Nursing Staff of The Coronary Care Unit
A coronary care unit (CCU) is a specially designed aad equipped facility staffed by highly skilled personnel who provide optimum care for patients with smpected or confirmed acute myocardial infarction. Many institutions have expanded the function of the CCU by admitting patients with other cardiac emerpen:.ies to the unit. Included in this latter group are puients with acute pulmonary edema, major arrhythmias unrelated to myocardial infarction, and those roquiring pacemakers.
The success of the coronary care system depends above all on the competence of the nurse members of the CCU team. As noted, unless nurses are adequately trained for their role and are delegated authority to make and carry out therapeutic decisions based on their own observations and judgment, coronary care is merely a token gesture.
For optimum effectiveness a CCU should maintain a ratio of one professional nurse for every two or three patients at all times. Thus a four- to six-bed unit requires two nurses per shift-or a total nursing staff of at least 10 or 12 professional nurses for full coverage (including relief during illness, vacations, and days oil). This high quota of nurses may be unrealistic for many hospitals. In this circumstance, licensed practical nurses can be employed to assume some of tile lesser duties of tile professional nurse. However, it is essential that at least one professional nurse be present in the CCU at all limcs, the responsibility of the unit must never be delegated to a licensed practical nurse, even for a few minutes. This is not to say that highly motivated practical nurses cannot provide valuable assistance in patient carc, but it does mean that duties and responsibilities ol’coronary care nursing are so encompassing that none but specially trained professional nurses should undertake them. When practical nurses are included as members ofthe CCU team, they should participate in relevant portions of the training program offered to professional nurses.
Nursing in a coronary care unit (CCU) requires skills, knowledge, and judgment beyond that which can be acquired in a basic nursing school curriculum. Consequently, additional training is necessary to prepare nurses (even those with extensive general duty experience) for their specialized role in the (‘CU. Before describing the details of this instructional program, it is pertinent to consider some of the most important qualifications (personal and professional) for coronary care nursing.
SELECTION OF NURSES FOR THE CCU
Despite hospital staffing problems, CCU nurses must be deliberately selected for their role rather than accepted merely because of their availability or willingness to work in the unit; under no circumstances should nurses be forced or persuaded to work in a CCU against their desire. The underlying purpose of the selection process is to ensure that the members of the nursing staff are all well qualified and able to work together as a team in providing quality nursing care. In view of the time, effort, and cost involved in preparing CCU nurses for the responsibilities they will be asked to assume, it is important for prospective candidates to decide at the onset if they are qualified and suited for coronary care nursing. To this end, it is useful for the nursing director to establish a list of basic requirements for those who contemplate working in a CCU. This practice minimizes misconceptions about CCU nursing and reduces undue turnover; it also results in a stable, smoothly functioning unit. The following personal and professional qualifications should be included among the selection criteria for CCU nurses.
It must be recognized that patients admitted to a CCU are usually seriously ill and that the death rate among them is substantially higher than in other divisions of a hospital. The prospective CCU nurse should evaluate tier personal reactions to working in this potentially depressing setting and make certain that she can cope with it. Also to be considered is whether making decisions instantly and assuming serious responsibility-inherent elements in coronary care nursing-are likely to produce adverse emotional effects. To be weighed and balanced against these emotional challenges is the sense of accomplishment and satisfaction that CCU nurses derive from saving lives through their own efforts-an experience that is probably unique in the nursing profession.
Because intensive coronary care is a team effort, an ability to work closely with others is an essential attribute for CCU nurses. It is understandable that in a small, confined area like a CCU, where team members are together constantly, frictions may develop easily, particularly during stressful situations. Unless mature interpersonal relationships are maintained, the team’s effectiveness is greatly weakened and the quality of care diminished. In addition to working collaboratively with fellow nurses, CCU nurses must also maintain a secure, interdependent relationship with the physician members of the team. Unfortunately, some physicians are still unaccustomed to delegating authority to nurses, and problems may arise because of this. It is not ancommon, for example, for CCU nurses to become more proficient in interpreting arrhythmias than some physicians, thus challenging the physician’s status and judgment. It takes considerable discretion and a -ature approach for nurses to handle these situations.
Although usually an exciting experience, coronary :are nursing can become dull and routine if the nurse Lacks enthusiasm for her work and the motivation to Learn continually. The nurse should appreciate that nursing in a CCU is meant to be an ongoing learning experience-something to look forward to and enjoy. The degree of enthusiasm of the nursing staff correlates well with the quality of care offered. In fact, one of the most revealing characteristics of a superior CCU is a highly enthusiastic nursing staff.
The importance of honesty in a CCU cannot be overemphasized. Errors are bound to occur at one . time or another because actions often must be taken instantly and usual safeguards are bypassed. If the errors are recognized and reported immediately, corrective measures can be instituted. Thus total Integrity on the part of all CCU personnel is mandatory. Those who cover up their mistakes or are fearful to admit them are ill-suited to work in a CCU.
Nurses who are frequently ill or who are unable to comply regularly with the CCU time schedule for other reasons are poor candidates for coronary care nursing. Recognizing that the proper function of a CCU depends on an adequate nursing staff at all times, it is understandable that any absence or lateness can create a serious problem. This is particularly true in small coronary units where there is a invited number of nurses available as replacements.
In view of the time required to prepare CCU nurses (and for them to acquire enough experience to assumefull responsibilities), it is only reasonable that candidates agree to remain employed for at least one year, unless some unforeseen circumstance arises. Lesser periods of employment weaken the stability of the CCU team and are defeating for all concerned.
As a general rule, relatively recent graduates of basic nursing programs are the most adaptablee and make the best adjustment to the demands required of CCU nurses. However, older nurses with excellent qualifications need not be excluded from CCU nursing solely because of their age. Indeed, the older nurse is often a distinct asset to the CCU staff, particularly if she is flexible and adapts relatively easily to the setting.
Nursing School Record
All CCU nurses must be graduates of an accredited school of nursing, preferably a baccalaureate program. It is clear that a high ability to learn is an important requisite for nurses selected to work in a CCU. The specialized training program for CCU nurses includes many new concepts and skills which must be mastered quickly. Therefore nurses whose academic record in nursing school indicates a high level of intelligence and superior learning ability are apt to be the best candidates for coronary care nursing.
Dedication to Bedside Nursing
Because coronary care nursing is concerned almost entirely with direct patient care, it is essential that CCU nurses be dedicated to bedside nursing care and enjoy the nurse-patient relationship inherent in this role. Unless a nurse has a keen interest in direct patient care, working in a CCU is ill-advised. In fact, nurses who are more interested in the medical than the nursing aspects of coronary care are not apt to be the best candidates to work in a CCU.
Previous Nursing Experience
A particularly valuable asset for prospective CCU nurses is at least six months prior experience in caring for acutely ill medical patients in other settings. This background provides a foundation for the added duties and responsibilities of specialized coronary nursing.
NEXT : PREPARATION OF THE CCU NURSE
Reference :Lawrence E. Meltzer,MD ; Rose Pinneo,RN,MS ; J. Roderick Kitchell,D (Fourth Edition). “Intensive Coronary Care a Manual for Nurses”, by Robert J. Brady Company, Bowie, Maryland 20715.