A Day in the life of a Telemetry Nurse?

Specialties Cardiac

Published

Hello, I'm considering applying for a job on a tele unit and am interested in learning more about telemetry. If anyone could answer these questions, it would be much appreciated!

What is a typical shift like?

How much personal care would you say you do compared to a typical med/surg floor?

How mobile are your patients?

What are the main tasks you do during your shift?

Do you feel like you are always running around, behind, or that things are more manageable?

Thank you!!

Specializes in Cardiac.
I get to work about 6:45, get my pt assignment for the day. I look up the H&P, consults, order's, labs, VS hx - to not trend or change.

I go and look in on my pt's rooms to make sure no one is in distress and assess who is the most critical.

I get report on my pt's during walking rounds, I check IV sites, IV tubing, rates of drips. Who's on a drip, who's getting antibiotic or other IV fluids, who's on maintenance fluids. Is there any out of date tubing, IV's, is everything labeled.

I only really write down in report info that I have not looked up and all the nurses know that I do this so it's no longer a problem.

We do not have doctors in our hospital at all times so I like to call the MD's in the AM regarding orders I may need - pt in pain -need pain meds, low H&H as compared to previous labs, a decline of of pt's condition, Dr. So and So has cleared this pt can they be DC'ed, clarify meds, etc.

I like to it this way b/c our floor gets crazy busy and it's easier to do whatever I can earlier.

I pull my meds, grab supplies, and to my morning assessments. I make sure I focus on lung sounds - with IV fluids I hate fluid overload, pulses, perfusion, O2 sat, VS, heart sounds, LOC, all that good stuff.

In between all this Im being called away for phone calls, pt in pain, pt has nausea, demanding family members who want to know why my grandpa who just had a stroke is NPO, critical labs coming in, some pt's heart rate is in the 30's, Im getting a new admit when I already have 6 pt's...........

After all this maybe I have time to sit down and chart, while Im charting the unit director wants to know why I'm charting when I could be the room talking to my pt about there life - BECAUSE I AM TRYING TO SAVE THEIR LIFE AND IF I DON'T CHART YOU WILL BE ASKING ME WHY HAVEN'T I CHARTED YET.

Then their are random people who want to know if grandma can have more vanilla ice cream but can I make it look like a sundae and mix it with chocolate pudding with crushed graham crackers on top. And of course I have to jump up and do it because we have to keep those HCAP scores up and my favorite thing to do is play waitress.

Pt X spent all his time asking me questions about anything and everything and I answer but not to his satisfaction and then the doctor comes in and gives him the same answer but he forgets the rest of his questions and is on the call light wanting to know more answers when he could have asked to the doctor 30 seconds ago but he tells me that he doesn't want to bother the doctor because he is too busy. Yeah, like I'm not.

That's my day or at least the first 3 hours, the other 9 are just as bad.

WAIT A MINUTE.........Do we work at the exact same place? Haha! Your day sounds just like mine! I especially love the sundae part, because ya know waitressing is what we became nurses to do, right?

0 Votes
Specializes in Trauma and Cardiovascular ICU.
With all that being said, I can say that it is a good place to start out as a new grad to get some experience and then move on. I could never see myself doing this long term. I think I would end up hating nursing and either be a horrible nurse or find some other profession.

Nail on the head... for me at least.

0 Votes
Specializes in Trauma and Cardiovascular ICU.
WAIT A MINUTE.........Do we work at the exact same place? Haha! Your day sounds just like mine! I especially love the sundae part, because ya know waitressing is what we became nurses to do, right?

It's like the perfect blend between a server, a drug dealer, and a customer service rep. Maybe add in an information booth too.

0 Votes

I had five years as a paramedic (all patients on portable monitor and the majority getting prehospital 12-lead ECG as well), and I had ACLS as part of that job's requirements.

0 Votes
Specializes in Cardiology.

Well, I'm a brand new nurse on a cardiac tele floor. I'm in my fourth week. Is it busy? Yes. Is it very busy? Yes, yes. Do I like it? Uh huh. I love it. I was bored out of my mind in my last job as an outpatient lab shift supervisor, so I like this stimulation.

I start my day around 6:45 getting my computer, filling my supply drawer, and grabbing a sneak peek at the hand-off report from the ED or wherever the pt was originally admitted from. I write down pertinent stuff from here before I get report. I look in MAK and write down med times, then I take a quick look at AM labs.

If the nurses I am taking report from are nowhere around at this point, I start AM assessments and try to get them all done and in the computer, along with ADLs and a Braden score (the three assessments that need to be charted for everyone in the computer.) Somewhere in there I get report. Then I get ready for and pass 8-9 AM meds. This can be time consuming, simply because some of my patients have 10-12 meds in the AM easily, because until the fall, we still care for the CHF patients, too.

