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Advice for New Nurse On Tele Unit

Cardiac   (3,351 Views 12 Comments)
by al7139 al7139, ASN, RN (Member) Member

al7139 has 5 years experience as a ASN, RN and specializes in Emergency.

1 Article; 8,909 Profile Views; 618 Posts

Hi everyone!

I graduated in May, and just started my first job. I am on a Tele/Medicine unit. I took this job because I did a clinical rotation there in school, and loved it. The nurses and other staff were so welcoming to us students, and really went out of their way to help us even when we "slowed them down." Because of this I decided to apply for a position. I just started work this week, and am going through orientation, so I am not on the unit yet because I have to go through some classes for the computer system, and a class on cardio, ECG, and Codes. Once I am on the unit, I will have a preceptor for 2-3 months, and will gradually have my patient load increased until I am able to "work on my own." But the more I think about being responsible for patient care, the more anxious I get. In school, you have someone there to help you all the time. I know that I will always have resources for help if I need it, now that I am a nurse, but it still makes me nervous. Is this a normal feeling? Do all new grads go through this? I know I will be a good nurse, and I am always conscious about my patients and my responsibility for them, but it seems that the more I learn, I realize that in reality, I have only scratched the surface of what I need to know.

Do any cardiac nurses have any advice for me to help me get through my first few months...years...whatever???? Help!

Amy

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All_Smiles_RN specializes in Cardiology.

527 Posts; 6,085 Profile Views

All so very normal! It can be overwhelming, but eventually you get settled into a routine so to speak. My advice, familiarize yourself with your cardiac meds. Figure out who on your floor is most receptive to new grads. Ask questions! Don't worry about feeling silly. I'm glad you are taking ECG and ACLS. Become familiar with your rhythms. This takes time, but you will feel comfortable with them. And once you start ACLS, it opens a whole new world up to you. At least it did for me. Once I earned my ACLS, I felt like I could take more control and could better handle sticky situations. Good luck to you. :-)

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Spatialized has 5+ years experience and specializes in Cardiac Telemetry/PCU, SNF.

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Totally and completely normal. In fact (hate to do this to you, but) it will probably get worse before it gets better. The first time a patient goes south, the first code, the first rapid response, heck, even the first time you sign your name on the unit. But the great thing is this: it will get better! You will get the tools you needs. ACLS, EKG interpretation, a pretty decent length orientation among other things, all of these will help you. Like said above, don't be afraid to ask questions - even if they seem minor and inconsequential.

I've been on the floor now for 7 months and I have many of the days you talk about. Has it gotten better? Yes. Do I have days where I feel like I never went to nursing school and am totally incompetent? Yes. What do I do? Learn. Take any and all opportunities to learn; from your peers, from your mentor, from journals/articles, even pull out those nursing textbooks every now and then.

The other thing I do is leave it at work. Develop a ritual that allows you to leave work at work. Me I cycle home in the morning. It clears my head, allows me to sort out the bad nights and makes me aware of the rest of the world outside the hospital walls.

You will start to get to a point where things aren't quite so intimidating, it will start to become easier. The other day, I had a patient who was post-op, having a hard time breathing. I knew what I needed (Lasix and nebs). Called the doc, got what I needed and did what had to be done. 3 months ago, I would not have been quite so sure about myself, but now I'm feeling a little bit better.

Sorry its long...

Tom

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al7139 has 5 years experience as a ASN, RN and specializes in Emergency.

1 Article; 618 Posts; 8,909 Profile Views

Thank you for your replies...you made me feel better about being a newbie on a unit that deals with complicated issues. Luckily, this unit has a great rep for awesome pt care and for the experienced staff making an effort to help us new folk! I never thought I would choose a unit that focuses on heart issues, but my clinicals were so great, that I had to work here. I am really excited to get to pt care, and I am REALLY glad that I am not the only person that felt like they didn't know squat when they started. I will definitely let you all know how it's going in the weeks ahead, and I am sure you will see my posts asking for help and advice in the future.

