Floated to Tele, no experience...

  1. 3 I work per diem as an agency nurse. My specialty is med/surg. A few times I've been floated to Tele/DOU. I am clueless regarding cardiac issues and rhythms. I had to ask the charge nurse what I should do every time the monitor tech called with a rhythm change with my pts. I had to get someone to review and sign off on my strips at the end of the shift. I spent the entire night asking questions about what to do and trying to understand why. It's not safe and I don't feel comfortable taking others word for what to do regarding pts that I am responsible for. I'm going to ask the hospital if there is a class I can attend if there is a chance I will keep ending up in working Tele from time to time. Just wondering if anyone knows of any good material that I can use to teach myself the rhythms and nursing interventions or something that will give me a clue. Staffing doesn't understand when I tell them I dont work Tele. They say it's like med surg and that I just need to get someone to sign off on my strips. I'm expected to be flexible since I'm agency and I dont want to get put on the do not return list. So I have decided to take it upon myself to learn enough to function on a Tele floor. Any advice would be appreciated. Thanks.
  2. Visit  RNewbie profile page

    About RNewbie

    From 'Southern California'; Joined Apr '10; Posts: 407; Likes: 279.

    14 Comments so far...

  3. Visit  Ashley, PICU RN profile page
    3
    A basic EKG interpretation course would help you learn a lot. If you're more interested in learning the interventions- particularly for emergency situations, ACLS certification will be very helpful. You'll learn the rhythms, what preliminary interventions are attempted (vagal maneuvers for SVT, etc), what medications are given, and how to respond in a code situation.
  4. Visit  Been there,done that profile page
    2
    American Heart Association has the best info.
    I was in the same situation many years ago. It is a very uncomfortable feeling. Your agency or the hospital should provide you with a course . I wouldn't suggest a self taught program, telemetry interpretation is complicated.

    Just remember when handed a strip... do a quick assessment of your patient, inlcuding vital signs and check for chest pain , palpitations or shortness of breath. Then have the charge nurse interpret the strip and have her tell you what the rhythm is.

    Good luck!
    nursefrances and lindarn like this.
  5. Visit  ChaseZ profile page
    3
    We handle situations like this, usually when nurses are pulled from other floors, pretty much the same way. The Tele nurses are each assigned one of the pulled nurses patients and must sign off on the strips and keep an eye their monitors. It may not be ideal for either nurse but it really is the best thing you can do in the given situation. Just my opinion, regardless of your speciality you need to have a very good understanding of basic cardiac rhythms. In my experience as a monitor tech we have more codes on med/surg floors than on cardiac. Nothing is more frustrating than calling a med/surg nurse and telling them their patient is in ventricular escape in the 30s and them having to first ask what that means and then ask what they should do about it.
  6. Visit  Been there,done that profile page
    2
    Quote from ChaseZ
    We handle situations like this, usually when nurses are pulled from other floors, pretty much the same way. The Tele nurses are each assigned one of the pulled nurses patients and must sign off on the strips and keep an eye their monitors. It may not be ideal for either nurse but it really is the best thing you can do in the given situation. Just my opinion, regardless of your speciality you need to have a very good understanding of basic cardiac rhythms. In my experience as a monitor tech we have more codes on med/surg floors than on cardiac. Nothing is more frustrating than calling a med/surg nurse and telling them their patient is in ventricular escape in the 30s and them having to first ask what that means and then ask what they should do about it.
    The nurse asking a telemetry tech what to do should never happen.
    That unit sounds like a mess.
    You could go a long way towards resolving that unsafe situation.
    Make yourself aware of the nurses that you know are not trained in telemetry.
    Any rhythms that require attention , notify the charge nurse and the patients' nurse at the same time.

