CVVH

Thank you all for the thoughts/experiences! Yes I guess I will see if it's really for me once I step into the role. I have also known a few people that were in management for some time then became clinical RNs again or finished NP school and now practice as NPs. Also, fortunately at my hospital system there's absolutely no expectation for managers/assistant managers to work the floor when short (plus do manager work at the same time). I know that at another hospital in my city where I had interviewed for an assistant manager position, they did mention that once in awhile if short, the assistant manager might have to serve as charge nurse, but I don't think it's common in my area for management to work the floor ever. I have seen them help out with various clinical tasks though, but never take a patient assignment. Thanks again!

Hi, so I will be starting an assistant nurse manager position at the end of the Summer, and as it gets closer to the time, I'm reflecting one the fact that I won't be a clinical nurse anymore. I'm wondering how other current RNs in leadership/management positions felt when they first transitioned, and how they feel now in regards to not being a clinician. This will be my first management role, so I know I have a lot to learn as I begin. From prior experience with my own managers, I do know that some participate in clinical care in various ways (I've had nurse managers help place IVs, round with the team and/or charge nurse, handle the code cart during emergencies, help with ADLs, etc.), so I'm curious what others think/have experienced in their own careers. I'm also pondering picking up a per diem position once I settle into the new job and routine, and wondering if I would do a per diem CVICU RN job (my current role, though I'm going into CV stepdown as an assistant manager with a future goal of being a nurse manager of a CVICU hopefully) or a per diem supervisor job. Thanks for any thoughts!

Sounds like you should look into Clinical Nurse Specialist roles. Depending on your area, you'll find that there are either a lot of opportunities for CNS, or not that many. You'd also have to complete a CNS program. But the role of the CNS aligns with your interests (and, depending on the state, can also include practice as a provider, as some states give prescriptive privileges to CNS). Perhaps being a nurse educator would also be of interest to you. And yes, as already said, perhaps a PhD in nursing would be of interest. Many academic medical centers have roles for nurse scientists. My hospital has a number of nurse scientists that have joint appointments with our affiliated nursing school and the hospital, which is pretty cool. Also, perhaps consider the feasibility of finishing your current program. It could open doors to positions/roles beyond being a provider. I know many with NP degrees that are in management/leadership, education, etc. roles.

I'm wondering, I often see mention of FNPs/primary care NPs and PMHNPs starting businesses, side-hustles, clinics, etc. I'm wondering, what are the business opportunities available to ACNPs? Do you think that it would be more challenging to have similar business opportunities to primary care NPs/PMHNPs since specialty practice (whether inpatient or outpatient) typically involves physician care as well, by virtue of the level of care needed?

I'm curious, what does your new role involve? And why the switch from CCM to Cardiology after so many years?

Is anyone here an APRN and also in management/administration? I recently completed an MSN in management, but have been going back and forth with whether I should do my DNP in executive leadership in the future or a DNP in acute care. I'm wondering if anyone can talk about what an APRN/Advanced Practice Provider manager role would entail (and not necessarily limited to Chief/Lead APP/NP roles). I'm also wondering, does becoming an APRN open more/different leadership/management roles and opportunities than being an RN? I'm considering applying to assistant nurse manager positions next year (currently I'm a CVICU clinical RN with charge, preceptor, hospital-wide and unit-based committee chair and co-chair, etc. experience), and I definitely do want to pursue administration/leadership in the future as my ultimate goal, however I'm also interested in learning and practicing more as an APRN, and wondering if pursuing that would open other leadership opportunities beyond what would be available as an RN leader. For those more experienced/knowledgeable in this area, I'd love to hear more!

I recently passed the CSC with 66/75. I studied for maybe a week (I work in a CVICU, and passed the CCRN a month before). I thought the CSC was harder than the CCRN. I used the Ace the CSC book and did the AACN practice questions. I had started to go through the Cardiac Surgery Essentials for Critical Care Nursing book, but wasn't really in a mood to read all of that, so stopped. The Ace the CSC book has the basic content review you need plus questions.

I passed last week (also with a little over a year of CVICU experience), and used the Barron's book, Pass CCRN question bank (I did about half of the questions, around 500 or so), the Ace the CCRN Study Guide (it's a short book, I'd read that at work during downtime), the Ace the CCRN practice question book, and the online practice question bank from AACN (probably did around 200 or so of those questions). I'd say at least do the Barron's book for content and the Pass CCRN question bank and you'll be fine. I got 113/125. Good luck!

"University Hospital" is now Westchester Medical Center in Valhalla, affiliated with New York Medical College. But yes, for the large academic center and NYP, it's either NYP/Columbia or NYP/Weill Cornell, both in Manhattan. The other campuses are all much smaller.

Just to followup with my earlier post: we're also running out of CRRT machines and dialysate. I work in two major academic NYC hospitals, and both have this shortage (see here for more info: New Covid-19 crisis hits ICUs as more patients need dialysis). I even witnessed an argument over whether a patient that was DNR should be put on CRRT because the hospital had a critical shortage, only one machine left, etc. Last night, a nurse had a very sick patient that was circling the drain, on multiple drips, CRRT, periodically maxing pressors, on 100% fio2 on the vent and desatting to the 60s, etc...plus another patient. Normally this would be a 1:1 assignment. Hoping things get better soon.

Yes, I work at a major hospital in NYC. We exceeded our normal ICU capacity (and this includes 5 ICUs, three of which have two units each for a total of 8 ICUs) and had to open up new ICU beds in other locations, such as the Cath lab and ORs. Stepdown units also had a number of their beds turned into ICU beds. We also made single ICU rooms into doubles in two of the ICUs. ICU nurses care for anywhere from 2-4 COVID pts, sometimes with a helper RN (a stepdown/medsurg nurse), sometimes not. When a patient dies, once the bed is clean another ICU patient rolls in. There's at least 2 overhead pages every shift for a rapid/anesthesia. PACU, cath lab, etc nurses are now functioning as ICU nurses. It's really happening.

We are doing something similar (team nursing with an ICU nurse and a floor/stepdown nurse caring for 3-4 pts), however in addition to dividing tasks appropriately based on role/skill level, we also divide the documentation (and we aren't required to document as much as we normally would due to the crisis).

Yes, in my NYC hospital CRNAs are staffing our surge OR-ICUs. They function in the same manner as an ICU resident/NP/PA (and are interchangeable with them as they all are part of the OR-ICU provider team).

Yes, non-ICU providers in areas that have low volume are also displaced to help manage covid patients in ICUs and elsewhere. Many of the ORs are now ICUs, and the providers there include CRNAs who function as the ICU residents/NPs/PAs would. Surgeons and other non-ICU physicians are now functioning as ICU attendings/"fellows" as well. All receive a crash course in ICU knowledge relevant to their roles.

In my NYC hospital PACU/OR/EP/IR nurses are being asked to function as ICU nurses (with guidance from the actual ICU nurses). Many/most of the EP/IR/PACU nurses haven't been ICU nurses in years, and most of the OR nurses have never been ICU nurses, so there's a lot of crash training/guidance from ICU nurses going on as they are being asked to function in this capacity due to lack of cases. If the patient is too critical or the non-ICU nurse is not comfortable, they'll have them function as helpers. They're also doing this with stepdown/floor nurses, where an ICU nurse/stepdown or floor nurse dyad will have 3-4 ICU pts and the floor nurse will be the helper and do tasks within their scope.