A Day in the Life of a Cardiac ICU Nurse
Cardiac ICU: A Day in the Life
Are you a detail-oriented person intrigued by the heart, lungs, and vascular system? You might have a calling to become a cardiac ICU nurse.
Cardiac ICU nurses are highly skilled nurses trained to manage complex cardiovascular health problems. Although community hospitals may have a cardiac ICU, the sickest of the sick are often cared for in large, academic medical centers. These cardiac ICUs often care for heart and lung transplant patients in addition to those on extracorporeal membrane oxygenation (ECMO).
Fun Fact: ECMO got a lot of attention during the height of the Covid-19 pandemic
Other conditions and devices commonly managed in the cardiac ICU include:
Post-operative coronary artery bypass graft (CABG)
Congenital heart conditions
Myocardial Infarctions (heart attacks)
Continuous Renal Replacement Therapy (CRRT)
Heart Failure
Ventricular Assist Devices (RVAD or LVAD)
Intra-Aortic Balloon Pump (IABP)
Valve replacements
Impella
Targeted temperature management
Thrombolytic therapy
Start of the Shift
At the start of your shift, you take a report from the off-going nurse. ICU nurse-to-patient ratios are typically 1:1 or 1:2, depending on patient acuity. A standard reporting structure used by many nurses is the SBAR tool. SBAR stands for situation, background, assessment, and recommendation. In short, nurses need a concise framework to gather the most current information necessary to care for their patients. Bedside report is the current best practice. Not only does it allow for both nurses to lay eyes on their patients, but it also provides an opportunity for the patient to ask questions. Bedside report also allows time for the patient to be repositioned (since it often takes two people) and for the oncoming nurse to assess key details to ensure a smooth start to the shift.
Some examples of details passed on during report may include:
Name, date of birth, code status
Reason for admission and date of admission
Allergies
Pertinent labs, medications, procedures, diagnostics
IV type, location, patency
Behavioral patterns of patient or family
Precautions (seizure, fall, etc.)
Assessment findings
Mobility, ADLs
Pain management, when the last medication dose was given
Necessary details for the oncoming nurse to assess at the bedside during report:
Are your IV bags empty?
When does the tubing need to be changed?
Is your patient soiled, or do they need to be repositioned?
Check for critical labs in case something pressing is needed
Assess your patient’s IV sites
Rounds and Assessments
Once you feel confident in the report, you must note your patients' medications due and collect all supplies. Nurses often prioritize their patients based on acuity. If one of the patients is more unstable, the nurse would most likely see that patient first. Clustering care is best practice, so incorporate physical assessment and medication administration in the same rotations.
Most facilities expect nurses to round on their patients at least every 1-2 hours, or more frequently if needed. Each round involves a physical assessment, pain assessment, repositioning, checking elimination status, calculating intake and output (I’s & O’s), and administering medication if needed. If your patient needs a bath, nurses in the ICU will often take on this task with the help of a fellow teammate. By participating in baths, nurses are provided with the opportunity to perform a thorough skin assessment and the option to perform any necessary wound care.
Nurses are expected to document every assessment, every intervention, every patient response, every medication administered, all intake and output, and everything in between. Just as often as nurses round on their patients, they are also required to document. You know the saying- If it isn’t documented, it wasn’t done.
In addition to rounding and documenting on their patients all day, nurses must assess and reassess specific items. In an ICU setting, it is not uncommon for patients to require frequent labs. Nurses will draw them, monitor and trend results, and alert the provider to any critical findings. Patients in the ICU have the potential to decline rapidly, so the nurse is always on top of their critical thinking game. A combination of factors such as assessment findings, vitals, lab results, etc., provide clues to the nursing staff about potential deterioration scenarios. Nurses tend to stay on their toes in anticipation of what may happen next.
End of Shift
As you near the end of your shift, it's also best to do one more final round on each patient. It is always a courtesy to set your fellow nurses up for success during this time. As you enter each patient room, take note of IV fluids and medicated drips to ensure they are at least half full. If they are almost empty, take this time to hang new bags (it's not fun to start a shift with empty bags). If IV tubing is expired, you should reprime and label new tubing. This would also be a great time to reassess your patient's pain level and determine the need for any medication.
Still not sure if the cardiac ICU is for you? Be sure to visit EARN to schedule an evaluation today to see what is the best fit for you!
References:
SBAR Tool: Situation-Background-Assessment-Recommendation
The Swan-Ganz Catheters: Past, Present, and Future
About the Author:
Krystle Maynard is the creator of Innovative RN Solutions and has been a nurse for over a decade. She has specialized in medical-surgical and critical care nursing, in addition to having a long-standing history of being an adjunct faculty member for a college of nursing. Innovative RN Solutions focuses on healthcare content writing (such as blogs, E-books, emails, academic coursework, and educational content for healthcare personnel and patients). Krystle also offers tutoring and mentor services for undergraduate and graduate nurses. She lives in Kentucky with her husband and children. If you would like to connect, you can reach her on Linked In or visit her website at Innovative RN Solutions.
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