By Megan Murdock Krischke, contributor
April 5, 2013 - In the cardiac intensive care unit (CICU), nurses work in a fast-paced environment--managing comprehensive care plans, often for just one or two critically ill patients. The work requires the critical care nurses to have a wide breadth of clinical knowledge to deal with complex cases, plus the ability to deal compassionately with the patients and their loved ones who are often in tense situations and experiencing emotional upheavals.
In an adult CICU, though patients are critically ill when they are admitted, they very often improve and it is not uncommon for patients to make a full recovery. In a pediatric CICU, this isn’t always the case.
Courtney Lazzaro, RN, MSN, who works in the CICU at St. Louis Children's Hospital, enjoys getting to know her patients and their families.
“It takes a special kind of person to be able to work here and handle the kids we see,” remarked Courtney Lazzara, RN, MSN, charge nurse at St. Louis Children’s Hospital. “When people come in to interview we always ask them how they would feel about their patients dying and what healthy ways they have of coping with emotional stress. Working with ‘peds’ patients is also a bit more specialized. Their heart conditions haven’t built up over years, like most adults in a CICU.”
“As in every area of critical care, people with cardiac disease can be extremely ill and fragile,” added Mary Stahl, RN, MSN, ACNS-BC, CCNS-CMC, CCRN, immediate past president and now a clinical practice specialist with the American Association of Critical-Care Nurses (AACN). “That’s why it’s so important for cardiac critical care nurses to keep up with the latest treatment changes. It is the only way we can ensure that a patient remains safe and achieves optimal outcomes.”
“Cardiac critical care nursing is ever-changing because so much research is being done in this area,” she continued. “New tests, procedures and treatments make it a very stimulating clinical area.”
For nurses considering working in the CICU, Stahl suggests reflecting on these questions:
- Do you like change and working with an evolving specialty?
- Do you enjoy collaboration and sharing your knowledge with your colleagues?
- Do you enjoy working with the newest technology--such as ventricular assist devices and extracorporeal membrane oxygenation (ECMO)?
Marcia Kent, MSN, RN, CCRN, CICU nurse manager at UF&Shands, The University of Florida Academic Health Center in Gainesville, added, “If you like to withdraw and think in a quiet setting, or you need predictability and structure, the CICU may not be for you. Advances occur quickly, so we have a saying that ‘Every day is a school day in CICU.’”
Lazzara said that working in a pediatric CICU requires a bit of a thick skin and that a nurse must develop confidence in asking questions of co-workers and advocating for the patient.
“You have to be comfortable not always having the answers a parent is looking for--peds cardiac patients are never textbook cases and the treatment plan isn’t always obvious and you don’t know what the outcome will be,” she explained.
CICU nursing requires quick thinking as patients can experience acute changes, minute-to-minute. Even when a patient is getting ready to move out to the floor, the nurse must be thinking about the whole spectrum of patient care.
“Assessment is the key to everything in cardiac critical care nursing, just like it is in every area of critical care,” remarked Stahl. “You may be assessing your patient very frequently. For example, every 15 minutes or more often right after heart surgery; less frequently as a patient improves.”
“I think the frenetic pace, the rapid integration of information with technology and the emotional toll can be challenges,” stated Kent, “But the CICU is never boring. There have been many technical advances in cardiac care, with new interventions occurring frequently. CICU nurses must be adept at hemodynamic monitoring, ECG interpretation, use of supportive technologies like intra-aortic balloon pumps, ventricular assist devices, pacing, ventilator therapy, titration of powerful infusions and bedside dialysis or CRRT.”
Because it is such a complex specialty, most new grads entering the CICU go through months of training that includes didactic, theory and bedside education.
AACN offers certifications in both critical care (CCRN) and progressive care (PCCN). CICU nurses should also obtain subspecialty certification in cardiac care. They can pursue either a certification in cardiac medicine (CMC) or a certification in cardiac surgery (CSC), or both.
“You can’t be a successful cardiac critical care nurse if you don’t focus on your continuing professional development,” remarked Stahl, adding that membership in AACN helps a nurse become part of a community of exceptional nurses with common interests.
“One of the best parts of working in the CICU is that we see people display every emotion a human can have. We see people at their very worst and at their very best--not everyone gets to experience that. And often we get to play a role in creating the best moment of their lives,” Kent concluded.
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