How A Miami CVICU Nurse Builds Confidence & Preps For CRNA School with Sam Del Toro

Ever wonder what it feels like to hold a patient’s life in your hands while learning a new device, managing six drips, and calming a terrified family—in two languages? We invited Sam Del Toro, a Miami CVICU nurse heading to CRNA school, to take us inside the reality of high‑acuity cardiac care and the leadership it demands at the bedside.

Sam opens up about choosing nursing over medical school, leveraging a tough science background to become a competitive CRNA applicant, and landing an ICU role during the COVID hiring crunch. She shows how Spanish as a first language isn’t just cultural identity—it’s clinical force multiplier. From explaining extubation to translating consent for open‑heart surgery, language and empathy reduce fear, prevent errors, and build trust in a city where many patients meet the hospital for the first time on the worst day of their lives.

We dig into Miami’s cardiovascular trends—STEMIs, heart failure, and the dangers of delayed care in middle‑aged Hispanic men—and explore how chest pain often hides as back or stomach pain. Sam's rule is simple and lifesaving: check distal pulses early and often. We also talk about confidence as a new nurse, why humility accelerates growth, and practical ways to learn fast—volunteer for codes, open the crash cart, handle documentation, and ask smart questions that make doctors’ decisions easier.

Toughest moment? Caring for her grandmother through septic shock, then using hair care and skincare to restore dignity and control. It’s a reminder that the strongest medicine sometimes looks like small, human choices. We wrap with honest talk on burnout, why many ICU nurses pivot to advanced practice, and how great managers build cultures that keep teams together.

If this conversation helped you think differently about critical care, subscribe, share with a nursing friend, and leave a review with your biggest takeaway!

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Transcript

Meet Sam: CVICU And CRNA Plans

SPEAKER_00 0:02

We got a code brown. Welcome to Bedpan Panzer. With me, Nurse Mike. Gonna get a Bedpan over here. I'm your host, Nurse Mike, and with me we have a very special guest today, Sam Del Toro. You are a Latina nurse here in Miami. I am. Representing Cuban nurses here. All right. I am. So what kind of nurse are you?

SPEAKER_01 0:24

So I'm currently a CBICU nurse. I've been a nurse for three years. Wow. I've been working as an ICU nurse for a little over three years, but specifically in the cardiovascular intensive care unit for two years.

SPEAKER_00 0:34

Matt, okay, so if you guys don't know, cardiovascular intensive care is like the Navy SEALs or special ops. A little bit. It's very, very high stakes. It's like the almost like neuro ICU, the highest you can go from brain and heart, the two biggest organs that keep you alive.

SPEAKER_01 0:47

Yeah.

SPEAKER_00 0:48

So what did you always want to be a C VICU nurse? That's a high bar to cheat to.

SPEAKER_01 0:52

So I knew that I wanted to do ICU just because once you get that level of experience, you can pretty much go anywhere. That's what they say within like the nursing community. You can get hired everywhere. But I really just wanted to go to CRNA school, which was my plan. I really wanted to be a CRNA, which I'm actually starting in January. I got accepted to CRNA school. I was like, oh, that's good.

SPEAKER_00 1:14

If you guys don't know, uh CRNA school is one of the top-earning nursing professions you guys can get into. So it's usually CRNA or nurse practitioner. CRNA is just fancy words for an anesthesiologist. You guys keep people alive during um surgery, you put them to sleep, you wake them up. Very critical job. And the best part about it is that it's not backbreaking work like a 20 or 30 year career at bedside. You're literally in one seat and you have one monitor, one patient, and you make really good money, uh like over 200 grand a year. I have five buddies who are CRNAs. Really? Yeah.

SPEAKER_02 1:45

They like it.

SPEAKER_00 1:46

They love it. Like CRNAs is such a niche.

SPEAKER_01 1:48

Really?

SPEAKER_00 1:48

And a tight-knit community.

SPEAKER_01 1:50

I've shouted a couple and I I've honestly loved it. So I feel like I'm gonna really like it.

SPEAKER_00 1:54

How did you even discover this? Like, because most people don't even know CRNAs.

SPEAKER_01 1:58

So I, my sister is in, she graduated medical school. So I originally thought that I wanted to go to med school. I wanted to be a doctor. Like every like a lot of the nurses in our community, they started off by wanting to be doctors. They started off by being pre-med. And I learned very on that I did not want to go that route just because it's not it wasn't for me, it wasn't meant for me. I saw what my sister was going through, and it was just not something that I saw myself. I shadowed in the hospital. I decided that I want to go to nursing school, I became a nurse. And for some reason, I don't know, it kind of just when I started in the ICU, it kind of just clicked with me. That like a lot of the people that were starting with me in my like cohort in the hospital, they wanted to do anesthesia school. I looked into it and I don't know, I kind of loved it.

Choosing Nursing Over Med School

SPEAKER_00 2:39

That's really cool. Yeah, yeah. It's it's very rewarding, and um, you can definitely have your career last a lot longer. Okay, so you went to FIU. I did for your undergrad or for your nursing career? Where did I start?

SPEAKER_01 2:50

I did for undergrad. So I started FIU, which is Florida International University. I it's here in Miami. I did that for four years with my undergraduate, my bachelor's of nursing. I got two degrees, I got interdisciplinary studies and nursing, of course, and I loved it. I loved it.

SPEAKER_00 3:06

And you switched throughout because you were gonna go pre-med and you switched, or oh wow.

