Congrats on your new job. I have worked in Tele since I graduated in 2007, and I LOVE it. It is stressful, but always a challenge, and I am never bored.
As a new grad it is really scary to be a "real" nurse. I quickly realized how much they don't teach you in school. I had to learn lots of stuff on the job, but I had my preceptor there so it wasn't so bad (FYI, you will never know everything so you will always be learning).
Here is my advice based on my own experience:
1. If you don't know, ask.
2. If you are not sure, or have never done a procedure, get help.
3. Make friends with your telemetry monitors. I am always calling them if I see a wierd rhythm to get confirmation that I am right.
4. Know your basic rhythms as well as the abnormals like afib/flutter, heart blocks, etc. Your EKG class will help you with this. In addition to my EKG class, I spent a shift with the monitors to reinforce what I learned. If you are not schaeduled to do this, ask to do it. I learned alot from them, they are specially trained to see things we may miss.
5. Know your basic disease processes like CHF,COPD, diabetes, acute MI, STEMI, GI bleed, and stroke. You get all kinds of patients in telemetry, not just heart specific.
6. Know basic classes of heart meds; beta blockers, ACE inhibitors, calcium channel blockers. Know anticoagulants, insulins. Also know drips your patient may be on like NTG, amio, dopamine, dobutamine, heparin. Diuretics like lasix are important as well.
7. When you give antihypertensives like lopressor, toprol, or coreg, ALWAYS check B/P and apical pulse before you give it, you don't want to give it if the pt has a low B/P or pulse. Ask your docs for parameters if they are not already ordered (they will often say hold med if B/P is less than, or pulse is less than). Keep in mind that diuretics and IV pain meds will lower B/P also so be careful if you have to give these.
8. Assess your patients! Do not ever take the previous shifts assessment for granted! Not that they are not doing a thorough assessment, but they could miss something or the patients condition could change (I once had a nurse report a red sacrum to me, and when I looked, it was a stage II ulcer). Always check vitals too. I look at vitals at the beginning of every shift, and follow up with the CNA's for updates.
9. If you need to call a doc, have all the info they need at hand, they hate when we have to look something up (this is where your patho will come in handy). Be ready to state the reason you are calling, the reason the patient is here, the current vitals, pertinent labs, any other important info (eg chest pain, gave 3 doses nitro, no relief in pain).
10. Realize you are learning. It's not going to happen overnight, but with every day you will learn something new. Be proactive. Ask to have the other nurses get you to learn a new skill, or do a procedure. Ask lots of questions and don't worry that you are being annoying. We all started out this way.
11. Get organized. Develop a brain sheet to help you with meds treatments, assessments, etc. It takes time to perfect it, but I have seen some good ones on this site.
12. Don't get stuck on getting your tasks done. Take the time to stop, listen to your patients and family, educate them, and develop the critical thinking skills you need to spot the potential problems that could arise.
I could go on, but I won't.
Good luck in your career, let me know if you have any more questions.