compressions. About 30 minutes after that, we had another code. As a new grad, this was overwhelming! I began to contemplate my choice and if I would ever know enough to not only act appropriately in these situations, but how to prevent them when possible. You will get there, and when you're there, you'll be shocked and amazed at yourself!

I started as a new grad in a CVICU almost two years ago now. I was absolutely terrified! But I hope you will find what I did, and that's a fantastic support system. The learning curve going into ICU is tremendous, but you will be okay. Know who you can go to for questions, glean as much information as you can from your preceptor, and work on putting it all together. The tunnel vision we are all guilty of as resident RNs will fade with time and experience. I by no means consider myself a highly experienced ICU RN. Believe me, I ask for help as soon as I get a feeling that things aren't going as they should. I recently started taking IABP pt's, and this has allowed me to reflect on how far I have come in a relatively short period. You guys are going to do great. Just remember, no matter where you find yourself as a new grad, none of it is like nursing school. The real world is much different! Take the criticism and use it positively, be open minded and motivated to grow. It's going to be hard, the first year was challenging, but you'll be amazed at the person you can become. Then, you'll get comfortable, and they'll gently shove you to the next level, and the anxiety will return. But it will fade quickly as your knowledge base grows and so does your confidence. Good luck and keep us updated! Great choice in career path!

I work in a CVICU and we use Amio drips with nearly every open heart surgery pt we have in the immediate postop period. We always D/C the amio if a new heart block develops (I know, different protocols at different places). Amio does, however, have an exceptionally long half life, so the effects will still last even after you turn off the drip. I would not be surprised if the med was stopped on that pt. Bradycardia becomes an issue when the pt gets symptomatic. If your pt is trucking along just fine with a rate in the 40-50's, generally it won't be treated. It may be in their plan to get a permanent pacemaker at some point in the near future, but you as their RN will most likely not be giving any atropine if your pt's BP remains stable and they don't become symptomatic.

I started out as a new grad in the CVICU, as well. We do OHS here, and I was oriented to fresh hearts about six months ago. I have been an RN for almost 2 years, now. Let me start out by saying welcome to the lifestyle, and you are perfectly capable of being a fantastic heart nurse. It's big and scary at first, but you will soon establish your own rhythm and routine and start feeling more comfortable. Each hospital manages their patients slightly differently, but the main things I would be at least moderately familiar with would be electrolyte replacement, vasopressors, inotropes, and insulin drips (though those protocols vary widely facility to facility). If you are not already familiar with your facilities Swan/PA catheters, study them. Learn what filling pressures are desired and your cardiac surgeon's preferences. All of that will come with time and experience. Relax, take a deep breath, and enjoy. You have just dove into a specialty that is as intriguing as it is complicated. Good luck with orientation!

I started in cardiac ICU straight out of nursing school as a new grad. Our unit hires new grads regularly. I think the previous posts give great advise. Talk to your nurse manager about shadowing and go from there. Does your hospital hire new grads into their ICU?