By the time I am done with all this, it is usually close to 10. I write (well, I start to write) the progress notes for the patients who aren't going home. I start getting discharge paperwork ready for anyone remotely likely to go home in the next day or so- I print out med information, dietary info, condition info, start the discharge instructions, etc. I throw them all in a folder and put them with their ADL chart in the wallaroo so it is ready when the need arises- I always get things ready ahead of time when possible because you never know when things are going to go awry.

Next it is time for noon meds or pre-meal insulins. I pass those, and by this point, I've usually done a discharge and might be taking an admission report for my next patient. Lunch? I might or might not get a chance for it, but my fellow nurses never mind watching my patients as long as things are relatively in order. Before I know it, I'm double checking my flow sheets to make sure all my last minute little-details are charted and I'm going home. Honestly, the days just fly by.

I have learned and done SO much in the last four weeks. Many pre and post caths, many pre-CABG pts (they don't come back to us- we're a pretty good-sized facility with a Prog unit.) Foleys, central lines, permacaths, IVs, biopsies, CT scans, MRIs, Echos, stroke, pneumonia, CHF, MI, pericarditis...I could go on and on. It has been a great learning experience thus far, and I expect it will prepare me well for becoming an NP- I'm even rethinking the specialty- I might forego family practice for cardiology.

Every tele unit will be different. You need to check it out, and if your unit is like mine, you need to ask yourself if you want to deal with the chaos- co-workers from other parts of the hospital have referred to my unit as the he** floor. I'm fascinated by the heart and kidneys and figured this type of floor would work to my interests. Also, I figured if I started with one of the hardest floors and cut my teeth here, everything else would be cake in comparison.

Oh, I forgot to mention that the patient load on first shift is typically 4-5 patients. Second shift usually gets 5-6. I've been working with 3 patients since about day 6 as a brand new nurse, and it is doable even with as little experience as I have. I think I get bumped up to 4 next week or the week after (we do 90 days preceptorship.)

0 Votes
Specializes in Cardiology.

Also forgot to mention that ACLS is required. I haven't taken it yet, because I was advised by our nurse recruiter not to. I will be taking it next month during the critical care consortium. I am also required to be tele certified, which will be done at the same time. As such, I am not allowed to travel alone with my patients. I either need my preceptor or a travel nurse to go off the floor with the less stable patients.

0 Votes
Specializes in ER, progressive care.
I get to work about 6:45, get my pt assignment for the day. I look up the H&P, consults, order's, labs, VS hx - to not trend or change.

I go and look in on my pt's rooms to make sure no one is in distress and assess who is the most critical.

I get report on my pt's during walking rounds, I check IV sites, IV tubing, rates of drips. Who's on a drip, who's getting antibiotic or other IV fluids, who's on maintenance fluids. Is there any out of date tubing, IV's, is everything labeled.

I only really write down in report info that I have not looked up and all the nurses know that I do this so it's no longer a problem.

We do not have doctors in our hospital at all times so I like to call the MD's in the AM regarding orders I may need - pt in pain -need pain meds, low H&H as compared to previous labs, a decline of of pt's condition, Dr. So and So has cleared this pt can they be DC'ed, clarify meds, etc.

I like to it this way b/c our floor gets crazy busy and it's easier to do whatever I can earlier.

I pull my meds, grab supplies, and to my morning assessments. I make sure I focus on lung sounds - with IV fluids I hate fluid overload, pulses, perfusion, O2 sat, VS, heart sounds, LOC, all that good stuff.

In between all this Im being called away for phone calls, pt in pain, pt has nausea, demanding family members who want to know why my grandpa who just had a stroke is NPO, critical labs coming in, some pt's heart rate is in the 30's, Im getting a new admit when I already have 6 pt's...........

After all this maybe I have time to sit down and chart, while Im charting the unit director wants to know why I'm charting when I could be the room talking to my pt about there life - BECAUSE I AM TRYING TO SAVE THEIR LIFE AND IF I DON'T CHART YOU WILL BE ASKING ME WHY HAVEN'T I CHARTED YET.

Then their are random people who want to know if grandma can have more vanilla ice cream but can I make it look like a sundae and mix it with chocolate pudding with crushed graham crackers on top. And of course I have to jump up and do it because we have to keep those HCAP scores up and my favorite thing to do is play waitress.

Pt X spent all his time asking me questions about anything and everything and I answer but not to his satisfaction and then the doctor comes in and gives him the same answer but he forgets the rest of his questions and is on the call light wanting to know more answers when he could have asked to the doctor 30 seconds ago but he tells me that he doesn't want to bother the doctor because he is too busy. Yeah, like I'm not.

