*Original post released on 11/2/2020
In light of my acceptance of a new position at a level II cardiovascular intensive care unit (CVICU), I thought I would gather all the tips and advice possible for anyone looking to start in or switch to the cardiac nursing specialty. This article will discuss some of the best advice I’ve been given for CVICU hopefuls as well as some of the resources it might be helpful to have on hand. Without further ado, let’s get started!
Whenever you start any new nursing position, ESPECIALLY in a specialty unit, understand that you are expected to be on a learning curve! You can’t come onto a new unit 100% prepared as a new grad or experienced nurse transferring to that specialty area. Just remember that you know how to be a nurse. You’ve done the training or even put in the years to gain entry level experience as a nurse; just because you enter a specialty area of nursing, this doesn’t mean you don’t know how to be a nurse. The CVICU is simply another skill set you’re adding to your nursing repertoire. Don’t be cocky though. A dangerous nurse is the one who thinks they know how to handle anything and everything that comes their way. Fear is beneficial to an extent, but don’t let it paralyze you or hold you back!
With this in mind, be prepared to learn on the job. Bring a notebook to jot down information, tips and tricks of the trade, surgeon/provider preferences, etc. If you get an orientation period, make sure to take FULL advantage of that time afforded to you! A good preceptor is an invaluable resource, however you can still learn so much from an inadequate preceptor as well. Take advantage of any and all trainings offered to you that might enhance your understanding of this unique population of patients, their circumstances, and various treatment modalities.
Approaching a specialty area of nursing may seem overwhelming at first and even for the first few months. Take each day, one at a time, to avoid over thinking and to help manage feelings of being overcome by the vast amount of information required of you to know. Show up ready to learn. Trust me when I say that your coworkers and supervisors will see and appreciate your eagerness. Find a good mentor early on to help guide you and cultivate your nursing knowledge base.
Now that we’ve discussed some of the general tips and advice, let’s move on to some of the more specific clinical-related tidbits passed down from those same cardiac nurses! As you get a new case that you’re unfamiliar with, read up on their history and the pathophysiology behind their specific disease. Then take the time to develop an understanding behind the selection of their treatments. Many nurses expressed that patients with the same diagnosis would receive various treatment modalities. If you’re unsure of why your patient is receiving one therapy (Ex: ECMO, IABP, impella, LVAD, RVAD) over another, ask the physician if they can discuss the case with you. The more you know about your patient, the treatments they’re receiving, and why certain choices are made, the better you can care for them and improve their overall outcome. Along with this concept, always make sure to ask questions whenever you’re in doubt! DO NOT make assumptions or guess.
Before you show up to the unit, take time to review, practice, and get good at ECG interpretation. This is a necessary skill that CVICU nurses need to be strong at when taking care of cardiac patients, especially those with recent surgery. Know how and why ACLS protocols change with open heart surgery patients. Learn, review, and understand basic hemodynamic monitoring and baseline values obtained with invasive and non-invasive devices. Potentially more important, ask and know your surgeon/physician preferences for these values and how to treat the abnormals. Each provider may take their own approach in treating the same set of data for a patient, so this is crucial information to be mindful of.
For any CVICU patient, or really any ICU patient in general, stay on top of laboratory and hemodynamic results so the patient gets exactly what they need and nothing additional. For example, in medical ICU patients, it is important to understand that after initial fluid resuscitation in septic patients, they do not continue to receive additional fluids for hypotension…a vasopressor is instead initiated. The same is true of cardiac patients, they may need fluids, vasopressors, albumin, electrolyte replacements, inotropes, etc. It is your job to be aware of and interpret all incoming data from the patient so complications can be avoided.
Your patient may have multiple devices, lines, and medications in place, so it is your job to be a guard to their room. Stop anyone who is about to enter the patient’s room and question who they are, why they’re there, and what changes (if any) have been or will be made to the client’s plan of care or current settings. Make sure you’re checking all of their monitor, IV, and machine settings frequently! Hourly (or more frequent) vitals/intake and output (I&Os) and daily weights are like gold to providers and are incredibly useful data used for dosing of many medications and guidance for plan of care decisions.
As for helpful resources to have handy, multiple were mentioned. For general ICU information, Marino’s ICU Book and Kathy White’s Fast Facts for Critical Care are a great starting point. There is a digital PDF version of Marino’s for those that don’t want to lug around a 1,000+ page guidebook! Other useful resources include the Manual of Perioperative Care in Adult Cardiac Surgery and Cardiac Surgery Essentials for Critical Care Nursing. These are all easily found online on Amazon and sometimes available on thriftbooks!
Other invaluable resources to have in your clinical repertoire include: West’s Respiratory Physiology, Cardiovascular Physiology Concepts, and the Field Guide to Congenital Heart Disease and Repair. There is also a phone application called “Heartpedia” which is useful for understanding cardiovascular congenital defects, especially in the pediatric population. If you’re wondering how to prepare for a CVICU position in advance or for applying/interviewing for such a position, consider utilizing the cardiovascular sections of various CCRN review resources. I previously posted an article about CCRN preparation and resources which I found helpful (or not so helpful). Be sure to check it out here if you’re interested in trying to prepare ahead of time.
I want to thank all of the nursing professionals who took a moment from their daily responsibilities to provide any advice to nurses and hopefuls like me with a desire to pursue cardiac nursing! I am such a firm believer in the fact that nurses need to foster and encourage the growth and development of each other. This whole “nurses eat their young” business has got to come to an end! It’s my sincere hope that this article reaches multiple students and nurses and helps shed light on the possibilities and sources of support that are out there. The nursing profession has endless opportunities, and it’s time we stop hesitating and embrace them wholeheartedly.