telemetry for new grads - page 2
i will be starting orientation on telemetry floor soon.... i havent even started but yet i feel very stressed already... other nurses who i know have asked me where i will be working and when i tell... Read More
Oct 29, '05Can anyone recommend any "good books" that might be helpful. Would like to take a basic arrhythmia course but don't have the time. Sure would appreciate any input...Thanks Pat
Oct 30, '05I have worked Intermediate Med/Surg for almost five months and it can be very overwhelming and scary at first. I agree with everyones advice on this post, become familiar with the bp meds, lasix and potassium and mag protocols. Everyone on our floor seems to be on them. I would also get used to electrolyte imbalances, insulin (if you get drips) and PT/PTT/INR levels, alot of pt's are on blood thinners too!! You will learn alot and I feel that it is the best decision I have made. When and if you ever decide to move, you will have so much experience, hospitals will be dying to have you. Good luck and I hope all goes well. Don't be hard on yourself in the beginning, I wanted to cry everyday because of dumb mistakes (thats how we learn ). It gets easier!!! :angel2:
Nov 1, '05This is so going to sound odd..but I tell you if you have the option is it soooooooooo worth it!!!!!
If you have a local paramedic company that does their CME on telemetry..SIGN UP! Oh they are so good at teaching it!!!!!!! They see three leads and have to make choices...and they are great at it!!!! Throw them a 12...most of them will outdo a cardiologist!!!!! (trust me...I know!)
Nov 1, '05I'm on a tele floor. mostly post cardiac surgery patients, who obviously need to be cardiac monitored, but we also get our fair share of other arrythmia pt's, chest pain pt's, etc.
Had 3 arrythmia pts today
1 came in for "heart palpitations"-rapid afib in the 120s-140s. he stayed in high rates, completely asymptomatic. im glad i had a monitor to see that! plus, with no meds, just using the bedpan, he went from rapid afib to sinus brady in the 50s.
1 came in for psvt-had a rate up to the 180s. when i got her, she was well controlled w/ a cardizem drip-again, im glad the monitor was there to make sure hte cardizem didn't drop her too low.
1 came in for cp, but had a history of bradycardia-she got as low as 37!
I love the monitors, i love knowing what they are doing. If my pt has chest pain, i can see their rhythm/rate is. If a med/surg pt (non tele) has chest pain, you have no idea what their heart is doing right away.
BUT, it can make you a bit nervous, b/c they wouldn't need that monitor if htey weren't at risk for heart arrythmias!
Nov 3, '05thank you again everyone.. i appreciate all the response... i have been on the floor for a few days and i'm loving it so far... i love tele... i hope this feeling will last long...
Nov 4, '05I worked on a medical ICU stepdown (telemetry) unit for 5 years. I had 7 years of experience on med/surg units before taking the job. It took me about 6 months to feel like I was on top of things. It wasn't so much the time management as it was the many procedures we had to know. Many I had never done before (ventilators, dopamine drips, chest tubes, tubes coming out everywhere!, code blues). These are busy units. There is very little time for breaks or just stopping to chit chat with another worker. You can pretty much expect that the activity and stress are ongoing from the moment you step out of report to the end of your shift when you pick up your purse to leave. These are transition units where half your patients are possibly going to end up in ICU or are on their way out of ICU. Either way they need a lot of watching, so you have to be in and out of these rooms all the time watching and observing these patients. These patients are not that stable and at any time a problem could come up that requires immediate attention. You will need to know how to deal with these attention grabbing problems quickly and efficiently. The problem for a new grad is that you have to develop a mastery of procedures, most of which you've never done before at all, keep track of labwork on patients, know how to deal with certain frequent problems that come up and learn time management all at the same time. It's a huge task for any new grad. I have seen new grads handle it, however. You have to develop your time managment skills and learn priorities quickly. The hands on skills come with time.
Here are a few things I think would be good for you to review and be ready to act on: hypoglycemia, chest pain, respiratory distress, sudden changes in mentation. You need to know what the S/S of hypoglycemia are and what to do about them (the hospital should have a policy on this). You need to know what to do if a patient complains of chest pain, so know the right questions to ask about the chest pain, and again, what the hospital policy is for treating it if there is one. Review the steps of CPR. You will need to know how to recognize when a patient is having difficulty breathing and the steps to take if the patient seems to be heading toward respiratory distress. I suggest you write up a reference sheet to carry with you at all times that has the normal levels of electrolytes, blood gasses, and therapeutic levels of Digoxin, Coumadin and Heparin on it because doctors need to be notified immediately when these things are way out of whack. You will need this cheat sheet until these normal test results are as easy for you to recall as where you drop your car keys when you get home. These are all things you could be reviewing while you are waiting to start your orientation.
Good luck! The reason there are so many openings on telemetry units is because many nurses can't handle the constant high level of activity that goes on there. I liked it because for me it wasn't as boring as med/surg or as frightening as ICU. It will never be boring!