Wow...the past few weeks have been CRAZY busy. First and foremost, I took my boards on 6/17 and passed...yippee!!!!! 75 questions, 22 select all, 2 put in order, and one diagram. TONS of infection control and prioritization. It was overall not as bad as I had anticipated, but stressful none the less. A few of my classmates have taken theirs in the past 2 weeks as well, and I am happy to report that we have a 100% passing rate so far :-). Good luck to those of you sitting for it in the coming weeks.
Now on to the good stuff!!
The learning curve in the CSU is insane. I never thought that I would learn so much in such a short period of time. Drugs, procedures, drugs, assessments, drugs, charting, drugs, labs, and did I mention drugs :-). I never realized how drug intensive our unit is, nor did I ever realize that drugs and their effects on the body was going to be so complicated. alpha, beta-1, beta-2, inotropic, chronotropic, direct or indirect sympathomimetic...it goes on and on. So many decisions go into the choice of drugs, and the time frame for choosing seems like microseconds...do they need volume...whats the SVR...why is my index low...are they bleeding...yikes!!!!! Glad I am not the one making those decisions (yet).
I have spent my on unit time taking simple vascular cases, stable hearts and thoracotomies (well...with one balloon pumped 2 day post CABG with an EF of 15%, and one 4 hour postop CABGx4, with an aortic and mitral valve replacement and a tricuspid ring thrown in, but I was not the primary on either of those). So, Carotids, Fem-pop's, and thoracotomies have been my jumping off point, and according to my preceptors, I am doing better than many of the ICU/floor nurses that have come into the unit. I am getting comfortable with my assessments, although I find myself constantly questioning what it is that I am hearing. The more I listen to, the more comfortable I get, so in the few quiet moments we have, I try to listen to other patients in the unit so I can get more experience. The charting has come quite easily since we are computerized, and I am the type that tends to err on the side of too much information, so I fit right in with the type A CSU personalities. I really LOVE all of the monitors and lines that we have on our patients because it gives immediate feedback on the drugs you are giving. I guess I tend to be the instant gratification type, so it really makes me giddy when I up my levo, and within a very short period of time, I see my SVR and BP coming up...I'm a nerd I know :-).
I took 2 patients for the first time last night (2 is our max unless there is some crazy emergency), and I have to tell you...I was comfortable with the flow of one patient, and all of my "stuff" was getting done. 2 patients is quite a bit more than 1...especially when you throw in 3 floor codes (we are code team/CAT team, so we go to all codes/CAT calls), 2 CAT calls, and 2 emergency transfers to our unit. I had a fairly stable patient that was going for a pacer this morning (aortic valve replacement knocked out the conduction to his ventricles, so he was being epicardially paced, but was otherwise stable), and an intubated CABGx3 that had his chest opened on the unit a week ago because of a pacer wire pull nicking the RCA and causing profuse bleeding. So, between suctioning, oral care, turning, keeping the sedation running, hanging antibiotics, titrating drips to keep my BP's in range, and helping out with transfers, codes, and CAT calls, my night was CRAZY. To top it off, we started out with 2 nurses, me, and 4 patients in the unit. By the end of the night, we had 6 patients, so it was a good thing I was there.
Now for a little bit on loyalty and commitment to your place of employment. Last night could have been a lot less crazy than it was, but one of our nurses called in. It is a blessing and a curse working where I do...a blessing because we have tons of autonomy, a great team of doctors and nurses, a state of the art facility, and lots of toys :-). It is a curse because it is not easy to staff, and if we have a call in, we can't just "float" a nurse over. There are not a lot of nurses that have the skill set to take care of the population of patients we get, and of the ones that do, many are not trained on our equipment and computer system. Because of this, call ins are a REAL problem for us. My personal feeling on it is that when you sign up on the schedule, you should be there unless you are REALLY sick...I have gone to work feeling a bit off before, and I am sure I will do it many more times. We are VERY luck to have jobs, and even luckier to have jobs at the place and with the team we have. We don't work at Walmart, and can't be replaced by any Tom, Dick, or Harry, so erroneous call outs are not cool (especially when it ends up leaving the new grad with 2 patients to care for while her preceptor is keeping 2 codes alive)!!!! If you want the autonomy, the high acuity patients, and the unit differential...show some loyalty to your unit. If you want the flexibility to call out and not have people put in a bad place because of it, go back and work on the floor where there are 5 people waiting in line to come in and get some extra hours. OK, off soap box now....suffice it to say, when your staff consists of less than 25 people for a 9 bed unit with 1:1 or 1:2 ratios, every person is needed. DON'T call out unless you are dying...your co-workers will really not like you (especially when it is a regular occurrence).
I am working on a "what I have learned in the CVICU" post with drug info, procedure info and other fun stuff, but I wanted to give a short update on how things are going. I am going to try to make more frequent, short posts in the future so things don't get so overwhelming and all over the place :-).
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