    There is no excuse for a delay when an unstable patient needs an intervention.
    I bet management will appreciate your proactive measures
    CCL RN and lindarn like this.
  7. Visit  JaneSmithRevisited profile page
    0
    I don't know if you carry telemetry pagers on your floor but if you're NOT formally trained to interpret ECGs don't take the responsibility on that piece of care... talk to the charge nurse if they or someone who is ECGs trained to carry the telemetry pager while you provide the non-telemetry care. It's not worth losing your licence over if something does happen to the patient-- telemetry wise. There's always other jobs and angencies out there.
  8. Visit  tiffanyleigh0212 profile page
    0
    our hospital doesn't allow pulled nurses on our floor unless they are from another tele unit and have been through the certifications. if your hospital does allow that, i think they should at least provide adequate training.
  9. Visit  delphine22 profile page
    1
    We often have float nurses on our floor, it's hard to give report to them bc they are pretty clueless about post-cath orders, groin assessment, etc. Though when I floated to ortho I was just as bad, and had to cry to the charge nurse to set up traction for me. :-P

    It's SOP for the charge nurse to take care of your strips. Just go to the monitor tech at the beginning, let them know you are not comfortable with rhythms and have them page the charge nurse instead of you if there's a problem (tell the CN first of course lol). Though you are an RN and know that VFIB is bad, etc. It would be great to educate yourself more, and you may even be paid more for ACLS in some areas. But it's not uncommon, or unsafe, and probably won't change any time soon.
    NurseNightOwl likes this.
  10. Visit  Dobeigh profile page
    1
    I really love the Basic Arrhythmias book by Brady. Here is a link: Basic Arrhythmias, 7th Edition: Gail Walraven: 9780135002384: Amazon.com: Books

    You work your way through the book from easiest to hardest. This is the book they used to teach nurses telemetry where I work.
    NurseNightOwl likes this.
  11. Visit  renardeau profile page
    3
    I agree with all the other posts about ACLS being super helpful. I kept my huge med-surg book from nursing school and find the cardiology sections very good review as well. I can't suggest any books as most of my training was through ACLS and then on the job, but this online tool helped me a lot and I return to it frequently when I'm bored and have a few minutes to burn.

    ECG Simulator | SkillStat Learning - Fast, Fun and Effective!
    gs776, NurseNightOwl, and HappyWife77 like this.
  12. Visit  lilredrunner profile page
    0
    Quote from Ashley, PICU RN
    A basic EKG interpretation course would help you learn a lot. If you're more interested in learning the interventions- particularly for emergency situations, ACLS certification will be very helpful. You'll learn the rhythms, what preliminary interventions are attempted (vagal maneuvers for SVT, etc), what medications are given, and how to respond in a code situation.
    Would definitely second the ACLS suggestion. The AHA has that certification as a very valuable learning tool. Also look into if there are any classes available at local colleges for ECG strip readings, or cardiac classes. Many community colleges with EMT/Paramedic courses offer them for health professionals.
  13. Visit  HeartRN_09 profile page
    0
    I also do some agency work. My agency has a policy that does not allow med-surge nurses to float to tele/stepdown or tele/stepdown nurses to float to ICU, etc. You can float to an area of lower acuity than you have training for but not higher. That just doesn't make any sense. (It's also a bad idea to float an ICU nurse to med-surge ) Ask for training or refuse the assignment. I also agree with a previous commentor that you shouldn't do a self study of rhythm interpretation, it can be tricky and you need to practice interpreting many strips and pass a competency exam. You also need ACLS....it doesn't do much good to be able to identify the rhythm if you don't know what you need to do about it or how it affects the pt from a hemodynamic standpoint.
  14. Visit  RnfromUK profile page
    0
    First thing is know the basic rhythms. Learn what is normal (Sinus rhythm) and what is dangerous (VT, VF, etc). I agree with the above and take an ACLS class for those. 2nd thing is ALWAYS check your patient first. If the monitor tech calls you with a rhythm change, check the patient. Are they short of breath, do they have chest pain, are they dizzy or lightheaded? What is the BP/HR and is it normal for them? Sometimes the monitor can show a rhythm that looks terrifying but when you check your patient they are simply moving around in bed or brushing their teeth. If after all these steps you are still unsure, ask a fellow RN or charge.

    In the case of a CODE....just run into the room ASAP and grab the code cart if not already there. Chances are someone will be doing compressions already but maybe you can grab the ambu bag or load up the latest lab results for the doc. Maybe run and grab equipment when asked or even be the recorder. Also bare in mind that compression are exhausting so be ready to swap with whoever is currently doing them to give them a break and keep the compressions effective!

    Cardiac nursing is extremely complicated and takes time to learn. I have been a cardiac RN for nearly 4 years and I am still learning. Good luck and dont fear tele!

Must Read Topics



Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top
close
close