I worked on a cardiac care/icu stepdown with VADs, transplants, complex heart failure patients, and post opens, as well as DKA, hyperkalemia, and just about any type of overflow you can imagine, including trauma.
1) I loved it because I felt I got excellent experience for a transition to critical care. I liked the diversity of patients but especially enjoy cardiac, particularly mechanical heart and transplant. I liked the opportunity to put together all the pieces of pathophys as well.
2) very stressful, yes. A huge need to critically think and not repeat the same mistakes multiple times. We provided primary nursing care with no aides, and our ratios reflected that, 1:3 and an absolute max of 4 at night. We also used an acuity tool that helped with assignments; for example, you wouldn't have 3 insulin drips. We also worked 8s which meant you needed to perfect time management on an unpredictable patient population in order to get your charting done and get out on time, all while maintaining a high standard of care. Lots of codes; we were also code team nurses for the hospital, responding to anything but ICU codes or partial trauma activations.
3) great team, particularly at night. Part of this was that we had strong leadership who served as excellent resources for the many new nurses on the floor, preceptors who liked to precept, and a nurse manager who set a tone of professionalism and civility. Many opportunities to expand skills and continue education.
4) I used a cardiac nursing text as a reference because we had a large focus on cardiac, but most importantly, know how to quickly and reliably access your facility's resources: policies/procedures, Med references, Mosby's or whatever for info on best practices.
You don't need to have all the answers, but you should be willing (and able) to use your resources effectively and not be afraid to troubleshoot situations. One thing that helped was that our ANMs for each shift served as the charge nurses, and they were a wealth of knowledge and outstanding clinical resources. However, you need to be able to locate information on your own as well. We had a free charge, helper RN, and the hospital overall had admission nurses 24/7 from the float pool.
Do: admit what you don't know. Do: be willing and adopt a posture of open-minded learning. Do be tough and thick skinned - willing to take feedback. Don't assume, don't act on partial knowledge. Do put safety first -- and definitely do use your chain of command and resources, including your house supe, if needed. Be comfortable using SBAR (particularly if working at night) so that you can clearly and concisely communicate with your sleepy and sometimes grumpy providers. Do take the time to make notes on provider preferences or important idiosyncrasies.
Advocate for your own learning and knowledge - be a self starter who doesn't wait to be "spoon fed" information. Always review unknown meds and commit your frequent drips/high alert meds to memory.
Wow! Thank you so much! That was all the news I really wanted to hear, and more, to give me confidence and a great start regardless of what really happens on the floor. I am committed and very sure I will do great. They must have seen something great in me, now I just have to trust that I can do this. Thanks again
martymoose, BSN, RN
1,946 Posts
Congrats!!!