SPEAKER_01 3:10

And then it so happened to work out where like I can get another degree with some of the prereqs that I got. It ended up helping me get into CNA school because I did take like chemistry one, chemistry two, physics, I took calculus. So it ended up working out in my favor when it came to being competitive for CRNA school.

SPEAKER_00 3:25

What was the biggest transition? You mentioned it a little bit, but you were gonna go pre-med. Did you always want to go to medical field, or was that something your sister kind of did? Because I didn't know I wanted to go into medical field until my brother did it. Okay. And I was like, okay.

SPEAKER_01 3:37

Um so growing up, my parents are business owners, they've always held a business. And I've actually had this conversation with my sister for a long time where like seeing them own their business go through what like profit, loss, people are stealing from you. People are robbing you, they're you're having these like immense losses. You're your own boss. It's it's basically your responsibility. And when it comes to the medical field, at least for nursing, I clock in and then I clock out, and then I have no other worries, right?

SPEAKER_00 4:03

Like go on vacation, I don't know.

SPEAKER_01 4:06

Clock out. I don't have to be worrying about like employees or like if somebody's stealing from me, like I'm getting paid because I'm clocking in, I'm clocking out, and that's it. So I think that's where me and my sister both agreed on, and like we leaned towards the medical field because we did like we had a niche for medicine, I guess. I'm not sure where we got that from, but we both kind of clicked in that sense. So my sister is becoming a radiologist now, she's in residency. Yeah, she started this year, and I'm going to see her in e school, you know. Thank you.

SPEAKER_00 4:33

That's that's amazing. So, when in your nursing school journey did you discover simple nursing?

SPEAKER_01 4:38

I want to say that it was like either my last year and definitely 100% for my NCLEX studies. Really? Yes, 100%. Because if I wasn't understanding a topic, I would just like look up a YouTube video. Somehow, nurse Mike had a video about that one specific topic that like it wasn't clicking.

SPEAKER_00 4:52

So when did you actually graduate nursing school?

SPEAKER_01 4:55

2022.

SPEAKER_00 4:55

2022, okay. Was it hard for you to get a job as a new grad nurse?

Landing An ICU Job Post‑Graduation

SPEAKER_01 4:59

No, because COVID was still a thing. Like the remnants of COVID was still around. Like, I think the second wave of COVID was going around. So people were still hiring, and especially in the ICU. Like, I did it, it wasn't super, super easy, but I did it on my first, like within like two weeks, I applied to all the hospitals, and I only heard back from one, which is for a hospital in South Miami.

SPEAKER_00 5:21

Okay.

SPEAKER_01 5:21

Um, but it took me a little bit. I want to say like two weeks.

SPEAKER_00 5:24

What were like all the hospitals? Like how many, like 10, 20 hospitals?

SPEAKER_01 5:27

I applied. The thing is, even upon graduation, I knew that I kind of wanted to do CRNA school or pursue like the advanced practice route 100%. So I wanted to do like a bigger hospital. So I think there's like five in South Miami. I'm not sure to be honest, but I applied to like the bigger ones. So I want to say like five. And every single time that I would apply, they would interview me in like a panel with like different floors. And somehow, like all of the interviews until the last one, which was like the actual very last one that I got accepted for ICU, they were all different nurse managers, but none of them were for ICU. They were all for step down.

SPEAKER_02 6:02

Really?

SPEAKER_01 6:03

And they would tell me that it would be like an ICU interview.

unknown 6:05

What?

SPEAKER_01 6:06

And they'd push you, it'd be like, oh, but then you can transfer, like you can transfer to ICU after a year.

SPEAKER_00 6:10

They want to put you in the float pool, they want to put you where the needs are.

SPEAKER_01 6:12

Yeah. I was like, I don't want to do ICU. I'm sorry.

SPEAKER_00 6:15

So like so the job offers, let me get this straight. You have a panel. You specifically applied for an ICU position.

SPEAKER_01 6:21

Yeah. Or like I would tell the recruiter, like, I want to do an ICU interview. Like, I this is like this is the position that I want. I knew that I didn't want to do pick you or Nick you. Something about me, I can't do babies. I love them, but like I think it's a lot. Like seeing like an adult go through something versus seeing a baby who has like five months on their like lifespan. It's it's too hard for me. You know, I love my viejitos, I love my old people.

SPEAKER_00 6:43

Yeah, yeah, it's very true. And in another podcast, we talked about me working in a pediatric ER.

SPEAKER_01 6:48

You did?

SPEAKER_00 6:48

And yeah, I had to quit. Um I worked because I mean, there's one thing to go see a person like an older person with a cancer, but seeing a three-year-old cancer, totally different. No, I can't. So I feel you on that. So obviously, you're a nurse in Miami, you are Cuban. You both your parents have a business, and they're Cuban as well. Yep. Um, so basically, culture diversity, career diversity, language diversity. You're bilingual?

SPEAKER_01 7:09

I am.

SPEAKER_00 7:09

Oh, very cool.

SPEAKER_01 7:10

Spanish was actually my first language.

SPEAKER_00 7:11

Does that impact it was your first language? It was.

