MusicGuy

It helps to have ICU experience and comfort with critically ill (AKA SAS-sick as snot) patients. You will have to learn ED nursing during STEMIs and provide care to ICU patients when they come down for a cath. It's good to be terrified! A new RN that isn't is dangerous. The teams are usually small, so do your best to listen. One of the best lines I've ever heard is: "Take the cotton out of your ears and put it in your mouth". Start reading Kern's book on catheterization. Congrats and best of luck!

There's not many EP RN's! Mostly because there are few educational programs available, and most of us learn on the job which takes years. I've been in EP almost 3 years. I like it enough to stay. I would say if you like details and physiology, then go into it. Everything is in milliseconds and time in between catheters that are placed throughout the heart. We break up the PR interval in 3 pieces and study exactly how long it takes a signal to go through the AV node to the perkingies. It helps to have an understanding of electricity (e.g. Ohms law and how it behaves). I would spend a couple hours in one and see if you like it. The workflow is divided into two parts, ablations (creating scare tissue to correct an arrhythmia) and pacemaker/ICD placement. Ablations are not as immediately satisfying as caths when you open up an LAD during a STEMI. Sometimes take hours to study and ablate, especially PVC and afib ablations. The other half is CRM when you put in pacemakers. Single, dual, Bi-ventricular or leadless, they all improve a patient's cardiac output. What I like most is that we perform one of few procedures in which a patient can come off meds afterwards. It is one of the areas of healthcare that fixes a problem instead of leading to the use of more medication. Not that this is a factor, but good to know - the field is growing and number of procedures monthly are expected to increase 10-20% per year. We are a very busy lab and personally say I've seen this happen. If you ever want to talk just send a PM. I'd be happy to answer any your questions.

I work in the CL as well, most of our staff is cross trained. So, that aspect will be easier for you. I didn't have any CL experience when I was hired, and had to learn it in addition to EP. You need to read daily, and it takes at least a year to feel confident in EP diagnostic abilities. Daily EP duties fall into 2 categories in our facility and I suspect at most others as well. First is pacemaker and ICD placement. There are two types, the traditional, in which a pocket is made, leads (wires) are screwed into the atria, ventricles and sometimes CS (for a bi-ventricular pacer/ICD). This is fun because you learn sterile technique and it resembles and operating room scenario. The other group is leadless pacemakers and left atrial appendage occlusion devices, both of which are inserted via a large bore catheter into the RV. In the case of a watchman or LAAO, transeptal into the LA. The second job requires ablations and diagnostic electrophysiology. Catheters that are placed into the various chambers (RA, RV, CS and his bundle). The EGM displays the signals they generate. It takes a while to learn the standard EP study. It's fascinating because we get a complete look at the heart's electrical activity. The heart is physically mapped via a computer, and shows electrical activity in real time. This is how the Dr knows where to ablate. The neat thing is that there are different techniques for each of the arrhythmias. If like to read and have a basic understanding of electricity, I recommend making the switch to EP.

Absolutely! If there's anything of my brain left after a 14 hour shift, it's yours!

Skillstat!

They want ICU/CCU experience so you have a good foundation of everything cardiac. Drips, 12 leads, anatomy, ect. in addition to good nursing skills. Some of our patients come from the ICU and you are expected to deliver the same quality of care along with the expertise of electrophysiology. We've had patients code on the table when PPM or ICDs are going in and it helps to remember your ACLS training. The thing that will take a year is getting comfortable reading EGMs and learning what the catheters are telling you.

I would caution against nights unless you're seriously OK with being up all night. I started on nights and found that not too many happy people were around to answer questions, but your situation may be completely the opposite. Also ask yourself if you can learn while sleep deprived. Another thing to consider is that there is much less physician interaction on night shift. I learned the most on days when I was able to discuss plan of care and find out exactly what the physician wanted for a patient and why. 6 weeks is crazy if your patients post CABG or thoracic surgery. You'll have to learn about chest tubes, pacers, wire care ect. If you do take the job, I recommend to read as much as possible.

Congrats on the new job! I recommend becoming familiar with the process. Your patients might come back with an arterial sheath still in the groin. The art of pulling is fairly straight forward. Hold pressure for 20 minutes, gradually easing off after the first 7. However, closure devices are very popular and quickly deployed in the lab. The biggest danger is a hematoma or bleed at the femoral site. Depending on the doc, radial access is becoming popular due to lower risk of bleeding. Cath lab recovery has a much different work flow than a floor. You might love it, but even if you hate it learn everything you can and transition into the lab. Several at our facility have one that and love their job.

Yes, understanding is the key word. I'm week 5 in an EP lab and it's a big learning curve to simply read intracardiac ekgs, let alone interpret the pathways and jumps. Most RN's are unaware that there are 2 separate pathways in the AV node!

