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.

Completely agree w/ you, StayLost! We rarely use them because of the discrepancies. I had one a few months ago and my CT surgeon had me hook up a CO/CI injectate syringe and shoot an index. It was way off.

Sounds very similar to the facility where I work. That's part of the reason why I'm on night shift. I have a year of CV experience under my belt, and I know I couldn't handle the pace of day shift yet.

Just curious, do very many facilities wedge anymore? I know this topic has been posted before, but it looks like the threads are several years old. We don't personally wedge at my hospital, but I'm curious as to whether it is still commonplace elsewhere. Our CT surgeons go by PAD, CI, and CVP.

I work CVICU and we are expected to float just about everywhere; SICU, MICU, ED, Med-Surg, you name it. On occasion, we will get nurses floated to us, but we only give them patients they are used to handling (i.e. MICU nurse will get the vented respiratory failure/CHF patient, not the STEMI straight out of the cath lab) Unfortunately, I have heard of nurses receiving patients that are not appropriate when floated to other units. A nurse from my unit with no SICU experience ended up receiving a fresh craniotomy when he got floated. Needless to say, it made him pretty nervous. :\

I work CVICU and our visiting hours were actually implemented by our CT surgeons. They are 9-11AM, 2-6 PM, and then 8-10 PM. Doors are locked otherwise. Nurses do have some discretion and we always let family members back for a few minutes whenever patients return from surgery. Honestly, I appreciate the restrictions. If I had a hemodynamically unstable patient, I would find it very difficult to concentrate with family members in and out of the room all of the time. For the most part, our family members are actually pretty cooperative. I think the primary reason is that the cardiac step-down the patients move to is 24/7 open access.

Sounds like you and I are a lot alike! Come May, I will have been on my CVICU for a year. That's great that you had some step-down experience under your belt. Your anxiety will improve over time when you get more accustomed to what your surgeons expect and what nurses you can count on when your patient crumps. Just remember you are truly never alone. My unit is very cohesive and when anyones's patient starts to go bed, regardless of how much experience that primary nurse has, there are at least two or three other nurses that are in that room helping. I have had fresh CABGs start to go bad and not once did I ever feel like I didn't have someone right there to help me. You will drive yourself crazy if you try to solve every bad scenario in your head. Just take it one day at a time and find those nurses you can really trust in an emergent situation and always, always, always ask advice if you're unsure. Good luck! :)

Being a new nurse is always a struggle, especially when you feel like the job you accepted is not a good fit. I was incredibly stressed out when I initially started. I worked on a busy med-surg floor that included ortho and oncology as well. It was absolutely not the job I wanted out of school. I knew I wanted to do ICU, specifically cardiothoracic. I ended up working on med-surg for about 10 mos. and by the end of it, I was so burnt out. I could feel my heart racing when I would ride the elevator up to the floor because I was so worried about what my assignment would be like. Thankfully, I stuck with it for awhile and actually got offered my dream job. You may actually find that, if you stick with the floor you are on, you may gain invaluable experience if you give it a chance. As much as I ended up hating where I was, the staff was great and I really got to hone in on the skills you truly need to practice as a new nurse. If you truly don't think you will gain anything from where you are though, then it may behoove you to get out sooner rather than later. Call HR and explore your options. Good luck!

I work CVICU and we are tripled on occasion. If we are, one or two of the patients will have orders to be transferred to the cardiac floor and are just waiting on an available bed (i.e. POD #2 or #3 CABG w/ Swan and chest tubes out).

I work CVICU and the most we ever have are three. If we are tripled, they are usually patients with transfer orders waiting on a bed. Our open-hearts are one on ones until extubated and balloon pumps and impellas are 1:1s as well.