SPEAKER_01 7:13

I wasn't eSOL until like the second or third grade. No, and I was born in Miami. I love it to be honest. It's helped me so much with even if like I struggled in the beginning, like when I was a baby, like learning English, and I was born and raised in the United States, like I should know English, but it helped me a lot because I am like a translator for my floor. Like, and I I'm known for it, and I love it because Miami is such a like a Latin community. There's a very, very large Latin community. A lot of them don't know English. A lot of them, it's their first time being in the hospital, having open heart surgery, having a transplant, taking meds, and I serve as like a person. I'm obviously not the only person, but like I serve as a person that like my coworkers can count on. Like, hey, can you translate that? This is like how the procedure's gonna be, how exturbation works. Like, tell them to squeeze my hand, tell them to like lift their head up the table.

SPEAKER_00 8:00

In Southern California, I only I'm like only knew like 30% Spanish at the time.

SPEAKER_01 8:04

Really?

SPEAKER_00 8:05

Yeah, this is like early 20s. Uh now no more, but they were talking to me and they asked for yellow.

SPEAKER_02 8:11

Yellow? Like yellow like yellow?

Culture, Language, And Care In Miami

SPEAKER_00 8:12

No, no, yeah. Uh there was Oh, yellow. Yellow. I'm like, yellow, and in Spanish, yellow, the color is amarillo. And I'm like, you want the color yellow?

SPEAKER_01 8:20

Amarillo?

SPEAKER_00 8:21

But what is what is yellow?

SPEAKER_01 8:23

Yellow is ice.

SPEAKER_00 8:24

Ice. But I'm like, what are you?

SPEAKER_01 8:26

That's hilarious.

SPEAKER_00 8:27

And then I gave them ice and I got ripped to shreds because they were NPO.

SPEAKER_02 8:30

Oh.

SPEAKER_00 8:31

So I had to learn that too. So, anyways.

SPEAKER_02 8:33

That's important.

SPEAKER_00 8:33

Yes. So yellow is ice. Yellow. So being a nurse here in Miami, what are some health challenges or patient trends that you see often?

SPEAKER_01 8:40

So I want to say a lot of semis, a lot of like heart attacks, a lot of people who have congestive heart failure. And I think that a lot of it has to do with like how bad our Hispanic community eats. You know, like this high cholesterol, high fat diet, high salt diet. It's not really the best. And I think a lot of our population is males, like mid-aged males, like 40s, 50s, because that's like our prone population for like stemies and heart attacks and all this stuff. So male Hispanic males in general are very like stubborn.

SPEAKER_02 9:14

Very stubborn.

SPEAKER_01 9:15

I'm not talking about all of them. I'm just saying from my experience, my dad. Yeah, my dad's um, they're very stubborn. So like if they feel even an ounce of chest pain or like an elephant amount of like an elephant's weight chest pain, they won't come to the hospital. They'll wait until like days.

SPEAKER_00 9:32

Yeah, I I worked in a STEMI-receiving ER in Soquel. A lot of Hispanic influence. And yeah, sometimes it doesn't even manifest as like chest pain. It manifests like back pain.

SPEAKER_01 9:40

Or like stomach pain.

SPEAKER_00 9:41

Arm pain, yeah.

SPEAKER_01 9:42

Yeah.

SPEAKER_00 9:43

And then you're right, they'll come in at the very last. I'm like, how long has it been going on for? Oh, about a week or two.

SPEAKER_01 9:47

Yeah.

SPEAKER_00 9:48

I'm like, what?

SPEAKER_01 9:49

I actually had a patient who she was having a heart attack and she was just taking like aspirin for like six months.

SPEAKER_00 9:56

Yeah. As slowly as your heart is dying, right?

SPEAKER_01 9:59

Yeah. But she was taking aspirin, so like she knew what to take, but she just didn't want to come in. Because why would she? You know?

SPEAKER_00 10:04

Yeah. That's like my grandma who was like, she didn't want to believe that diabetes was a thing.

SPEAKER_02 10:08

Oh.

SPEAKER_00 10:09

And so her blood sugar was constantly like in 500.

SPEAKER_02 10:11

Oh, DKA.

SPEAKER_00 10:12

Oh my.

SPEAKER_02 10:12

I'd love to see it.

SPEAKER_00 10:13

So speaking of grandmas or in Spanish, abonitas, like that means like a little cute grandma. Um, your grandma, we saw on social media that you posted she was in the hospital.

SPEAKER_01 10:22

Yep.

SPEAKER_00 10:23

What happened to that?

Heart Health Trends In Hispanic Communities

SPEAKER_01 10:24

So my grandma has rheumatoid arthritis, like severe osteoporosis. She became septic because she had like this cough for forever that she didn't mention to anybody. She just like was coughing up a lung and she didn't tell anybody. So my grandfather called me. He's 93 years old. Oh my god. He calls me, he's like, I don't think your grandma's acting like herself. Like she's like completely super, super baby. Like she's super weak. I don't recognize her. So I come over. I've actually had to call fire rescue on my grandma a couple times. Like, this is not our first rodeo whatsoever. Me and grandma are like this in the hospital, okay? ER knows us. UM ER knows us. Um, I get there and like just by touching her, she's like february. Like, I was like, Do you guys have a thermometer? And her, she had a fever, she had like 101 fever. I called ER, like the EMS. We took her to like the hospital, she was in septic shop, we took her to the ICU. She was also in like adrenal insufficiency because she takes steroids for her rheumatoid arthritis. And it was a mission. And it definitely like puts things into perspective. Like when you're a nurse and you know, and this is like your field, like you work in the intensive care unit. And it was funny because a lot of the doctors that came by, especially rapid response, when we needed to call ICU, I knew them personally because I've worked with them. So I started crying because they're like, What are you doing here? And I was like, What are you doing here? I started crying just because like you can you know anything that can go wrong, and like you've seen the chest x-rays. I'm not a radiologist, I don't know how to read a chest x-ray like word for word, but like I know a bad one and a good one when I see one, you know. So I was scared she would go into like ARDS, but we spent two weeks in the hospital, and oh, she made it. She's she's kicking.

