Coronary Care Unit (CCU) Nurse: Core Competencies & Critical Responsibilities

CCU nurses manage acute coronary syndromes (ACS), post-PCI, post-CABG, cardiogenic shock, arrhythmias, hemodynamic instability. Requires advanced cardiac monitoring and intervention skills.

Core Competencies

Domain	Key Skills
Hemodynamic Monitoring	Arterial line / CVP / PA catheter (Swan-Ganz) waveform analysis; CI, SVR, PCWP interpretation; calibrate/zero
ECG Expertise	12-lead + continuous ST-segment monitoring; ischemia/infarction localization; arrhythmia ID (VT/VF, AFib, HB, Brugada)
Vasoactive Titration	Norepi, epi, vasopressin, dobutamine, milrinone, nitro, nicardipine — dose-adjust per protocol + hemodynamics
Mechanical Support	IABP timing/weaning; Impella (CP/5.0) management; ECMO circuit awareness (VA/ VV)
Emergency Procedures	Defibrillation/cardioversion, TCP, pericardiocentesis assist, intubation assist, code leadership
Post-Procedure Care	Radial/femoral access monitoring (TR band, closure devices); contrast nephropathy prevention; antiplatelet/anticoag management
Pharmacology	ACLS drugs, anticoagulants (heparin, bivalirudin, DOACs), antiplatelets (ASA, P2Y12, GP IIb/IIIa), lipid-lowering

Soft Skills & Professionalism

• Family communication in crisis (goals of care, withdrawal discussions).
• Moral distress resilience; debriefing culture.
• Preceptor/charge nurse progression.
• Certifications: CCRN, CMC, CVRN-BC; ACLS, BLS instructor.

Staffing & Environment

• Ratio: 1:1 or 1:2 (ventilated, vasoactive, IABP/Impella).
• Centralized monitoring + bedside alarms.
• Rapid response / code team integration.