I Get My Ass Kicked by Babies | RN Life in the Pediatric CVICU
Written by Stacy Stravitz - BSN, RN, CCRN, DNP 21’
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Want to know what the CVICU is like?
I get my ass kicked by babies.
That's what the pediatric CVICU is like.
The line from Hamilton, "We are out-gunned, out-manned, out-numbered out-planned," has run through my mind on super crazy days. Usually, I'm "out-gunned" by a baby no more than a few weeks old and no bigger than 5 kg.
By the end of this post, you will have a great sense of if the CVICU sounds like the kind of nursing that is right for you. Much of this could apply to ICU nursing in general, but the CVICU is a place all its own.
FYI - Colorful language warms my heart, but you got that from the title. 🤩
If you don't know much about the world of congenital heart defects, that's a topic for another post. What should be a straightforward plumbing system keeping you alive can get jacked up in a surprising number of ways:
Pipes connected to the wrong stuff
Only half the pump formed
Valves are too tight, or too leaky
The whole thing is dysfunctional…
These tiny pipes need to get switched back, we make a half-pump work double-duty, surgeons carefully repair valves' fragile butterfly-wing tissue. The smallest problem can bring the whole system down in seconds.
The technology, medicine, and surgical repairs for these tiny hearts are mind-blowingly cool. 😲 We bust out the oscillator on occasion, there’s ECMO on the unit more often than not, and we use assist devices like the Berlin Heart, Heartmate, and on occasion the Total Artificial Heart.
Mind-blowing, complicated, and touchy.
So what does that mean for me, the bedside nurse?
From the moment report starts, I am hyper-aware of the monitors, machines, orders, results, and small changes in my patient.
I am not exaggerating when I say hyper-aware. If you vibe with a slower-pace - which is great - this may not be for you.
I'm kicking my situational awareness into high gear. It's like diagnosing the problem and fixing the plane while flying it. I absorb all the information from monitors and medication pumps, and ventilators and try to keep the "plane" in the air.
CIVCU nurses will shame the crap out of you if you let something alarm for more than 5 seconds. And you wanna know why? Because that alarm could be nothing, or it could be that your patient disconnected the vent, the epi drip ran out, or that patient is desatting to the 20s, and if you don't get your ass in there, you'll be hitting the code button instead.
I've gotten good at recognizing the very beginnings of trouble and doing all the things before the patient starts to go down.
Photo courtesy of Phoenix Children’s Hospital @phxchildrens on IG
Anticipate the badness. That’s what I was taught coming to the CVICU.
Being ready for everything before it goes down has helped me save a baby's life more than once.
That's also why you will meet some of the most OCD nurses of your life in the CVICU. If I know exactly where my flushes are, if I know all the crazy details of my patient's history, and if the lines on the baby blanket are horizontal and not vertical (kidding), then, in a critical moment, I can do what I have to do as fast as freaking possible.
I know a lot of nerdy stuff about pediatric congenital heart defects. I care about a tiny bump in my patient's creatinine. It matters if my single ventricle now has Sats in the 90s when we used to be in the 80s. We discuss all the details about what is going on in rounds. Where I work, nurses present in rounds. That may make some of you wanna cry or vomit, but I'll tell you it made me a better nurse. I say the things I know about the patient and participate in discussions about what we should change. As the person who has to deal with those changes for the rest of my shift, I've come to enjoy knowing the details about why we do what we do. Being a CVICU nurse means I Get To understand the medical plan better than I ever did before and be a part of shaping it.
My patient is someone's child! As a mother of three kids, that sits heavy. Nurses, you feel me. We're not making lattes at work (and thank God for lattes); we are keeping people alive the best we can. I don't know what it feels like in adult land, but it is some scary shit to watch tiny humans go down. My heart still drops EVERY TIME the code alarm goes off. I do actually run towards the room. Because I'll be damned if I didn't do every single thing I could for someone else's kid.
So yeah, working in the pediatric CVICU is all of the unicorns and rainbows you assumed it is. More seriously, I know the reputation we CV nurses have, and I'll say most of us resemble it. It's for a reason y'all. This place is not for everyone, but I love it.
If that sounds like your kind of nursing, keep up with the EARN blog for more. They have a vision to precisely match RNs and NPs with the positions and organizations that fit your skills and personality. The right fit means everything.
👩⚕️Hi I'm Stacy; as an experienced BSN, RN, CCRN in AZ, I'm excited to be a part of building a better way for RNs and NPs to be precisely matched with nursing positions that really fit them. I’m fueled by oat milk lattes, telling people I do CrossFit, and whisky 🥃 neat.