Advice for the Transition from Med Surge to Telemetry / Stepdown Units

Medical Gore, ASN, RN · Dec 21, 2020

Hey Mickey,

Currently working on a Cardiac/Tele unit, and from what I can tell you is that you probably don't need to worry all too much. There should be a telemetry nurse who is sitting in front of the monitors all day 24/7, who will keep track of everything for you. As long as you know basic rhythms that will carry you a long way. Most floors aren't going to expect their float pool to know rhythms such as wenckebach right off the bat.

For drips and IV medications, anything which is too major is most likely going to be sent to the unit. I don't think many hospitals are going to be keeping someone who is on a lopressor up on a tele floor. It really is not a huge change from your regular med-surg floors. You might push some labetalol or hydralazine, but you're most likely going to be in good hands.

Now, don't take what I am saying lightly and think that you can slack off either, definitely know what you're doing, but don't go about stressing out over working on a new floor either. If you have questions, ask. I am sure the RNs who work on the floor will be more than happy to help.

-MG

Been there,done that, ASN, RN · Dec 21, 2020

4 hours ago, Medical Gore said:

Hey Mickey,

Currently working on a Cardiac/Tele unit, and from what I can tell you is that you probably don't need to worry all too much. There should be a telemetry nurse who is sitting in front of the monitors all day 24/7, who will keep track of everything for you. As long as you know basic rhythms that will carry you a long way. Most floors aren't going to expect their float pool to know rhythms such as wenckebach right off the bat.

For drips and IV medications, anything which is too major is most likely going to be sent to the unit. I don't think many hospitals are going to be keeping someone who is on a lopressor up on a tele floor. It really is not a huge change from your regular med-surg floors. You might push some labetalol or hydralazine, but you're most likely going to be in good hands.

Now, don't take what I am saying lightly and think that you can slack off either, definitely know what you're doing, but don't go about stressing out over working on a new floor either. If you have questions, ask. I am sure the RNs who work on the floor will be more than happy to help.

-MG

OP is asking how to manage the new position. She/he cannot count on anybody to interpret telemetry for them or just turf a patient to ICU.

Been there,done that, ASN, RN · Dec 21, 2020

8 hours ago, MickeyMarieRN said:

I'm preparing to transfer to a new hospital and will be joining the float team. I do not have any telemetry experience, but will become Tele / ACLS certified as part of my training on the float team. I will orient to all of the tele floors, including cardiac telemetry and the Covid Respiratory stepdown floor.

Ohhh and an inpatient psych floor.

I have three years of experience working at the med surge level on a very busy ortho/neuro/trauma floor. I also worked as a tech on an ICU stepdown floor for one year prior to obtaining my RN license. Have I bitten off more than I can chew? I hope not.

Please tell me all the drips, IV meds, skills, and telemetry advice / lessons that you have learned over the years. Aside from the basic tele rhythms and ACLS drugs, what else should I be studying?

Thanks in advance!

You would need an intensive critical care course in order to learn to interpret telemetry. My advice is, treat the patient ... not the monitor. If you see anything you are concerned about on the monitor... assess your patient FIRST.

As for inpatient psych, get CPI certified. Be aware of escalating behaviors and medicate early. Know how to call for help. Keep your back towards the door.

I don't know if you have bitten off more than you can chew.... but you have a lot to learn and process.

Best of luck, let us know how it's going.

JBMmom, MSN, NP · Dec 21, 2020

You probably haven't bitten off more than you can chew, but you're in for a learning curve. By changing both hospitals and roles at the same time, make sure that your new hospital understands clearly your current background and level of experience so you can get the necessary orientation time.

Obviously it's not possible here to share all of the drips, meds, skills and telemetry info that you will need here, but there are many online resources to help you in many areas. Life in the Fast Lane EKG resources is a great EKG blog/website with information. Every hospital will have different drips that are allowed on certain floors. Your cardiac floor may have cardizem, lasix or bumex drips, your step down may have phenylephrine, nitro, ativan, precedex, and you've probably already had heparin on your regular floor. I'm sure there are many others, and you will get more orientation at your new hospital.

Good luck with your new position, floating throughout the hospital will give you experience in many areas and provide many opportunities for learning. And, when coworkers see you ride in on your white horse it means they are less short staffed, so you're usually a welcome sight!! ?

TheMoonisMyLantern, ADN, LPN, RN · Dec 22, 2020

You should take a cardiac monitoring course through your employer or some equivalent and that's going to teach you the bulk of interpreting rhythms and may go over some treatments. ACLS is going to cover rapid identification of life threatening rhythms and how to treat them. You're going to learn A LOT in these classes and it can be a little overwhelming but it is all important to learn.

Do not assume that there will always be someone else to monitor/interpret the rhythms for your patients. There's just too many what if's that can happen where the ball is going to be in your court to interpret the rhythm. For instance, in my area tele techs, secretaries, etc, have all been done away with and nurses just have to share responsibility of monitoring the rhythms at the desk but no one person is responsible.

As far as what drips/pushes you'll be doing, that'll vary from hospital to hospital. In my area most of the PCU/Stepdown takes non-titrating drips, Cardizem, esmolol, dopamine, dobutamine, nitroglycerin, etc. with some units allowing titration within certain dosing parameters. May have some cardiac pushes labetolol, lopressor, hydralazine, vasotec, adenosine, cardizem, digoxin. The stepdown units around here also take chronic vents so there's a strong respiratory component too, but your mileage may vary.

Stepdown units can be really crazy because the acuity can vary widely among your patients as can their diagnoses, they can be stable one second and circling the drain the next and you usually have 3-5 patients which sounds like heaven but can be incredibly busy depending on what's going on. But let me tell you, a well run stepdown unit can be an incredible place to learn!