Thanks again,

Amy

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I have been at my hospital on the TCU/tele unit for about 4 months now. I feel like I have grown so much since graduating in December but since have days when I feel totally inadequate. My best advice is to ask. Ask, ask , ask questions to your charge nurse, resource nurse, fellow RN's. Dont be shy. Its your patients well being thats at stake. These types of units are usually fast paced and busy. Lots of transfer in and out, lots of admissions.

Try not to let the craziness get a hold. If I feel like things are moving too quickly or crazy, I take a step back and go even more carefully. You can only do so much and it doesn't help if you are stressed to a breaking point.

Keep in touch and let us know how things are going...Good luck.:nurse:

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Don't forget your med surg stuff. The patient's on a typical tele unit usually: CHF exacerbation, Chest pain r/o MI, STEMI, non STEMI, DM, poss. acute or end stage renal failure.

The only thing I hate is that tele can turn into a dumping ground. There is alot of tasks to complete and it seems like no one in management treats it as a speciality.

IMO the art of tele is understanding the medication, the psyche, the electrical and the motor and creating harmony. Everything is about balance. Water in, water out = cardiac input and output.

Stress is high within these units, you can feel it in the air. Learn techniques to help you bring down your tension so you can think clearly. It is possible to feel afraid and full of adrenaline but learning to focus it should be a goal for you the first year.

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al7139 has 5 years experience as a ASN, RN and specializes in Emergency.

1 Article; 618 Posts; 8,909 Profile Views

Hey All!

Thanks for your replies, it made me feel SO much better...I just finished my second day on the unit. What a day today was! No codes (thank God!), but VERY busy. My preceptor today was great, but I still felt overwhelmed..and I only had one patient! I never really realized how easy we had it in school! In school, we never had to worry about keeping up with orders, coordinating different specialties (Why is it that MD's expect us to be the go-between?), charting, and ensuring the patients are recieving the best care possible all at the same time. In school, we passed meds, did assessments, but we couldn't chart in the computer or receive orders from a Doc, and almost always had an instructor right there to help us. Don't get me wrong, the preceptors where I work are very much involved in what we do, except now it's ME doing chart checks, charting assessments, and making the decisions on patient needs. My preceptors are there for help and guidance, and I still don't feel comfortable doing much without running it by them first to make sure I'm on the right track, but YIKES! How am I ever going to organize 6-8 patients! I barely kept up with one patient. I really need some help with organization, and also how to delegate to my nursing assistants (it's hard to get out of the habit of doing it myself, since I am used to that) so I can get my own work done.

Any advice?

Amy

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470 Posts; 6,256 Profile Views

How am I ever going to organize 6-8 patients! I barely kept up with one patient.

You can always come to California...come January the ratio on a tele unit will be 1:4. I cant wait. That extra patient (right now 1:5) make a big difference in my opinion.

New nurse here also, 5 whole months.:thankya:

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mrod is a LPN, LVN and specializes in ICU/CCU/SICU.

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I know exactly how you feel!! I just graduated myself and passed my boards about a month ago and I started on a tele floor. This whole month is classes every day except 4 days I am with my preceptor. I have been on the floor twice, once was to "observe" and the second time I just passed a few meds and observed as well.

I am super nervous as well....my first day I was afraid and thought to myself that I could not do this nursing thing either. But I find that everyday gets easier and I cannot help myself to keep trying to put the pieces together.

I am taking advantage of this time as well, to see what people do and don't do, who to ask, who not to ask, all that good stuff.

I want to get the ball rolling here but I feel the same way you do. I will be 3 twelve hour nights and patient ratio is 4-5, (it is 3-4 during the day).

Good luck and we can do this!!! :lol2:

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al7139 has 5 years experience as a ASN, RN and specializes in Emergency.

1 Article; 618 Posts; 8,909 Profile Views

Hey all,

Just a quick update on how it's going...

