TRAVEL NURSING IN THE PEDIATRIC CVICU

I have been a Pediatric CVICU Traveling nurse for 1 year. I started travel nursing in the CVICU after I completed 2 years in my specialty as a staff nurse. Most agencies require that you have 1-2 years of experience before they can contract you with a hospital. This is because as a traveling nurse you are expected to be an expert in your niche. Usually, the more specialized the unit, the more years of staff experience they prefer.

CVICU stands for Cardiovascular Intensive Care Unit. Most of the patients we see and take care of have congenital heart diseases requiring surgical intervention. These patients are extremely sick. Some children come back from the operating room with their chests open for easy emergent access. These patients are on multiple drips that are titrated by the nurses to perfection. Their labs and arterial blood gasses are constantly assessed so we can meet their body’s needs. The patients have lines coming out of every crevice that are all managed by the nurse.

Here is what you can expect a typical CVICU patient to have:

  1. Endotracheal tube- a machine breathing for the patient. This is managed by the nurse and Respiratory Therapist.
  2. Arterial line- measuring constant blood pressures and serves as easy blood access for labs and arterial blood gasses.
  3. Central Venous Catheter (CVC)- a medication line that goes into the heart delivering medications to the patient.
  4. Intracardiac Pressure Line- a medication line that is used to measure pressures within a heart chamber. Some patients have multiple.
  5. Drip medications- these include medications like inotropes, sedation, paralytics, and diuretics that are titrated to meet the patient’s needs.
  6. Rectal Temperature tube- constantly measuring patient’s temperature
  7. Chest tubes- removing excess fluids or air from the lungs
  8. Neers- monitoring forehead and renal temperatures and oxygen flow
  9. Foley catheter- drains urine from the patient’s bladder
  10. Other IV access- this can be in the form of a PICC line or even a Peripheral IV. All the kids have emergency IV access elsewhere

I hope you are starting to see just how sick these patients are. This isn’t even a conclusive list of all the things a patient could have attached to them, however the most frequently seen combination in a semi-stable post-operative case. Some patients have ECMO cannulas, a CVVH catheter for dialysis, or a Ventricular Assist Device (VAD) helping their heart beat. All these devices require training by the specific facility, so it is uncommon to get patients with these devices on a short 3-month travel contract.

A typical Pediatric CVICU assignment depends upon what state you are working in. In California, the patient-nurse ratio for an intubated patient is 1:1. However, in New York, it is 2:1. As mentioned before, traveling nurses typically do not take the advanced medical devices because of the required hospital trainings. Because of this, we tend to get the deescalating patients. A deescalating patient is one that is being weened off or having devices removed (the items I had mentioned in the list above). These patients are ready to soon be transitioned out of the ICU so they no longer require all their lines and measuring devices. These patients are very tasky and busy…and we are usually given 2 of them. They require a lot of forward thinking to not become overwhelmed. For instance, a patient being extubated will have all of their sedation turned off abruptly. Ensuring we have rescue dose medications ordered before extubation can create an easier shift. This is why experience is pivotal to travel nursing success in an ICU setting.

As a pediatric CVICU nurse I have been floated to the PICU, NICU, and Neuro ICU. I felt more than prepared in these settings with my training as a Pediatric CVICU nurse. If you are interested in traveling, EXPECT to get floated and EXPECT the taskier assignments. Doing so will make your transition into traveling so much easier.

Here is the moral of the story as a traveling nurse: go into your shift expecting a tough and busy assignment. After all, traveling nurses are there to fill the gaps. We make sometimes double what staff nurses make so in my opinion we should be the first floated! Expect the taskier, busier, and less than ideal assignments and you will crush it as a Pediatric CVICU traveling nurse.

Learn more about travel nursing and different specialties at https://www.thegypsynurse.com/.

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