That's my day or at least the first 3 hours, the other 9 are just as bad.

:lol2: Do we work in the same place??? And I love that sundae part...oh those darn HCAP scores!!! :banghead:

0 Votes
Specializes in ER, progressive care.

My floor isn't strictly cardiac. We get a lot of chest pain, CHF, HTN, a-fib, HTN and MI patients but we also get patients with pulmonary problems, coagulopathies, ARF/CRF, hyperkalemia, hypo/hyperglycemia, altered mental status, sepsis, PE, etc...but everyone is put on telemetry. It's a 24 bed unit and we'll sometimes get med-surg overflow patients, too. Typically we each get 4 patients but sometimes 5 if we are short-staffed. On a good night, we'll get 3. It can be a very fast-paced environment but there have been nights where it feels like time is standing still. Patients can be mobile or immobile...it's a mix, really. I've had some VERY sick patients but I have also had some patients waiting for a stress test in the AM. We'll prep patients for cardiac cath and we'll get them post-cath.

I work nights, so I get to work by around 18:40 to get report. Ill go through the chart to get any additional information, such as meds and med times, any new orders, pending tests, lab results, etc. If I have time at the beginning I will look at the physician's H&P but sometimes I do not have time to do that until much later in the shift.

I will go in and do my assessments, then do my med passes. I do dressing changes. I pull arterial sheaths on post cardiac cath patients. We can have drips on my floor that cannot be a on med-surg floor, such as cardizem, nitroglycerin, dopamine, dobutamine (though usually they are the ICU transfers and we're weaning them off from it), Protonix, Lasix, Octreotide, heparin (can go on a med-surg floor) along with some others. Give blood and blood products. Play all night with ordered medications to get a blood pressure or heart rate down lol, and once you do it's a great feeling. We have codes every so often.

I personally love my floor. I do not love it all of the time because some nights are horrible but overall I am very satisfied. We have great teamwork on nights on my floor and I think that really helps. Plus I have always wanted to be a cardiac nurse :) I started on this floor as a new grad and have been here for over a year now.

As for ACLS, I obtained that after I got hired. I had basic EKG interpretation skills that I acquired from school but I also went to a basic EKG interpretation course as well as a vasoactive medication course (that also covered other medications). EKG skills is definitely needed on a tele floor and also for ACLS...you need to be able to recognize the different rhythms and which ones are life-threatening.

0 Votes
Specializes in Cardiac.

I'm actually a new grad on a telemetry floor! I go off on my own at the end of this month (both excited and super nervous!)

*A typical shift is pretty busy. But even though it is so busy, I think that is where you get the best experiences. There is SO many different patients that end up on the floor so you kind of get a bit of everything. Typically, you start of pulling strips, seeing patients/assessments, AM meds, and then get around to charting and doing all of the miscellaneous tasks that are due like dressing changes, skin care, etc.

*Personal care on our floor is typically done by the patient care aids. They do the bathing, help feedings, bring trays to patients, vitals. If they are too busy to do so, the RN usually does their own accuchecks or helping the patient to the commodes/restroom.

*The patients' mobility varies. The patients are mostly elderly so they have mobility issues; but on our floor we really have no "total care" patients that need help doing everything. Generally they are patients who need help being turned every 2 hours, or help getting up to te restroom; but they can usually feed themselves, or reach for things if they need them.

*The main tasks on the floor are meds, skin cares, occasional dressing changes, things like that.

*Usually running around; but so far nothing I feel I can't handle. If I get behind i just try to replan my day around so that I can get things back on track. The nurses on my floor average 6-7 (then there are admits/discharges). I am up to 5, and it seems to be going fairly well. The day seems to go by fast too if you are running around for most of it!

Goodluck! :)

0 Votes
Specializes in Telemetry.

I started in telemetry last fall, returning Monday morning after a couple months of maternity leave.

0 Votes
Specializes in Telemetry.

That's my day or at least the first 3 hours, the other 9 are just as bad.

sooo true. this is the closest depiction to a day in the life. i'd like to also add that my floor does "tele triage" for JCAHO which means VERY high turnover. we are expected to call the doctors daily and clear out anybody w/o arrhythmias etc, which we do-resulting in DOUBLE the patients per shift. usually i end up charting/medicating 10 different patients, and meeting the requests of tea, warm blankets, and lotioned up butts.

if you interview, ask how many pt's per nurse AND how many aides! they can really save the day if they are in the mood.

0 Votes
Specializes in PCU.

Simonemyheart....I feel the exact same way you do. Word for word.

0 Votes
+ Add a Comment