Cardiac nursing is a challenging yet fulfilling profession that requires dedication and commitment to patient care. It’s not unusual to feel overwhelmed by the fast-paced environment and the complexity of cardiac patients’ needs, especially when you’re a newbie. However, with the right mindset and preparation, you can thrive in your duties.
Here are five essential tips to help you navigate your new role as a cardiac nurse:
1. Learn the ABCs of Cardiac Rhythms
Knowing how to recognize and interpret cardiac rhythms, especially deadly rhythms such as ventricular tachycardia (Vtach) and ventricular fibrillation (Vfib), is one of the first steps you can take to ensure safe and effective care for patients with cardiac conditions. Of course, you start by mastering the basics—understanding the electrical conduction system of the heart and how electrical impulses travel through the heart to produce a normal sinus rhythm.
Interpreting cardiac rhythms takes practice, so take advantage of every opportunity to practice. This may include reviewing EKG (electrocardiogram) strips, practicing with a rhythm simulator, or shadowing experienced nurses during code situations. Familiarize yourself with common cardiac rhythms such as sinus bradycardia, sinus tachycardia, atrial fibrillation, atrial flutter, supraventricular tachycardia, Vtach, and Vfib. This will help you to quickly identify when something is wrong.
Each cardiac rhythm has specific criteria that you can use to identify it. For example, Vtach is characterized by a wide QRS complex (a combination of Q, R, and S waves) and a rate greater than 100 beats per minute. Depending on the rhythm, different interventions may be required. For example, if a patient is in Vtach or Vfib, immediate defibrillation may be necessary. Early intervention for Vtach or Vfib can increase the chances of successful defibrillation and improve the patient’s chances of survival.
2. Know How to Read an EKG
Conversations about the role of cardiac nurses—including other emergency nurses—around the use of EKG machines isn’t new. While some argue that it’s not a nurse’s primary duty to interpret EKG, an article in the Journal of Multidisciplinary Healthcare stated that accurate EKG interpretation is a critical skill for ER nurses and EMS professionals.¹ In a study by the Emergency Nurses Association published online by PubMed, 93% of the emergency nurses who participated demonstrated high EKG interpretation competency.²
As a newbie who’s just starting, EKG interpretation is a very useful skill for your profession. From knowing how to prepare a patient for an EKG test, to reading a 12-lead EKG, as well as knowing how to take an EKG, stat! These responsibilities should be a top priority. For ease of duty, it’s important to know the anatomy and physiology of the heart like you know the back of your hand. You should also be able to identify common EKG abnormalities such as irregular heart rhythms, ST segment changes, and T wave changes.
However, not only is the identification of these abnormalities important; reporting them to the healthcare provider or physician immediately is also imperative. They will determine if further intervention or treatment is necessary.
If possible, take an EKG course and become certified for Advanced Cardiovascular Life Support, or ACLS. While this step isn’t mandatory, it’s highly recommended. This is especially because many healthcare facilities may require new nurses to demonstrate proficiency in EKG interpretation before being allowed to work in the cardiac unit. If you can’t lay your hands on formal training, take every opportunity to learn! Attend workshops or case presentations, and seek guidance from experienced colleagues.
3. Know the Different Types of Cardiac Drugs
As a new cardiac nurse, it is important to have a good understanding of the various cardiac drugs that are commonly used in the management of cardiovascular diseases. This knowledge will enable you to provide safe and effective care to your patients, as well as to communicate effectively with other members of the healthcare team. Depending on the floor or unit you are working on, the medications used in your area of practice may vary. Nonetheless, here are some of the key classes of cardiac drugs you should be familiar with:
- Beta-blockers: These drugs work by blocking the effects of adrenaline on the heart, reducing heart rate and blood pressure and are commonly used to treat hypertension, heart failure, and arrhythmias.
- Calcium channel blockers: These drugs work by blocking the influx of calcium ions into the cells of the heart and blood vessels, resulting in decreased heart rate and blood pressure. They are mostly used to treat hypertension, angina, and arrhythmias.
- ACE inhibitors: Used to treat hypertension and heart failure, they work by blocking the action of angiotensin-converting enzymes (ACE), which is involved in the regulation of blood pressure.
- Diuretics: These drugs work by increasing urine output, which can help to reduce fluid buildup in the body and decrease blood pressure. They are commonly used to treat hypertension and heart failure.
- Antiplatelet agents: These drugs work by preventing platelets from sticking together and forming clots, which can help to prevent heart attacks and strokes. They are commonly used in the management of coronary artery disease and other vascular conditions.
- Anticoagulants: These drugs work by inhibiting the clotting factors in the blood, which can help to prevent blood clots from forming. They are commonly used in the management of atrial fibrillation, deep vein thrombosis, and pulmonary embolisms.
These classes of drugs can have potential side effects and interactions with other medications. So when in use, be sure to closely monitor patients for any adverse effects and also educate them about proper medication use and potential side effects.
4. Understand How Diuretics Work
Diuretics are often linked to causing imbalances in electrolytes such as potassium and sodium, which can be dangerous for patients, particularly those with pre-existing cardiac conditions. This makes it an important part of your job as a cardiac nurse. From time to time, you may need to monitor patients closely for signs of electrolyte imbalances. Prioritize having a fundamental knowledge of the types, uses and side effects of diuretics.
One potential side effect of diuretics, particularly loop diuretics like Lasix, is the loss of potassium from the body. This can occur due to the increased excretion of potassium in the urine, which can lead to low potassium levels, or hypokalemia. Low potassium levels can cause a range of symptoms, including muscle weakness, cramps, and arrhythmias. Therefore, it’s important to monitor potassium levels closely in patients receiving diuretic therapy, particularly if they are also taking other medications that can affect potassium levels, such as ACE inhibitors or potassium-sparing diuretics.
5. Develop Effective Communication Skills
Generally speaking, healthcare is a multidisciplinary profession that requires collaboration and active communication. As a cardiac nurse, you can’t bypass your way around this. You need to be able to communicate effectively with patients, families, physicians, and other healthcare professionals.
Learn to listen actively, provide clear and concise information, and collaborate well with teams to achieve optimal patient outcomes. Additionally, when you’re just starting out, make yourself known to team members. Don’t forget to be courteous and friendly. It aids a seamless work environment.
Develop a Positive Mindset
On the days when your job becomes very demanding, maintaining a positive attitude will carry you through. A positive attitude can help you cope with challenges, build resilience, and improve patient outcomes. Learn from your mistakes, stay optimistic, and focus on what you can control.
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- Abdulmajeed Mobrad. “Electrocardiogram Interpretation Competency Among Paramedic Students”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443414/?report=reader. Accessed March 8, 2023.
- PubMed. “Emergency Nurse Competence in Electrocardiographic Interpretation in Spain: A Cross-Sectional Study”. https://pubmed.ncbi.nlm.nih.gov/28673466/. Published November 2017. Accessed March 8, 2023.