SPEAKER_00 11:58

All right. So speaking about family in the hospital, um, everyone probably comes to you, your family and friends, right? Do you get hit up like a lot about with your family, like your theas, theo, like aunts and uncles?

SPEAKER_01 12:08

I want to say, like, in regards to my grandma, my her whole like medical issues, like she'd call me like in the cardiologist or like the urologist or anyologist, and she'd be like, wait, speak to my my my daughter, my granddaughter. She's a nurse. Like, she loves to tell everybody that I'm a nurse. But I think in general, yeah, they'll tell me like I haven't peed in like two days, like not two days, but like I haven't peed in like eight hours. Like, what should I do? I'm like, you should probably go to the ER. Like, yeah, I don't my my recommend this is what I would do, you know. Obviously, I can't diagnose because I'm not I'm just a nurse. Like, I don't know, I don't know. Um, but my recommendation would be like be safe, you know, like safe practice, go to go to the ER, go see a doctor.

SPEAKER_00 12:46

Yeah, I get that a lot with my friends. They give me the lap reports, and like, what does this mean?

SPEAKER_01 12:50

I don't know.

SPEAKER_00 12:51

Okay.

SPEAKER_01 12:51

And even if you do know, like sometimes you don't want to be the one to like ruin their news. So just be like, I recommend you go to the ER right now.

SPEAKER_02 12:57

Yeah, yeah, yeah.

SPEAKER_00 12:58

Your urgent care for sure. So speaking about patients, I think doctors or healthcare providers and nurses make the worst patients because we know too much.

SPEAKER_01 13:05

100%.

SPEAKER_00 13:06

Self-diagnose.

SPEAKER_01 13:07

100%. I'll be exercising and I'll be like, oh my god, I'm getting out of breath way too easily. Like, what if I have a low EF? Like, what if I'm in heart failure? What if I need to talk to like my heart failure doctor? Like, what's going on? But in reality, you just haven't worked out in like two weeks. So that would explain.

SPEAKER_00 13:21

You get out of breath going up the stairs.

SPEAKER_01 13:23

Listen, what if I need like a transplant or like an LV? Like, what if that's what this means?

SPEAKER_00 13:28

Uh yeah, I become like a hypochondriac sometimes. So going back to your grandma, we saw you post on social media that you took care of her in the hospital and you braided her hair, maybe did her nails, made her feel comfortable. Yep. In that same thread, and we always tell you know, nurses or soon-to-be nurses to treat your patients like your family. Yep. Was there any did you notice a difference in your care from your grandma to your other patients? And obviously, it's gonna be different.

SPEAKER_01 13:50

I want to say, like, it is my grandma, and I was harder on her than I say my patients, because like we were in the ICU, she was on like leave of that, she was on pressers, and I was like, We're getting out of bed to chair. Like the CVICU nurse in me was like, I don't care, I don't care. We're going out of bed to chair, you have pneumonia, you need to be sitting in the chair, sit up, open your lungs, we're gonna do the insectance spherometer every hour. I don't care if you feel bad, I don't care, I don't care. This is how we're doing things. So it definitely does put things into perspective. And she wanted to do her skincare. I brought her her skincare, I braided her hair, we washed her hair. She needed to feel as normal as possible within the surrounding that she was in. Some of these patients, they just want some sense of control, right? So that's why sometimes they'll just tell you no for anything. Like, I'm not gonna take my meds, I'm not gonna get out of bed to chair, I'm not gonna do this, because they have no control in their health in a sense, because they've lost control. They they're not in their normal place. Um, so you need to provide some sort of like like, I don't know, how do I say this? Maybe like some sort of structure, but as well as like options for them to say, like, yes, no, like you want to do your hair, yes. You wanna do your nails? Yes. Let's let's braid your hair. Do you want that? Yes.

SPEAKER_00 14:58

Well, what we're really talking about is building rapport. Like, how do you build rapport? Have you ever obviously you've you've probably had like, you know, um patients that are just very standoffish.

SPEAKER_01 15:06

Yeah.

SPEAKER_00 15:07

Keep you at arm's length.

SPEAKER_01 15:08

Yeah.

SPEAKER_00 15:08

How do you bridge that gap? Like for new grads?

Caring For Abuela Through Sepsis

SPEAKER_01 15:10

I think loosening up the environment, like the tension in the room of like, okay, your diagnosis is terrible. Like you're on ECMO, you're not like you're not doing very good. But I think like if you if they see that a nurse is tense and like like very serious, like they are scared themselves, right? Because, like, why is my nurse not like normal? Like, why is she like so serious and hovering and like doing things super fast? So I think like breaking the ice is what I'm trying to say. Like, breaking the ice, being casual, like when you see me worried, then you get worried. And then you just like casually just keep it going. Like, don't freak out. Don't like, I don't know, don't be tense, just be yourself. Like it in a sense, like just let them get to know you as well. And I'm like a very goofy person, like I'm very bubbly, like I'm gonna laugh at anything you say. It's okay, like everything's gonna be fine. Oh, you pass some gas. I do that too. Like, it's fine, it's fine. Been there, done that, like it's normal.