The last two weeks have been a little hectic (made worse by my car breaking down). However, I am glad to say that it has been getting alot easier for me. I am feeling MUCH more confident in my organizational skills, and especially my decision making ability. I still run things by my preceptors, but usually my instincts have been right on target. I have not had my usual preceptor the last two nights, since she has been team leader, so that has been a little difficult. The preceptor I had was an experienced RN, but her way of organizing did not really gel with mine, so I was a little frustrated with it. I am up to 4 patients now, and doing pretty good with that so far.

Last night I took 3 patients, and my preceptor took the other 3. About 4:30 pm, she was called by tele monitor for a pt who was in VFib/VTach. We dropped what we were doing and went to the room. A little background: Admitted for syncope at home. Hx of HTN, DM, and ESRD with hemodialysis. Older female (70's). LOTS and LOTS of family present all the time. Not a problem...great people who love this woman tons. She had been having runs of VF/VT all day...would occ lose consciousness. On amiodarone IV, and Cardioversion. Dr. there. Checking vitals, etc. every few minutes. Came out of it on her own, then once again. During this, I asked if I should get the code cart, was told yes, so got it. Pt had a pulse, and resp, but kept having runs. The family is freaking at this point...all in hallway. We had called our medical response team, and they arrived as she came out of the last run. Did I mention she was a full code? This time cart not needed. The MD and RN's etc. left the room, family back in. The MD at the nursing station next to her rm. I did not feel comfortable leaving the pt alone, so I stayed, and tried to reassure her and family. I was there for a few minutes, and she had another run, lost consciousness. Could not rouse her, breathing agonal. I had my hospital phone, so I called my TL. Said I needed someone there NOW!!! I did not want to yell for help and scare the family more, but I probably should have. My TL said OK, she would let my preceptor know. I said please send someone stat. At this point husband and I are shaking her and calling her name...she stops breathing. No one there. I go around the corner, grab the first RN I see, and say to her and Dr. that there are no resp. We call a code and start ambu bagging her. MD shocks her, and she starts breathing spontaneously, but still not conscious. Husband decides after speaking to MD to make her a DNR. Dr. does not think she will last much longer. Family in tears, I have to go to bathroom to collect myself, since I am almost in tears. My first code (sort of ), and I made it through, even though I totally forgot any of my BLS at the moment.

Later on, some of the family is leaving, and I am in the hallway. A few of them hugged me and thanked me for my help, and I am saying to them how sorry I am for their loss, etc. She still has not exp, though, but inevitable.

Heres the REALLY freaky thing though...

A little while later, she starts to come around, and is moaning etc. We go in and she is starting to rouse, VS pretty stable. Shortly after, she is talking, and asking for water. We call the Doc, who comes and checks her, and is as perplexed as the rest of us! He said he has never seen this happen in his 20 years of practice. Of course, she still has a very sick heart, and is ESRD, but OMG, I feel like I witnessed a little miracle yesterday. I realize that she does not have long to live, but amazingly, she was there today when I reported to work, and is doing fine, and has not had any more episodes since her code! She was awake, A&Ox3, etc. all shift. Even joking around with everyone.

Has anyone else ever seen anything like this? I feel like it's a unique occurence.

Amy

Th

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Spatialized has 5+ years experience and specializes in Cardiac Telemetry/PCU, SNF.

1 Article; 301 Posts; 5,750 Profile Views

Kind of seen something similar to that.

Patient w/endocarditis, coded. woke up gasping and cursing us all. Sent to the Unit for monitoring. Came back up 2 days later and went home 5 days after that. Was a frequent flyer and it was not the first time they'd coded. Someone remarked that they "just needed a jump-start".

Sometimes it's just not their time to go...

Glad to hear that things are going well!

Tom

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al7139 has 5 years experience as a ASN, RN and specializes in Emergency.

1 Article; 618 Posts; 8,909 Profile Views

I found out today she passed away this afternoon. :( But the blessing is that she got to see her son get married, AND died at home, surrounded by a very loving family. I'm sad for the family, but very happy that she was able to say goodbye on her terms, and in the way she wanted.

No matter how hard, sometimes death can be a good thing...she was very sick.

Amy

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