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.

The duties are the same as an ICU resident/NP/PA: manage pts, write orders for medications/labs/tests/vent settings, interpret tests, procedures (though this may be limited as the hospital developed a specific procedure team for the OR-ICU to come in and rapidly insert lines), etc.

In my hospital in NYC some of the ORs have been converted into "ICUs", and the providers for these patients now include CRNAs (in addition to the usual anesthesia, surgery, medicine residents). We now have anesthesiologists (non-intensivist ones), surgeons, and CRNAs functioning as "ICU" providers.

Could you describe more, I'm curious about that! I work in a CVICU now and thinking of doing per diem Cath lab next year maybe (though I'm assuming I wouldn't have the "full" experience there as a per diem), so curious to know how it compares to ICU, and the "perks". Thanks

I'm finishing my MSN in management/administration this year, and I'm curious to know if there are any nurse managers/nurse executives that miss being clinicians? I know that leadership/management is the direction I'd like to take my career, but part of me is wondering if I'll miss being a direct care clinician (depending on the day the answer is yes or no, haha). As a nurse leader, do you maintain some sort of clinical practice? Or is there no time for that? I've read previous posters mentioning that sometimes they'll be pulled into staffing or stay after their "shift" to help out, and while I've seen our nurse managers/assistant managers help out here and there, they aren't expected to do that, and will never take a patient assignment (at the hospitals I work at the charge typically will not have patients unless we're short, and we have float pools/per diems, and will ask staff to come in for OT if needed, so leaders don't have to be pulled into the staffing mix as it seems to be the case at other institutions or in the past). So I'm wondering, how do you maintain clinical relevance as a nurse manager/executive? Is this something all leaders end up facing at some point or another? Sometimes I wonder if I should do CNS, but there are limited opportunities for that in my area, and although I like being a clinician, I also lean more towards management/leadership, which is why I'm doing that degree currently. Thanks!

To me, it sounds like the main issue is continuing to work at the bedside when they're short. Hopefully in your new position there isn't that expectation. At my hospital, neither assistant managers nor managers are expected to take patient assignments when the unit is short (and none do whether or not it's expected). We have float pools, per diems, and can call staff in for OT. If all else fails, then the unit is just short (and fortunately it isn't a regular thing at my hospital), and there's just the understanding that we do the best we can. Sure, the ANMs and NMs will help out here and there during their day with ADLs, codes/rapids (and none of that is again expected), any conflicts, etc., but taking an assignment is unheard of. I also like the idea of calling the night staff at 9pm to see what's going on, etc. This is something that our attendings do with the fellows before they go to sleep, I think it would be great for the night charges to have the same interaction with the nurse manager so that potential issues are already discussed.

Try to finish finish the year and your BSN in that year if possible, then transfer to one of the private hospitals in the city. I work at one of the major private hospitals in NYC, and having 10-12 pts in telemetry, let alone any inpatient unit, never happens (same at NYP, NYU, Mount Sinai, Sloane, etc). Max in med-surg at my hospital is 6. And the salary is a lot higher as well than the public hospitals (like 20-30k higher). Good luck!

I'm currently on orientation in a high acuity CVICU (ECMO, LVADs, RVADs, BiVADs, heart/lung transplants, etc). Three books that I find the most helpful are: 1) Fast Facts for the Cardiac Surgery Nurse-very quick and basic read, good for the basics 2) Cardiac Surgery Essentials for Critical Care Nursing-excellent book from the nursing perspective covering everything you really need to get started and get into details as well. This is the book my unit recommends to all new hires, and I strongly recommend it. 3) Manual of Perioperative Care in Adult Cardiac Surgery-another great, detailed book. It's not specific to nursing, however it contains very detailed information that fleshes out what you read in the prior two books. These three books are all you really need to have a didactic background to your orientation recovering fresh hearts. Hope that helps!

Hi, so I'm grateful to be transitioning from a neurology unit to a CVICU soon. I'm pretty nervous, as our CVICU is very high acuity (we do everything-ECMO, VADs, heart and lung transplants, etc.), and it's definitely going to be a lot different from where I've been in neurology stepdown, so I'm wondering if anyone has any tips to help me get started. Thanks!

Thanks for the tips. Yeah the mechanical circulatory support devices sounds pretty fascinating. I really want to work in a setting that is high technology. My hospital is having a CT surgery/ECMO conference soon, so I'm going to attend that to hear a bit about what goes on in the CVICU. That makes sense to me about independence and ACNPs. Interestingly, at my hospital we don't have NPs in the Neuro ICU (there are PAs), while the CVICU has ACNPs (the unit is split in two, with one managed by ACNPs in an "attending" role, though these are the less complicated patients (I believe they're termed "fast track"), while the other has the traditional medical team, though NPs are on those as well). We do have a neurohospitalist NP service, however their patients are on the neurology and neurosurgery stepdown units. Another hospital in my area is pretty progressive, and they have ACNPs doing both cardiac caths (I believe diagnostic for the most part though at least one is trained to do interventions as well) and diagnostic cerebral angiograms (NPs also assist on interventions). They also have NPs in the Neuro ICU. So there are many NP opportunities in both fields in my area now that I think about it. I'm going to shadow in both units soon and find out about potential opportunities in the near future, as well as attend the CT/ECMO conference.

Thanks for the reply! Cardiac has always been my interest, however I've come to love neuro as well. I think I've found a middle ground between the two by my interest in stroke (I do research related to stroke and I'm planning on getting stroke certified (SCRN) by the end of the year). At the same time, I'm very interested in heart/lung transplants, and working in a high technology/device area, and CTICU seems to fit the bill. Another option I've recently thought of is applying to transfer to CTICU then I could always do per diem at another hospital on a neuro unit.