SPEAKER_00 16:01

So I think just breaking the ice, you know. I just did that in the Pixas, you know. All right, picture this. You're walking into clinicals or a shift and you already feel behind. The last thing you should be worrying about is your scrubs. That's why I personally shop at Uniform Advantage. It's not just scrubs, but it's the marketplace for healthcare professionals. You'll find top brands like Cherokee, healing hands, sketchers, and more. Plus, nursing shoes that don't destroy your feet. Trust me, you're gonna be on your feet for 12 hours. Also, stethoscopes, which come in really handy and doctors love to take it. Jackets keep you really warm for those very cold hospitals, and all the extras that you'll ever need. And what you'll love the most are the options. We all have options, right? So whether you're into joggers, classic fit, or something in between, Uniform Advantage has you covered with the latest styles. And it's all priced for nursing school budgets or your first new grad paycheck. So go ahead and check it out at uniformadvantage.com today. Use discount code SIMPLENERSING at checkout and upgrade your shift with 15% off your next order. So, yeah, I always tell that the famous line like, don't freak out unless you see me freak out. Exactly. It's kind of like taking a flight. Like, imagine if your pilot came on, like, oh my gosh, everyone breaks for like look at the flight attendant. Yeah, exactly. Everyone's cool.

SPEAKER_01 17:26

She does this all the time.

SPEAKER_00 17:27

Turbulence, okay. This is your captain speaking. We're gonna have some turbulence in the spine. All right, so C V I C U, top tier, high stakes. Walk us through a typical day if such a thing exists.

SPEAKER_01 17:36

I don't know if there is a typical day. It kind of just depends like what the patient has going on. Um, I want to say, like, typical day, I clock in, I see my assignment, so like what patients I'm gonna have, if I'm gonna have one really sick one, or if I have two sick ones, or they're all generally very, very sick, but sometimes they're so sick that they require to like one-to-one, so one nurse for one patient. Um, I get report, whether it's one or two, and I go in, I assess my machine, I assess my patient, I look at the monitor, I look at their labs, I want to make sure, like, if it's like an open heart patient, if they just had a cabbage, like a bypass surgery, I want to make sure they're on aspirin or plevix. Why aren't we on aspirin or plevix? Do they have chest tubes? Are we off of suction? Like, what was their output? Did they like not dump that much? So maybe I can like when the doctors round or surgeons, they have a lot on their plate, they have a lot of patients, and sometimes it eases the stress of just being like, Hey, can we take out these chest tubes? Because I don't know about you guys, but like chest tubes kind of suck. I heard they kind of hurt. So I would love to take those out because regardless, we do have to ambulate the patient, we have to walk them every single day. It'll make my life easier and it'll make the patient's life easier if we just have less lines, less things going on. So I want to say in the morning, report, assess. Um, we obviously ambulate our patients sometimes with physical therapy, sometimes without. To be honest, it's not solely on physical therapy to walk the patient, it's also our responsibility because we should want what's best for our patients. And sometimes, yeah, like that's what's best for our patients.

Autonomy, Dignity, And Patient Rapport

SPEAKER_00 19:00

So, what I'm hearing is being a patient advocate for sure. 100%. And for everyone still in nursing school, everything she just described, that first segment was all nursing process assessment. There wasn't even no interventions, it was just all critical thinking. And the biggest thing for anyone taking their unclex is what kills my patient first.

SPEAKER_01 19:16

Yeah.

SPEAKER_00 19:16

And that's what he had to think, especially high stakes.

SPEAKER_01 19:18

Yeah. So, like, let's say I have like an ECMO patient. I want to make sure like my cannulas are there. Like, what are my flows running? What's the sweep at? Um, it's an emotion? The sweep. It's like the sweep is basically like your CO2, like how we blow off CO2. There's different types of ECMO. There's V V A and then there's V V V. Um, so I also want to know what like what my arterial cannula is, what my venous cannula is. There's impellas, there's balloon pumps, and there every machine has its own thing where you want to check, you know, like what's something that's like my top priority when it comes to like my balloon pump is like I've got to make sure my pulse, like my patient has a pulse on that leg, because if not, like they could lose that leg.

SPEAKER_00 19:55

Oh my gosh.

SPEAKER_01 19:56

And it's happened where like they lose a pulse, and like you are your patient's advocate. Like, if they lose that pulse, you're the only one that knows that right now. And like you tell like a doctor, and they were like, Oh yeah, we'll get there, like we'll round there. You better go make sure that like you tell everybody. Wow. You make it known, you text the surgeons, like you tell them everything because that's that's your patient.

SPEAKER_00 20:16

Loss of life, loss of limb. So basically, if they lose the limb, it's usually because the nurse, maybe because they didn't alert at it or no. Have you ever seen that before? Has anyone lost a limb?

SPEAKER_01 20:26

Yeah, we've seen lost limbs. It's it's a complication that can happen for sure, but I don't think it's more nursing like like nursing's fault. Sometimes it is just what happens that's that's a complication of the device itself. But I just like to make sure, like we should make sure that the patient has a pulse process. Yeah, yeah. Yeah, that's because even though like sometimes it's like Q2 pulses or Q1 pulses, in the hour that you didn't check, like in the 20 to 30 minutes after you check that pulse, they can lose a pulse. And then you're not gonna check after like 30 minutes after, and by that time, like they can lose like their pulse.

