Cardiac Nurse – A Typical Day

If you’re thinking about working on a cardiac unit as a cardiac nurse, let’s go through a typical day!

This example will be an inpatient cardiac nursing floor (not an ICU) on the day shift. 

Cardiac Nursing report on cardiac patients

First, you will get a report on 4-6 patients. Before going into each room and seeing each patient, quickly check latest vitals, labs, telemetry to make sure we don’t have anything urgent going on.

Pro-tip: Make sure the off-going shift didn’t forget to give any meds before they leave!

Cardiac monitoring

As a cardiac nurse you have to monitor their heart, which is often done with something called “telemetry” or “continuous cardiac monitoring”. It’s a device attached to their chest that (most often) wirelessly transmits the tracing of their electrical activity of their heart onto a monitor. You’re able to view it from the nurse’s station, and they typically have monitor techs on other floors watching as well. 

It’s your job to look at the tracing, interpret it, and document it at least every shift, and with any rhythm changes. You’ll learn about how to interpret them in nursing school, and most hospitals offer a class to brush up on them. We have a telemetry basics brush-up mini course here, and a more extensive review here.

After you’ve got a report on your patients, make sure their vitals and labs are stable, there’s no urgent situation needing to be addressed, then you have to go take care of your patients!

Cardiac-focused assessments and medications

Patients on your cardiac unit may have a plethora of different cardiac issues going on. Some of those can include:

• Myocardial infarction
• Pleural effusion
• Recovering from major cardiac surgery like valve replacement/repair, coronary artery bypass graft, aneurysm repair, and many more
• Pneumothorax and/or hemothorax
• Heart failure exacerbation
• Heart rhythm issues, like atrial fibrillation
• Blood clots

Your job as their nurse is to follow through on the plan of care established by the medical team, monitor the patient, and communicate with the team when the patient goes off-course. 

We do this by first “assessing” the patient. We check out different body systems in a systematic way at the beginning of the shift. We make sure what we see isn’t incredibly different from the previous shift. To do this, you listen to their heart and lungs, look at your cardiac monitoring, their vitals and labs, their skin, perform a basic neuro check, and ask them to do basic things (like squeezing your hands, wiggling toes, etc.). This is called your baseline assessment. Throughout the shift, you monitor to make sure they’re not getting worse or having subtle changes that could indicate a problem.

Naturally, these patients will get cardiac-specific meds. Your job is not just to look at the list and give whatever you’re told, you have to make sure it’s still appropriate for the patient to get the med(s). This is called critical thinking. Patient conditions constantly change, and it’s our job to recognize and adapt. 

So maybe your patient has a medication ordered to lower their blood pressure that they normally take every morning at home. Their latest blood pressure was low, at 96/44. As the nurse, it’s your job to notice that the BP is low and to question whether or not you should give something that would lower the blood pressure even further. This typically requires calling a physician or advanced practice provider for clarification as to whether or not to give it. That’s a pretty basic example, and the situations can get exceedingly more complex… but it’s our job to think like that continuously throughout a shift as we evaluate if what we’re doing is safe for that patient at that time. 

Working with cardiac physicians and advanced practice providers

As a cardiac nurse, you’ll likely work with many different kinds of cardiac physicians. I used to think a cardiologist covered everything heart-related, but there are actually a ton of cardiac sub-specialties. 

Here are some examples:

• Cardiothoracic surgeon
• Cardiovascular surgeon
• Electrophysiologist
• Echocardiologist
• Interventional cardiologist
• Heart failure and heart transplant specialists
• Adult congenital cardiologist

Your job is to work together with them as you implement the treatment plan they create. You’ll have to clarify orders, notify them of changes in the patient’s conditions or new needs, and chat with them on behalf of the patient when concerns arise. 

Bedside cardiac procedures

In addition to your normal daily activities as a cardiac nurse, you may have to facilitate bedside procedures. (A bedside procedure is one done in the patient’s room, rather than the patient going off of the unit to a procedural center.) You may be the one performing the procedure, or you may be the primary person assisting the physician or advanced practice provider.

Examples of bedside procedures include:

• Synchronized cardioversion
• Emergent chest tube insertion
• Chest tube removal
• Urgent central line insertion
• Thoracentesis
• Pleurodesis
• Peritoneal dialysis
• Central line dressing changes

If you work in a cardiac ICU, you’ll be involved in many more bedside procedures and urgent/emergent situations. 

Managing cardiac emergencies

Not everything goes to plan. Sometimes patients don’t do well or have unexpected complications. As the bedside cardiac nurse, it’s your job to notice these changes as early as possible and work with the medical team on changing course promptly. 

You may have to urgently send a patient back to the operating room after noticing their labs and BP trending down, and realize they are probably having internal bleeding. Or, you may have to code a patient who flipped into a lethal dysthymia. Or, you may have to urgently transfer a patient to the cardiac ICU because they need a lot of vasoactive drips to keep their blood pressure up and regular their heart rate and/or rhythm. 

After you get the patient stabilized and where they need to go (provided they survive), you’ll have to help notify the family and get their questions answered. You’ll also have to document appropriately so everyone going forward knows what happened. 

Getting ready to have patients on telemetry, but need a little refresher first?

Telemetry Basics Brush-Up from FreshRN is a self-paced mini-course where we walk through the basics of cardiac electrical conductivity and how that is reflected on your telemetry strips, discuss rhythms based on the level of urgency you should have, go over insider tips and tricks, and more.

Providing cardiac education

Throughout the shift, you’ll have to tell the patient what you’re doing and why. As you get more experience in the field, you’ll notice that a lot of hospital admissions are often preventable. It’s really important to explain what you’re doing and the rationale for it (it’s tough at the beginning to do this because you might not be totally sure, but that’s okay and part of learning this complex role).

You’ll talk about their disease process, what meds you’re giving and why, what procedures they need and why, about pain management, and what to look for at home. 

Cardiac shift summary

1. Get report on cardiac patients, ensure there are no urgent or emergent situations
2. Assess patients, give meds
3. Round with medical team, chat with them on behalf of the patient, clarify orders
4. Continue to monitor patient, give meds, and perform procedures throughout shift
5. Discharge or transfer patients when ordered
6. Admit new patients 
7. Continuously educate patients and support system on plan of care and any necessary changes
8. Document all the things!

Overwhelmed yet?

Cardiac nursing is very rewarding and interesting. Just when you think you’ve got the heart all figured out, you’ll discover something new. While it’s a lot to learn at once, when you do get to that point of being able to confidently manage your shift as an awesome cardiac nurse, it’s such a magnificent feeling. 

Learn more about cardiac nursing

• Afib with RVR: Nursing Responsibilities – FREE email course
• Telemetry Basics Brush-Up – mini course
• ECG Rhythm Master – self-paced online course that dives deep into ECG (7.0 contact hours)
• Cardiac Confidence: A Crash Course for New Cardiac Nurses – a comprehensive course (11.0 contact hours)