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Posted: Mar 30, 2008 03:46 AM
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A Newbie’s Guide to Cardiac Telemetry
It’s like a nursing nightmare. Not the kind where you end up in front of the school body naked, but close. There’s a patient in rapid atrial fib who keeps climbing out of bed in room 23. A new admit just came up from the cath lab and is cooling their heels in room 34. You hear an IV pump going off in room 24 and hope that it’s not your cardizem drip out of fluid. The family of the gentleman in room 22 keeps coming up and asking when their patriarch is being discharged as you grit your teeth and try not to blurt out, “When I’m good and ready!” And finally your charge nurse comes up to you to say, “I have an admit holding for you in the ER…oh yeah, and they’re trying to call report right now.” Welcome to chaos. Welcome to a cardiac telemetry floor.
Have I scared you away yet? No? Good. We joke on the floor where I work, that if you can make it a year here, you can make it anywhere. We also say, if they have a heart they can come to us. And it’s not far from the truth. That is what I love about cardiac telemetry: no day is ever the same. We see everything from post-cardiac catheterization patients, chest pain, hip fracture patients in atrial fibrillation and pre/post-open heart surgeries to patients who took everything in their medicine cabinet, GI bleeders and those coming off of drugs and alcohol. But the common factor is that they all have a heart. The chops you can hone on a telemetry floor will take you anywhere due to the radical diversity you may encounter on a daily basis. That is if you can survive.
So in that light, here are some survival tips for cardiac telemetry. These are not the facts, like meds and rhythms, but the intangibles that give you the ability to survive and thrive.
1. Get real. Be cognizant of the realization that you do not know everything, and probably never will. That in itself is incredibly freeing. You will continually encounter symptoms, situations and diseases where you will scratch your head and say, “I have no idea.” Luckily, that is OK. Patients know when you’re bluffing, so don’t. Go find a resource, like a fellow co-worker, a charge nurse, or gasp, …a book. Most floors have a large resource base between the above, you just have to find it and make use of it.
2. Get organized. I don’t mean Rubbermaid totes and Moleskin notebooks, but a way of organizing all of the relevant information about your patients. What’s their condition? Where are they going today? What are their meds and when? What is their history and current situation? Somehow figuring out a way to stay organized will make it easier to roll with the inevitable punches that come along. For each patient I take the time to write down diagnosis, Code status, and relevant history, time for meds, treatments, tests and current labs, along with my assessment information. While it sucks to carry a clipboard everywhere I go, I know when meds are due, where people are going and what going on with them. The other side of organization is prioritization. Learn who to see first and who can wait. Also learn how to cluster care. Doing things in a group will reduce the constant running back and forth, therefore saving you miles a day.
3. Get educated. Take every opportunity to learn new information and skills. Many units have education budgets: use them. The Integrillin rep hosting an in-service about Integrillin. Go, learn and pick up some flair and pens. Then push yourself outside of work to find new information. Professional journals, interaction with peers and even some blogs can have embedded nuggets of information that you can incorporate into your professional career.
4. Get calm. In the swirling sea of chaos this sounds like a mighty task, but there can be small quiet moments. Take the time while washing your hands to take the deep cleansing breath and blow out all of the tension. Take your breaks. Nothing leads to burnout faster than never taking a break to pee, eat and sit for a moment. It is the law, remember? More than that it is just a good idea.
5. Get ACLS certified. Knowing what to do in an emergency will boost your confidence level when the situation arises.
6. Get away. Find a way to get away. I’m not talking about the seven day Caribbean cruise, although that does sound great, but the ability to leave work at work. Figure out the way that works for you to do this. I commute by bike and even when I have had an incredibly rough shift, by the time I get home I am free. Some exercise, some meditate, others knit, read, work on cars, spend time with their children, blog, whatever it takes. Make this as much a priority as you can. We inhabit an environment that can be very draining; taking the time for yourself is the way to recharge. A cruise never hurts though.
7. Get healthy. Yes, I know, broken record. Eat right, stay hydrated, stop smoking, exercise. But really this ties into #6. Enough said, we’re all nursing-types and should know this already. Heck, I like a greasy burger and a beer every now and then, but it’s not something to do every day. Get it?
8. Realize it will take time to become both comfortable, much less proficient. We all struggle in new situations; it will take time to get used to this new world. Don’t be too hard on yourself if even at 6 months in you’re still having issues. We all do. It doesn’t make you weak, slow, stupid or unsafe (well there are exceptions, but): it makes you human. Keep at it. Figure out your weak areas. Is it time management? What about assessments? How about getting out of patient rooms in a timely manner? Figure it out and start to work on it. Make a conscious decision to change that each time you work until the first goal is accomplished, then go to the next.
9. Get mentored. Your unit may not have an official mentoring program, but you can always find someone to unofficially. Find someone you work well with and feel comfortable asking questions of. It doesn’t have to be a formal thing, more an informal thing where you have someone to turn to. Another perspective on a problem can make a world of difference.
10. Get help. When you need help ask for it. Like above, an extra set of eyes and thoughts can shed light on a situation.
Meds we can learn. EKG rhythms we can learn. In my experience these tips are the things no ever gets taught, they have to be learned on the job. That can be a long frustrating task with many wrong turns along the way, but hopefully this provides a road map of sorts. Good luck. Telemetry is a great challenge, physical, intellectual and psychological, but a rewarding one. There are many great moments, families you touch, patients you help, the ones you win, the ones you lose, the ones you want to forget and the ones you remember. They’re all here. Are you ready for the challenge?
Here’s a bonus tip for y’all:
What’s in my pockets at work:
bandage scissors
forceps
penlight
tape
alcohol wipes
tele pads
sharpee marker & highlighter
calipers
a couple of flushes
stethoscope
PDA (on occasion and not necessary)
pens
ID Badge
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So true. I worked a tele floor right out of school, and loved it. The variety, the never ending admits/discharges, the calm in the chaos. You have to find your moment, they do exist. Well said, and should be a must read for any nurse considering telemetry.
