LNRN11

Yeah, I'm not a fan. Our cardiologists in particular seem to like it. When I see it running, I'm just like, "Greaaaattt…"

You will certainly still have some say so as far as the ventilator is concerned. Most RTs are good about collaborating, like previous posters have stated. I work in CV surgery and all of our open hearts come out vented. We wean them down with the RT, but at the end of the day, that's still my patient. If we extubate and they don't fly, that's on me. So, say I don't feel comfortable with extubating (ex: their NIF, VC, and/or ABG aren't good), I will be the one that calls the anesthesiologist or CT surgeon to get their decision. Additionally, even if we aren't necessarily the ones obtaining the ABG (I know some nurses do at their facilities), we still know how to interpret and treat them. If the RT calls the pulmonologist/attending/whomever and that patient needs bicarb, for example, the phone is going to be passed to the nurse to take the order and administer. I hope that kind of clarifies for you! Good luck.

Out of curiosity, do any other hospitals make Neo/Levo combination drips rather than having two separate? Some of our docs are big on that at my facility, but I feel like it makes it confusing for titrating. I know our max on Levo is 20 mcg and our Neo is 300, so if they're together, what the heck would the max be?!

I would most certainly have been alarmed in that situation. 2 1/2 hours?! I get that the house sup probably had a multitude of things going on, but yikes! Hospitals have got to quit sending pharmacists home at certain hours. I've heard of this, but it still blows my mind. I think of how much I rely on mine on nights, and I can't fathom being without them. Being that that patient had a K that high and a blood pressure that high for that matter, that sounds like a train about to de-rail.

I think it depends on your location, because I ran into the exact opposite problem. When I was a new grad, no ICU in my area wanted me. I know there's a lot of places that like new grads because they can essentially mold them; but, there are also those places that like nurses with experience so they aren't having to teach the basics along with the critical. I had about ten months of med-surg experience prior.

Cath lab definitely has transfer friendly devices, but they also pull sheaths all day in recovery. It is very hard on the shoulders and hands holding manual pressure like that. I work in CVICU and just holding pressure for like 20 mins on one patient makes my hands go numb and they shake. I can't imagine doing it all day like they do.

If you get a chance to lay hands on one, I guarantee it will start to make more sense. I work in a CVICU and every single one of our open hearts comes back with one. They have not, by any means, gone out of favor with our surgeons and they will actively treat based on the numbers we report. We use Flo-Tracs on occasion, but they can be pretty unreliable at times. We don't wedge our Swans either unless we are helping our surgeon insert one at the bedside. Some examples as to how we use it and report it: I've got a CABG whose pressure is dropping in the 80s with a PA diastolic of 5, CVP of 2, SVR of 650, and a CI of 1.8. The surgeon is going to give volume first and he will decide crystalloid vs. colloid based on the amount of chest tube drainage, urine output, and labs (i.e. Hgb/Hct). Say I've also got a CABG whose filling pressures are pretty good ( PAD of 17, CI 2.4, CVP 10) but they're still very dilated (pressure is still in the 80s) and their SVR is only about 450 after quite a bit of volume replacement, they're going to start a pressor.

^^^ Exactly what they said. It can take people quite awhile before they wake up from Versed, especially if they already have renal or hepatic issues. Diprivan is very quick! I've had patients where you shut it off and it seems like they are awake almost instantaneously. Careful when you are titrating up; it can tank your pressure.

I feel for ya. I definitely remember being there not too long ago. Med-Surg is rough. I really commend those nurses that stick with it for years or even their whole careers. I did M/S for about ten months and then transferred to ICU. Although the patient acuity is much higher, it was the perfect fit for me. I remember being in the same scenarios you're describing. We didn't have a tech on nights for probably the first 7 mos. I was there and our patient load was 5-6. I left crying many a morning because I felt so inadequate. I certainly agree with the previous posters. It's crucial that you have some form of organization sheet. I still use one to keep my two patients organized. Clustering care is very important as well. Make a point of asking your patients if there's anything else you can do for them before you leave the room, that way they (hopefully) aren't calling you right back into the room two minutes later. I would definitely approach your charge too. Make sure you speak up and let her and your co-workers know when you're drowning. Sometimes, even when you feel like you're noticeably stressed, those around you don't realize you need the help unless you come right out and say it. Good luck to you! I hope it gets better for you.

I did! It's totally doable! :) I worked M/S for about ten months. I was on orientation with a preceptor for two months when I transferred to CV. It was actually the perfect amount of time, too. I was a little worried it wouldn't be long enough, but towards the end of my orientation, I had had plenty of open heart cases to prepare me to take them on my own. My charge nurses were great too about keeping a close eye on the newbie nurses and always being right there when you need them. Good luck! Hope you love it as much as I do!

We don't have a formalized program either. If you're a new grad on my unit, they stick you with a preceptor for three months. If you come with some prior nursing experience, you're with a preceptor for about two months. One of our CT surgeons who is incredibly sarcastic (but a wonderful doctor) made this statement: "Nursing should be like diving...start on the low dive and work your way up. Not here, though. We take them up to the high dive and push them off." That's essentially what it was like. Very much sink or swim, but it's very much dependent on the type of co-workers you have, too. We did start slow to begin with. We would start with POD #2 or 3 CABGs that needed pacing wires and chest tubes D/C'd and work from there. Once the charge nurses felt like you were ready, they would start throwing more and more open hearts at you. By the time I was done with orientation, I was getting one every single day that I worked. I highly suggest looking things up outside of work if you don't get formal classroom training.I think I filled two notebooks with information on critical gtts, vents, interpreting swan values. It's very much on the job learning, though. Good luck!

Speaking as a relatively new nurse (two years in), I have to agree w/ the two previous users. Sometimes, even a sparkling resume won't get you an ICU position right out of school. I remember getting so bummed when I would apply and they would deny my application w/in a few days. I graduated top of my class and did plenty of extracurriculars, and it didn't make a difference. I ended up taking a med-surg position for about ten months prior to transferring to a CVICU position. I will say, as much as I realized M/S nursing is NOT for me, it did help cushion the blow when I did move to the ICU. I remember recovering my first open-heart and being like, "Omg...can I do this?!" One year later, I couldn't imagine myself anywhere else; but, coming to the ICU initially is VERY intimidating. Good luck to you! Just keep an open mind! If you don't get your ideal position immediately, just be patient. It will come.

I hear you! I work CVICU and get floated pretty frequently to SICU, MICU, and ER. It's so irritating because we purposely sign up for OT days on my unit so we aren't understaffed. The other units don't do that, so we end up floating to staff theirs. When we float, it's never a choice on your day off either. It is one of your scheduled days...definitely leads to some resentment. I've worked with some pretty nice and thankful staff so far, but I have heard of them making some unfair assignments to some of my fellow CV nurses. For example, assigning a fresh craniotomy or tripling someone with an admission. If one of our surgeons found out we assigned one of our open hearts to a float nurse, heads would roll.

Ktlitz, the CVICU I work on has been. Our entire unit closed the week of the 4th. It's starting to pick back up, though.

We had a younger gentleman on our unit who was incredibly rude to the nursing staff and pretty much anyone he encountered. One of our female surgeons was on call that weekend and rounding for her colleagues patients, which included this particular patient. She walked into the room, asked him how he was doing and he proceeded to go off. She cut him short and said, "Well...aren't you a miserable son of a *****." She then walked out and wrote "security to room" in her orders.