SPEAKER_00 20:57

So we should because that actually happened in the ER. Someone had a DBT that we knew about, and literally the last four hours, the nurse just didn't check and assess, and they charted, and they said they charted, and they really didn't. And then what happened was the leg was leaning over the bed because there was like a packed at ER community hospital, not a good resources, they had to put her on an OBGYN bed, not a regular bed, and the OBGYN bed is like there's like an octagon, there's not all the rails go all the way out. So you fucking easily slip out. And when the next nurse came in four hours later at 7 a.m., they did the assessment, took out the sheet, black leg, and it's like so. Sometimes, guys, you guys are the only nurses are the only people in between your patient's life and limb and safety. So speaking about being a new nurse, uh confidence is one of the biggest things. Any tips for new graduate nurses who may be intimidated by healthcare practitioners, doctors, PAs, fellows, whoever's taking care of the patient, to build rapport or just to like bridge the gap between being really scared and confidence?

Sponsor: Uniform Advantage

SPEAKER_01 21:57

I think that comes with time, in my opinion. Like being exposed to it, doing it more and more and more every single day, and experience. Like, people think that like just because you have like 15 years of experience, that means that like you're gonna be the best. And I think that is true. Like you you gain your experience with years, but also exposing yourself, like being the one to like go out of their way to talk to doctors, even if it's something so minuscule, like, hey, listen, like this patient doesn't have aspirin ordered, that'll actually build like a report with that doctor, like, oh, she's very detail-oriented, like maybe like, oh, she kind of knows, and then long term they will listen to you and they'll be like, Hey, do you have any suggestions? Like, what do you think we should be doing? Wow, yeah. So I think just with exposing yourself more to that thing that you're afraid of will make you grow more as a nurse versus just being scared and holding off and like not wanting to do it just because you're you're timid and you don't want to be embarrassed. Embarrassed, I don't know if I would use the word like embarrassed. I would just say like shy.

SPEAKER_00 22:53

Yeah, because you're also you don't want to mess up.

SPEAKER_01 22:55

You're the newest one. Like you you you know the least in a sense, but at the same time, like your experience is not the same as anybody else's experience. Like maybe you've seen something that like the doctor hasn't seen ever.

SPEAKER_00 23:04

So it's a teamwork, really thing. Yeah, and it's like you make the job easier for your doctor, your healthcare provider.

A Day In CVICU: Assessment First

SPEAKER_01 23:09

And they'll come and they'll ask you for your info. Like, what do you think we should do? Or like what's your recommendation? Like, what's what's your favorite drug? Like, what's your drug of choice? I'll be like, um, let's do some held all. All right, why? Okay, I want to do held all because of this. Okay, go get it. Beautiful, gorgeous. Obviously, that's not right off the bat, that takes time, like months, years, but you'll get there.

SPEAKER_00 23:30

Did did you ever have like residents come to you or fellows or like new doctors?

SPEAKER_01 23:34

Or I want to say yes. Yeah.

SPEAKER_00 23:38

Suck life off of you.

SPEAKER_01 23:39

Like fellows definitely do come up to you because sometimes they're they're only there for like X amount of time for a rotation. Because I've seen it with my sister, and as a resident, she she comes and she learns for like two weeks and then she leaves. Um, and the fellows that are the best and the residents that are the best are the ones that they come and they ask you, like, oh, so like how do you usually like what are these epicardial wires? Like, what do you guys do? Like, what's this? Okay, the epicardial wires, you have to make sure that it's connected or not connected, the rate, the output, the sensitivity. Um, what about these chest tubes? Like, what does this bubbling mean? And sometimes they'll come up to you and they'll ask you, and you it's so important to like make them feel obviously I'm a nurse, like I'm just a nurse. Like, I love saying that. Like, I'm just a nurse. Um, but I love it when they come up to me and they ask me questions and like they ask me for like their input. And I love that report, to be honest, because my sister's a resident south.

SPEAKER_00 24:25

Oh, that's amazing.

SPEAKER_01 24:26

I understand you guys, guys.

SPEAKER_00 24:27

It's so funny. I I forget which um which show it was. I think it was Gray's Anatomy, but there was a great segment that people have sent me all the time, the clockwork, a few times a year, where it's like, I forget which uh character it was, but they were showing all the new residents, doing the rounds is like, all right, rule number one here are the nurses, here are the most experienced nurses, listen to the nurses. Because sometimes these new grad, or not new grad, but these resident doctors, they get that uh you know, high and mighty complex, and they know everything.

SPEAKER_02 24:55

Yeah.

SPEAKER_00 24:55

And they talk down, and it's like, come on, guys, like we're all teamwork here, we're all here to learn.

SPEAKER_02 24:59

Yeah.

SPEAKER_00 25:00

Wait, so let me get this straight. You were a new grad and you jumped right into CPICU, or did you start on medical?

SPEAKER_01 25:05

I started in regular ICU. Like it was like a combined ICU for like neuro, medical, cardiac, and surgical. But it was mostly on like the medical neural side.

SPEAKER_00 25:12

How long did it take for you to feel comfortable as like your confidence level?

