If Your Cardiac ICU Has You Convinced You are the Problem, Read This First

Rachel M., BSN, RN

Former CVICU, now travel nurse · Updated this week

If a post stopped you mid-scroll, one nurse standing in front of an ECMO circuit, a CRRT machine, and an Impella all at once, a skipped lunch, a code no one ever debriefed, you already know the feeling it was pointing at.

For two years, if a patient was on VA ECMO, CRRT, and an Impella at the same time, that was one nurse. Me. I found out later that a lot of places double that, two nurses to one patient when the stakes are that high, because someone needs to watch the circuit and someone needs to watch the person, and both are genuinely full-time jobs. Nobody at my hospital ever mentioned that. I thought one nurse on three machines was just what cardiac ICU was.

That single fact explains most of why I left that job with my self-esteem in pieces. And it is why I want to walk through the signs with you, because almost none of them were ever a referendum on me, and there is a good chance almost none of them are a referendum on you.

1. You are being handed two people's work

I was not slow. I was not unsafe. I was one person doing what should have been two people's work, on the sickest patients in the building, and then going home and blaming myself for how impossible it felt.

That is the cruelest trick a bad unit plays. It hands you an unwinnable assignment and lets you conclude you are the reason you cannot win.

2. There is no lunch, no resource nurse, no debrief

It was not just the staffing. We never had resource nurses. I do not remember the last real lunch I ate on shift. We never debriefed a code, ever. Something catastrophic would happen and twenty minutes later you were charting on it like a normal task, because the next patient did not care what you had just watched.

The culture punished mistakes hard and punished questions just as hard, and I did not understand until much later how much worse that combination is than either one alone.

3. You have no baseline except theirs

It took becoming a travel nurse and meeting people from units all over the country to hear it said plainly. What I survived was not a hard specialty. It was a hospital gambling with patient safety and nursing licenses and calling it a normal assignment.

If you have never worked anywhere but the unit that is burning you out, you have no baseline to judge yourself against except theirs. That is not a fair trial. Get one more data point before you sentence yourself.

4. But be honest about the one gap that is actually yours

Here is the part I made myself be honest about, because pretending would have kept me stuck. There was one gap that was genuinely mine, not the unit's. In two years on that unit I had never recovered a fresh heart or managed ECMO. They made you wait two years for that training and I left right before mine.

Even after I understood the culture had broken me, that gap remained. It was the specific thing that made me feel unqualified every single time I pictured applying somewhere new. That part was not the trauma talking. That was an actual hole in my hands-on experience.

The fix was not going back. It was building the pattern recognition on my own, away from any unit, before I had to prove myself again. A visual guide made specifically for cardiac critical care did it. Impella waveforms laid out to study. Swan-Ganz tracings. IABP timing. ECMO mechanics shown the way you actually have to picture them, not just define them. EKG territories. Cardiogenic shock recognition.

5. Close the gap, then walk in on your own terms

I closed the gap in the evenings, on my own terms, and walked into my next round of interviews understanding the mechanics of what I had not done, instead of ashamed that I had not done it.

If your unit has you convinced you are the problem, ask two separate questions. Are you being handed two people's work and then blamed for needing two people? And is there a real gap underneath the exhaustion? Those are different questions with different fixes. The workload was never a referendum on you. The gap, if it is real, is the only part that was ever yours, and it is the only part you actually need to close.

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