I was thinking the same thing! And little jealous too. I wish I had had a more involved preceptor during my orientation. I'm surprised most managers don't see this as a crucial role.

This was my path and I'm glad I did it. I started as a unit secretary and learned what labs and orders are used on different patients and why. Then I became a CNA and learned my rhythms and how to interpret a 12 lead. The only caveat here is that the job is extremely important. It's easy to get on the bad side of a nurse during busy times and when things go south. Keep focused on the patients first and RN's second!

As disturbing as the video is to watch, it baffles me that a security guard just stood and watched. Security officers are also mandated with protecting rights of patients in addition to rights of fellow employees. Clearly two people's rights where endangered. Why is the RN the only one who stood up? And why did security do nothing but watch?

RRT's prevent code blues! I'd rather have the RRT if my patient is not doing well.

Removed

Making them happy is doing them a disservice, and I would explain it that way. A jester can make them happy, but what our patients deserve is to be happy AFTER they leave us!

To the OP: I have been there! I'm not sure if I had the experience because I was new, a guy or both. Serve the time (a year usually) and find a better unit or even hospital. You'll be twice the nurse compared to the one that is on the PC shopping or in your case went to the dollar store. It takes a thick skin to be successful and you'll come away stronger. The next gig will be a breeze and you'll appreciate (and recognize) a good floor and a good team.

I was the victim of a horrible preceptor as well. She didn't care, and half of the time I was pawned off to multiple other preceptors. I was happy when that happened because I learned more, but the others where disappointed and surprised at what I did not know. Since they were colleagues of my primary preceptor, I was the problem! I remember at week 5 thinking to myself, "How the heck am I going to do this?" As yourself I was let go and devastated. I got another job a month later. I was nervous meeting my preceptor, but she took one look at me and said, "you are going to be great"! That was 10 months ago. Don't let one situation get you down.

Absolutely! Last night we had more psych patients on our floor than MS. Some stay a year or so as well!

Love skillstat! When it comes to books, Dubin is OK. But if you want more of the "nuts and bolts", go for the "only EKG book you'll ever need" by Thaler. It goes into much more detail!

As Craig from Keep it Real RN says, "night shift is a different type of hell". I personally like it. Some good points where made to survive it: Eat well and often - healthy snacks like carrot/celery sticks, bananas, apples. Stay away from the doughnuts left in the breakroom! Try to cluster your days so that you're working the end of one week and the start of another. The only gripe I have after doing it for years, is that unless it's a couple days off in row , you don't get one. The single day off is spent recovering.

Hello Rubyvee. I can understand what you say about some folks missing "subtle hints" about how they are doing, and appreciate that you shared it. That is valuable advice. However, I feel that this NM acted unprofessionally by saying one thing, then doing another. Either you give someone a chance, or fire them.

The same thing happened to me. Let's start with your original conversation with the NM. She was willing to give you another week, then changed her mind. It may not seem obvious yet, but they did you a favor. If things were "that bad", after 8 weeks of "good things", then you should have been told that you were close to being fired. A good preceptor would not let that happen. A NM gave me the (BS) same speech, and couldn't even provide any examples after stating she observed "unsafe practices". A new grad after 8 weeks on the floor does not know everything. I'm in my second orientation at a new hospital and can't believe the difference. My preceptor is supportive (as well as the other nurses on the unit) and has the time and patience to answer questions. I did learn a lot from the first experience, most of which are on youtube. I'll mention that working on a unit, there's a social element to it. Try to foster a good working relationship, because you will need to depend on your colleagues after orientation. But keep your mouth closed about your personal life unless asked, then be discrete. 10 weeks is average for orientation. Yeah, 8 is a little short. But time management is a huge deal, and oddly enough difficult to find any references since it is unit specific. Just look around you and learn from the nurses doing the job. How are they keeping up with charting, meds and assessments? I felt devastated as well. Take a couple weeks and try to separate the BS from what is valuable to take away from this experience. Leave it off of the resume and practice interviewing with other nurses. Lots of good info on this site.

It sounds like a hostile place. I'm not sure that it's ever acceptable for a preceptor to yell at a nurse who is orienting. It shows immaturity and deficits of the preceptor. Just because they might have taken a "preceptor class", does not equate that they are in any way competent to teach you. I was in a similar position only months ago after being yelled at and let go. Now I have good preceptor and am amazed and appreciate the difference. She is building confidence and is always supportive. Don't give up! There are millions of sick people that need nurses to take care them.

I did get a rejection call. Needless to say I wanted job and liked the hospital. But having a voice tell me such was very professional (IMHO) and made me want to apply again. It's a rare thing; most don't bother with the email!

I was in a similar situation where I felt a different unit would be a better fit a couple months into orientation. My mistake was to "check it out" and not just keep it to myself. My advice is to get through orientation and learn your unit. Undoubtedly skills you acquire will serve you in future situations. It is not easy to recover from not getting through orientation.