SPEAKER_01 25:16

Great question. I want to say like over a year. In my in my opinion, because I think as a new grad nurse, one of the things that I tell nurses that I'm training or students that I'm training is like you need to have humility. That's so incredibly important. When you don't know something, you be you better be the first one to say, like, I don't know this. Like, I've never done this before. And I'm still like, even though I've been doing this for like three years, I'm still the first one to be like, I don't know what I'm doing. Like, I don't know, I don't know what this is. But I'll find out. I need I need another person to like come and tell me. And sometimes, like, you wouldn't believe that like the 20 years of experience nurse also doesn't know that either. So, like, don't go in thinking like I'm gonna know everything, I'm gonna act like I know everything. No, that's that's the wrong way to approach it, and that's the one way ticket to like making a mistake is thinking that you know everything, which you you never do. I want to say it took me like over a year, and then after a year, I transitioned to C V ICU, which was a different ball game. And I think in C VICU it took me like a year to get comfortable. So a total like two years.

SPEAKER_00 26:13

But the big overarching theme is like telling yourself, like, I'm not dumb, I'm just new.

SPEAKER_01 26:17

Exactly. That's all that's my favorite saying, yes. You're not dumb, you just have never seen this before. And especially in like critical care nursing as a new grad, it's hard because you're not only learning how to one, be a nurse, like baseline, like a regular nurse who knows how to put IVs in, how to like dilute drugs, like make sure you're antibiotics, you're not only in the charting, you're not only learning that, but you're learning that in a high stake scenario where it is like, and especially the type of ICU that you work in, it's so and especially the acuity of your ICU, it's hard because now you're learning what an A-line is. Now you're learning how to put in blood, and now you're learning like blood administration, vents, drips, like it's it's a lot. So it's important to like take it easy on yourself because you're not dumb, you're new. Like you've never seen this before in your life. So it's okay.

SPEAKER_00 27:02

So speaking of, do you think you jumped in too early? What if we could do it all over again? Would you still use the route or would you go to med search first?

SPEAKER_01 27:09

If I were to do it all over again, I would do exactly what I did.

SPEAKER_00 27:12

Really? Even though it was like a lot.

ECMO, Devices, And Vigilance

SPEAKER_01 27:14

It was a lot. I at least my last semester of nursing school, I was able to like shadow in a trauma ICU, which that exposed me and it helped me a lot. And I recommend that for nursing students in their like, what is it called? Like their practicum. I highly recommend they do that.

SPEAKER_02 27:26

Yep.

SPEAKER_01 27:27

Um, and then starting in the ICU, you have to have this personality of like, I'm gonna get this done, I'm gonna learn, and I don't care how like I need to go home and I need to study what I just did. I need to go home and I need to study the drips. What's the difference between like Pressidex and Propofol? What's the difference between Levo Fed and Epinephrine drips? Like, it's important to know and expose yourself. Like, my this patient's crashing, they they just finished the code. That crash cart is gonna be taken. Open the crash cart, open like like see what meds are on the primary, the secondary, the third drawer, see what's in there. Like, see and like touch it, like open it. Like, if you need to open it, open it, volunteer yourself for codes, volunteer yourself for chest compressions, volunteer yourself for recording. That's also very hard. So I think just exposing yourself and being comfortable with being uncomfortable and being safe. Always be safe.

SPEAKER_00 28:13

That's the biggest thing. Being safety is their own rule. Yeah, but yeah, expose yourself, go above and beyond, get your hands dirty. Remember, it's just like driving a car, right? Yeah, like nursing school is not real nursing, I don't believe. No, it's just like driving school is not real driving.

SPEAKER_01 28:26

They teach you like the basics of what you might go through. Yeah, you know?

SPEAKER_00 28:29

All right, next segment here. We're digging into your DMs. Your followers send you questions all the time. Yes. So let's answer some questions. We have a question from uh from one of your followers. What is the craziest thing, or one of the craziest that you've seen in the ICO?

SPEAKER_01 28:44

I don't know. I've seen a lot, in my opinion, because I also work in a very high QED floor, like especially the hospital that I work in. I think transplants coming out of transplants, complications from transplants, patients that come out with their chest open, having to do like surgeries at the bedside because the patient's too unstable to like take to the OR.

SPEAKER_00 29:04

That's probably they do surgeries at bedside.

SPEAKER_01 29:07

Yeah, they do surgeries at bedside. Um, I want to say triple A repairs are mighty.

SPEAKER_00 29:13

Triple A, if you guys don't know, that's aortic aneurysm, basically the largest organ in your body just bursts.

SPEAKER_01 29:18

Yeah, especially type A's, those types of surgeries, like having to do like the massive transfusion protocols like multiple times in one shift, coming like sometimes that patient needs like two nurses for one like patient because they're so sick. And like to do blood like administration, you obviously need two nurses to like verify the blood product and all those things, but with that transfusion protocol, you're just like spiking and spiking and spiking, and yeah, it gets bloody, it gets it gets messy.

SPEAKER_00 29:44

All right. So, speaking of blood, you know, you can't be squeamish. We have another question, question number two from a follower. What area of nursing should they go into if they're squeamish of blood? What do you recommend?

SPEAKER_01 29:54

I think there's different types of nursings, to be honest. Uh, there's a lot of fields in the nursing community that you don't need to be working. Working inpatient, you can also work outpatient. Like you can be an outpatient nurse, like in a Obi-Gyne clinic, where you don't, you're not the one that takes out blood because they'll go to like a clinic to go like draw blood. There's also like aesthetic nursing.

SPEAKER_00 30:12

You don't see that much blood, yeah. Also education, though, because I teach and I'm I'm like almost away from bedside entirely.

