A Day in the life of a Telemetry Nurse?

LoveSbux · Jul 1, 2012

i'm a new grad on a tele floor (i've been working since february, on my own for 3 months now). since it's my first job i can't really compare to a regular med/surg floor but we do occasionally have a fair number of med/surg (non-tele) patients. in our whole hospital there are only 2 or 3 units that are not tele capable so we tend to see everyone mixed up. we don't get many ortho patients at all, and relatively few surgical patients though.

so--it's a 30 bed unit and our usual assignment is 5 patients. my unit specializes in heart failure, lvad, and post-transplant patients (once stable enough to come out of icu). a nurse with a transplant or lvad patient only has a 4-patient assignment.

what is a typical shift like? i work days, 7am-7:30pm. i come in, and depending on how early i am, print ecg strips, check labs, and look over my patient care summary for the day. i try to get my brain sheet organized before taking report. report is usually done by 7:30, i check to see who needs insulin/8am meds, and assess those patients first while passing meds. then i see the rest of my patients, try to chart assessments on 2-3 of them, participate in interdisciplinary rounding (with the case manager, social worker, head nurse, and sometimes physician advisor), and start working on 10am meds. after that i try to finish charting on my other patients but it doesn't always work out....then deal with lunchtime meds/insulin. between 1:30 and 2 things seem to calm down and if i had a busy morning i might not eat lunch till then. the afternoon consists of dressing changes, more meds, more charting (try to get education charting done in the early afternoon and then we do/chart a 4pm assessment as well). dinnertime meds and insulin, finish charting, etc etc etc.

how much personal care would you say you do compared to a typical med/surg floor? our floor generally has 3 techs, each with an assignment of 10-12 patients (the unit also has a 4-bed intermediate care unit and one tech will cover that area as well) though lately one tech has been dedicated to a 4-patient group needing more frequent observation (delirious, disoriented patients). they tend to take care of most bathing but if my patients need help getting to the commode or on/off the bedpan, i *think* i wind up doing it most of the time. i may be wrong, they don't always tell me if they helped a patient with that, but i tend to answer the call bells very quickly and i just do it if i'm already in the room.

how mobile are your patients? depends on the day; the majority of our patients are

elderly and come in with chf exacerbations or pneumonia and for the first few days they seem to be bed bound/chairfast. we do see a good number of post-cath patients and a lot of them were ambulatory and in good health before coming in; they tend to get up and walk the halls asap.

what are the main tasks you do during your shift? see above, i think i covered that :-)

do you feel like you are always running around, behind, or that things are more manageable? usually running around, but manageable. on mornings when i have patients with a lot of early requests or procedures or lousy vitals i tend to run behind but everything does get done...eventually....

does that help? quite a dissertation...

ivyleaf · Jul 1, 2012

Thanks! That's very helpful! How many pts did you have while on orientation? DId you have any tele experience before you took this job?

Seas · Jul 2, 2012

I am doing surgical telemetry. I have 4-6 patients (usual is 4-5, 6 is when short-staffed). It is a very fast paced, stressful environment. But I have learned a lot of things. My patients are mobile or immobile; all kinds of them. I work nights; I pass meds, do dressing changes, deal with the crisis situations where people go unstable from stable. Codes every once in a while. Do I like it? Not really; my passion lays on a different specialty. Do the other nurses like it where I work? No; everyone but about 2-3 is actively looking for work elsewhere . It is stressful, but the experience is priceless and valuable. I would say go for it. You will learn a lot.

Sorry, my post is not very detailed, but I just wanted to keep it short.

smleahy11 · Jul 2, 2012

I agree with what everyone above has said. I think it is a great place to start out. You get harder patients than med/surg but easier patients than ICU. After you get your experience, you have a lot of opportunities. You can obviously go up to ICU or ER or go down to Med/Surg if you like.

Been there,done that, ASN, RN · Jul 2, 2012

Telemetry means different things in different places.

You need to observe the flow of the unit and know the job description.

It could be anything between patients awaiting a stress test to... a patient suffering an MI and going into cardiogenic shock.

Either end of the spectrum.. you better know your stuff! ACLS prepared and know your cardiac rhythms like the back of your hand.

newstudentrn · Jul 2, 2012

I've been working on a telemetry cardiac surgical floor since February. Been on my own for a little over a month now. I have been working day shift up until this past Friday, will begin night shift Wednesday (by my own choice). Day shift seemed to be a tad bit overwhelming most days. We take 4-5 pts but typically 4. This is due to the fact that we are the CV surgery floor in the hospital, so we take all of the CABG pts after they leave the unit. Day to day it was a struggle to get everything done, and I honestly did fine until I would have times that I felt I needed to be in 2 or 3 places at one time due to actual medical issues (not just people hitting call lights for sprites or ice). The most stressful situations are definitely the days that they bring me 2 patients back from the cath lab at the same time. I have had 1 pt arterial site break loose and bleed and it scared the crap out of me, especially knowing that while I was elbow deep in this lady's groin, I had another patient across the hall who could be doing the same thing but I couldn't get to them so that was the worst moment for me. I can say that the best preparation I had for time management as a tele floor nurse was the several waitressing jobs over the years I held. I know that doesn't really paint a pretty picture, but it's the honest truth from my perspective. I recommend all new grads start out on nights for a while, you have a few more precious moments to think about what you are doing and why you are doing it. Most day shift days, I barely had time to look at lab results or review new orders. We are a very busy hospital and a very busy floor, so it's nothing for me to discharge 4 patients in a day and get them all back which is extremely stressful as well. 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.

NewGoalRN · Jul 2, 2012

Wow! Sounds like moving to nights may be the best thing for you but it also sounds like you've learned a whole lot!

As a new nurse on a tele floor, did you or have you done ACLS? Did you have any EKG reading experience and / or have you done a Basic EKG or 12 Lead EKG class and would you recommend it?

Thanks for the insight.

NewGoalRN · Jul 2, 2012

Thanks for taking the time to paint a picture of a day in your life as a tele nurse for us. You did a great job. I had these questions for you:

As a new nurse on a tele floor, did you or have you done ACLS? Did you have any EKG reading experience and / or have you done a Basic EKG or 12 Lead EKG class and would you recommend it?\\

How long was your training? Did you train with a precept and when did you get your first patients on your own? do you feel that your training was enough before going on your own? What do you think prepared you for this postions besides waitressing if anything? Would you recommend any classes?

simonemyheart · Jul 2, 2012

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.

newstudentrn · Jul 3, 2012

Our hospital requires ACLS for all telemetry floors, we also have a mandatory EKG course at orientation that I found helpful for review. My particular school program had a very extensive EKG interpretation program, so I felt pretty comfortable with that aspect before hand but a review is always a good idea and definitely was helpful.

You are very welcome! If you have any other questions you think of, let me know. I know it helps to have perspective of someone who is in the position you will be upon graduation.

newstudentrn · Jul 3, 2012

I did 90 days of preceptorship/orientation. Actually, the first 30 days was a lot of classroom work so basically 60 full days of preceptorship on the floor. I feel that no matter how long you are under the supervision of a preceptor, you will always feel that you need more time. I'm still constantly asking questions and searching policies/procedures to be sure I am doing the right thing. All in all, I feel that I was given a decent orientation.

As for classes or additional training, I can't think of anything specific. Mainly time management is the most essential part of being a successful floor nurse. Being able to decide what's most important and what needs to be addressed immediately is at the core of most of my day.