I am officially a GN

Hmmmm....where to start.....no time like the present I guess. Today is the first day of the rest of my life. Well, really it is the first day of my life as a nurse. May 3rd 2009 was the day of our pinning ceremony, and I, along with 100 or so of my closest friends, was inducted into the world of nursing with a ceremony that was as rich in tradition as a presidential inauguration, and with all of the fanfair of a superbowl game (airhorns and bodypaint included). All in all it was a very nice ceremony, and we all walked away with roses, hats, lamps, pins and pens, and a rosy outlook on the lives and careers stretching out in our future. I immediately ditched the white uniform, and safely tucked my nursing cap, school pin, and nightingale lamp away so that 20 years from now I can pull them out and reminisce of this special day. I am now a graduate nurse....one measly test away from my RN, and hopefully a long and happy career (notice the positive outlook that I still embody).

Oh yeah...speaking of tests...the NCLEX is looming large in our heads, and first thing this morning my classmates and I attended the orientation for our NCLEX review course. Taking a 180 question practice test was NOT my ideal way of spending the first day after "finishing" school, but it was either now or 2 months from now, and I would much rather get it done and focus on my new career. I now have the rest of the week "off", and we start back with the rest of the review course next Monday. I am planning out my time for the rest of the week, trying to see how many things I can get checked off my todo list while still fitting in some fun time with friends. I have 3 very short weeks before my new career starts with a full time vengeance, and I really want make the best of my last days of freedom.

Now that you know a bit of background, we can get on to the real purpose of this blog...the CSU (insert dramatic piano chords). I have been lucky enough to procure a job as a graduate nurse (the very first I have been told) in a 9 bed cardiovascular surgical intensive care unit. Many of you may know this as the CVICU, others as the CSU, and even occasionally as the CSICU...basically it is the place where any cardiac, thoracic, or vascular surgery patient goes after they are out of the OR. We call ourselves the CSU, but the sign outside the door says that we are the "Cardiovascular Surgical Critical Care Unit"...I guess CSCCU was just too much of a mouthful so they shortened it to CSU. We are located inside a dedicated heart institute and research center, but our building is attached to a regional hospital. Our patients are typically post-op CABG or valve replacement patients, but we also get AAA's, CEA's, Fem-pop's, Thoracotomy's, and unstable CV surgical candidates (Caths gone bad, pacers, cardiac alerts, etc.). We are lucky to have a sister CCU that takes the cardiac medical patients and an interventional unit that takes stable post caths/pacers. We get to see lots of "stuff" on our unit...Swan's, IABP's, VAD's, CRRT, etc. I have been told that it is a golden opportunity for learning, but that I will need to be on my game all the time and do lots of reading and learning on my own time. I don't know if the person that told me that was blowing smoke up my you know what or not, but I get the point...I was given an opportunity that many would kill for (especially in this job market), and I better grab it and hang on with both hands. I will say that the only reason I was even considered for the job was that I have been a tech on this unit for almost a year. I went in and wow'd the staff with my amazing cart stocking, blood sugar checking, and poop cleaning skills, and when the time came they decided that I was a valuable team member (that made me blush), and they wanted to keep me around.

Now let me take a minute to talk about my thoughts on making the all important first job choice. This could be long and drawn out, so if you already have a job, or just plain don't care, skip this paragraph). I have heard many people say that they learned more in their first year of nursing than they did the entire time they were in school. This learning is extremely important because it is literally the foundation that you will use to build your career on. It is a proven fact that what you learn first you learn best, so you might as well put some serious time and effort into the choice of who and what are going to shape your career. I looked at 3 different options for my first job, and made my choice based on what I felt was best for me and my learning. The categories I used to "rate" my options were (in descending order of importance) length of orientation, orientation type, availability of a critical care class (all of my options were critical care based, but this might not apply to you), education opportunities, culture of the unit, location of hospital and lastly pay. Length of orientation for obvious reasons was at the top of my list. My current unit offered me a minimum of 6-9 months with an extension of up to an extra 6 months if I felt I needed it. The other 2 hospitals both had 4-7 month orientations. Orientation type was second on my list. My unit offered me a spot in the hospital graduate nurse program and the critical care course with concurrent one on one preceptorship. One of the other hospitals offered the same arrangement, and their critical care class is said to be the best in the region, but it was not enough to sway my decision. The third hospital had a rotational preceptorship where you were placed with different nurses on a weekly basis. While this might work well for some people, it was not a good fit for me. The critical care class offering was my third category, and while all 3 hospitals offered it, only my first 2 choices integrated it into unit orientation. The third hospital provided it at a cost on your own time. Education opportunities should speak for themselves, and on my list, all 3 hospitals were fairly even. Unit culture was a biggie, and was IMO what ultimately swayed my decision. As a brand new nurse, it is hard enough to get accustomed to your new job roles, so when you thrown in a new hospital with new policies, procedures, and computer systems, it just gets insane. Mix a group of type A personalities, an enclosed space, 9 unstable patients, and a clumsy newbie that can't even find tape in the pyxis...bake for 12 hours in a 370 degree oven, and you have a recipe for disaster. I have noticed that nurses in CSU's tend to be super anal type A with no room for error. Some call them catty, some call them B*&%$'s, and others call them cardiac queens...I can see all of the above, but I can also see that they have the patients best interest at heart, and you would act that way too if you had to answer to the surgeons. Anyways...I got off topic...unit culture...my unit is a very tight nit group of people that works well as a team. When I say team I truly mean team. Many of our nurses have been working together for upwards of ten years, and it shows when the rubber hits the road. Our group knows what the others need almost before it is said. All of the nurses jump in when needed, and there is always someone with a helping hand, listening ear, or even shoulder to cry on. I have worked myself into that culture over the past year, and I can wholeheartedly say that I know for a fact that I will not be eaten alive. I can see where unit nurses get a bad wrap, and I would be scared to start out as a brand new nurse on a brand new unit. These types of nurses don't blindly trust...you have to prove yourself as trustable and that takes time. Patients lives are truly at stake every minute, and that is a lot of responsibility. If CSU nursing is your dream ( or any critical care type nursing for that matter), I urge you to get a job in one of these units as a tech. Work yourself into the culture and give the nurses the opportunity to learn to trust you before they are expected to trust you with a life and death situation. My nurses are the best, and I have 100% confidence that they will do whatever it takes to mold me into the best CSU nurse I can be, and ultimately that is why I made the decision to stay where I am at. Location and pay are pretty self explanatory. Driving an hour or more to work would be no fun, especially with the added stress being a new nurse brings, so please take that into account. Pay is pay...1.00 here, 1.00 there...don't throw away a great work environment with tons of orientation and awesome education opportunities for $0.80 more an hour...trust me it won't be worth it in the end.

I feel like I have written a small novel, and i don't want to bore everyone before we get to the good stuff, so I will stop now. I will try and do some NCLEX review updates next week, and will start full force on May 26th with my first day. In the meantime, a great nurse and awesome friend recommended the following books for me to look over in my "free" time:

Kathy Whites Fast facts for Adult Critical Care
Thelans Critical Care nursing
Marino's The ICU Book
Bojar's Manual of Perioperative care in adult cardiac surgery

Those should keep me in reading materials for the next 2 years or so.

I am truly looking forward to the journey ahead of me. I am excited, anxious, elated, and scared to death all in one. It is a crazy feeling, but I guess I should enjoy it while I can.