SPEAKER_01 30:18

You can be a nurse educator. Um, what else?

SPEAKER_00 30:21

You can be a hospital educator where you educate the hospital. Like we had a department educator, I believe her name was Liz. Amazing woman.

SPEAKER_02 30:28

Yeah.

SPEAKER_00 30:28

She would always come with poster boards because we were teaching hospitals well.

SPEAKER_02 30:31

Yeah.

SPEAKER_00 30:32

And we'd always have like little in-service, in conferences, and she was on our butts about like this and the drug.

SPEAKER_01 30:38

It's like there's remote nursing, right?

SPEAKER_00 30:40

There's remote nursing. There's uh case management. That's amazing. So social workers. Next question is all about your social media. How long have you been doing social media? It was did it happen in nursing school?

New Nurse Confidence And Humility

SPEAKER_01 30:50

Did it happen during your I think it happened in nursing school, to be honest? Yeah. I did I started social media in nursing school. I started posting that I was a nurse, like obviously when I graduated. That was a little harder because I don't consider myself an influencer. This is like my hobby, okay, guys? Like this is something that I do for fun. This is not my own. That's the best way to do it though. When it becomes a job, it's like Yeah, and I post like everything I post about nursing. My thing is makeup. I'm like a girl's girl, you know, like I love hair, makeup, getting ready in the mornings. Um, and definitely transitioning into the hospital. Some people knew me from social media, some people were nice about it, some people were not very nice about it. Some there are mean girls in nursing, unfortunately, but um did you ever had to toe the line with management? It's like, you know, HIPAA or privacy or I'm a very big I don't film in the hospital. Like I never, never, never I try not to. Okay, and try means like 99.9% of the time I don't film in the hospital just because I don't want problems. I love my job. As a C VICU nurse, like I love what I do, I love my job. I'm sad that I have to leave in the future, but I love my job and I don't want to put anything at risk or put patient information at risk. Never ever. You'll never catch me like talking about like a specific case that I worked in. For me, it's very broad and yeah.

SPEAKER_00 32:05

But the only exception was your uh your grandma, right? Yeah, but she wasn't technically your patient. No, that's my family.

SPEAKER_01 32:10

And my grandma, it was funny because when she was in the hospital, like the RTs and the nurses would be like, I saw you go viral on TikTok.

SPEAKER_00 32:16

That's what I mean. That's what I mean.

SPEAKER_01 32:18

Like, I saw you go viral on TikTok.

SPEAKER_00 32:19

Did you tag your grandma?

SPEAKER_01 32:20

Like, that's gonna be she commented for sure.

SPEAKER_00 32:22

She commented.

SPEAKER_01 32:23

But it was funny because the RTs would be like, Oh my god, I just she was my patient like two days ago, and I was like, So cute.

SPEAKER_00 32:29

Do you see a trend? Do ICU nurses go somewhere else?

SPEAKER_01 32:32

Yes. I I actually was talking about this with one of my coworkers that like a lot of ICU nurses, it's a very hard for, like, it's extremely hard on the body, on the mind. And sometimes they do leave because it's a hard job to do for forever.

SPEAKER_02 32:46

Yeah.

SPEAKER_01 32:47

Um, and I think now more nowadays it's more like common to leave ad to advance practice or to go to CRNA school or to pursue like Botox and Fillers are at like an all-time high because it's like what's in right now. It's are it's the it's the trend. You can make money from it. It's it's beautiful, it's girly. Like women love to go to that, and so do men. But I think that's more common.

SPEAKER_00 33:08

That makes sense. I mean, I I I have a lot of friends that go to CRNA school. Yeah. And so yeah, on average, what do you think um is like the average lifetime of a C VICU nurse? Like, because everyone I guess not everyone, but a lot are using as a stepping stone.

SPEAKER_01 33:22

Yeah. I want to say average would be like three to four years. You've seen, yeah.

SPEAKER_02 33:28

Yeah, but yeah.

SPEAKER_01 33:29

There's some nurses that they really do love the field, and like I work with nurses that have been on my floor for like 20 plus years, but also management takes a big part in that. Like, your manager is truly what determines the culture of your floor, and I have an incredible manager. She's really done such an amazing job with how we treat each other, how we work as a team, how we like communicate with each other if we have a problem. I think she's done an incredible job. And I think that's why she's retained so many nurses on her floor. Wow. Yeah. And I'm sad to leave to go to CRNA.

SPEAKER_00 33:58

All right, guys, that wraps it up here for BedPed Manter here with Sam. Thank you so much for joining us.

SPEAKER_01 34:02

Thank you for having me.

SPEAKER_00 34:03

Tell all the listeners where they can find you, follow you.

SPEAKER_01 34:05

So on IG, I am Sam D-E-1 Toro. So it's like Del Toro, but replace the L with a one. And then TikTok at Sam.del Toro.

SPEAKER_00 34:14

Sam.del, like del Toro.

SPEAKER_01 34:17

Like the insurance.

SPEAKER_00 34:18

Oh, okay.

SPEAKER_01 34:18

Like Del Toro Insurance?

SPEAKER_00 34:19

Oh, Del Toro or Del Taco with the R.

SPEAKER_01 34:21

Yeah.

SPEAKER_00 34:21

Okay, well, I just love tacos. Anyways, thank you so much for joining us. Thank you for having me. All right, guys, thanks so much for watching or listening. And as always, like, share, and follow. And always remember don't let the bed pass bite.