Anyone else start in tele?

I started on a cardiac tele unit, and I'm still there. We're primarily an interventional unit, recovering post PCI, cardioversion, pacemaker, and a lot of chest pain r/o MI. We also get a lot of CHF exacerbations and valvular heart disease, and we get pulmonary patients as well, such as COPD and pneumonia. We do a lot of nitro, heparin, diltiazem, amiodarone, and a few furosemide drips. We take care of pre-surgical CABG patients, but they go to another floor post surgery. When patients on other floors in the hospital go into fib or experience chest pain, they come to us, so we can also get patients transferred from ortho, med/surg, general medical, and neuro. We also get our share of psych patients, including accidental overdoses and suicide attempts. Right now, the vascular patients like the fempops and carotid endarterectomies go to the med/surg floor, but we're trying to woo the vascular surgeons to send them to us. For some reason, we get a lot of renal patients too. Maybe it has to do with the electrolyte imbalances.

I can't think of any general advice, but if you have specific questions, just ask.

I also started on a telemetry/ stepdown unit as a new grad. I've been on the same unit for three years. It can be difficult at times, but hang in there. The best advice that I can give you is not to be afraid to jump in there, and ask lots of questions. It will probably take 6 months to a year for you to start feeling comfortable. You'll probably want to brush up on CHF, MI, Pneumonia, Renal Failure, Strokes and cardiac meds just to name a few. Take ACLS and a basic arrhythmia class ASAP (it will help a lot).

Tele was the only thing that I wanted to do, so that is where I started. On the floor that I work on we are also a step-down unit, which is the best part!!,. It is true the first year is the most nerve racking, but I would think that all new nurses go through that when they start. I have been working here for 8 years. My unit is fast paced and I love it!!

I started as a new grad 6 mo ago on a tele unit, and I LOVE it. Before I started I did by an EKG Made Easy book to get the basics and I reread the cardiac chapters in some of my school books just to refresh. It helped alot, I felt I had an edge on the other residents. Have fun

Hi,

Good choice!

I am on a telemetry/medicine unit (our cardiac stepdown is PCU), and I love it!!! I started there right out of school, and have never looked back. I always thought that I would not enjoy cardiac patients, but I changed my mind after doing a clinical and preceptorship on the unit I work on. The patients are diverse and their problems challenging and interesting. The nurses are great and the MD's for the most part easy to work with (meaning if I have to call them, they are easy to get along with as long as it is a legit reason to call and I have all the info they need to give orders). I was very overwhelmed at first and did have days where I left work convinced it was a huge mistake to be a nurse and that my school and the state board were crazy for giving me a license and a degree, but it got easier, and the other nurses were very helpful. I learned by experience, and that did mean that I did make some mistakes at first...luckily I never hurt or killed anyone. It does happen but you learn and move on.

I don't know what you mean by residency program, but as long as you are willing to learn, and also realize that you do not know everything, and ask lots of questions, you will be fine.

In alot of ways, once you get to be a nurse, it is trial by fire, and you really have to stop, think, and get your data before you make a decision in care. The first time I had a patient with active chest pain, I had no idea what to do, and froze. Luckily, my preceptor was there, and helped me through the protocol (EKG, NTG, vitals, etc.). My first code was really scary, but I got through it with help, and I learned what to do in future codes.

Important things for me to know:

1. Know your basic rhythms. We have to be able to interpret basic tele strips, and to pay attemtion to changes, and potential problems. I have a good relationship with the tele monitors and will call them to get feed back on a wierd rhythm, and also to let them know about what we are doing (i.e. the patient went from sinus to a-fib, and the MD ordered a Cardizem drip. This way they know to look for problems with the rate/rhythm from the med, and also to be alert to the patient converting back to sinus). Also if a monitor calls you for an abnormal rhythm, go see the patient ASAP!

2. Know your vitals. Your NA's may get vitals, but I don't always rely on them to recognize a problem ( they are often not trained to alert the nurses to abnormal vitals, just to do them). I also ALWAYS do a set if I have to give a B/P med or an antiarrhythmic (B/P, apical pulse, overall condition of the patient), even if vitals were obtained an hour ago, since things can change quickly. Learn from my newbie mistake! I once bottomed out a patient because I gave lopressor and lasix at the same time, not thinking about the potential effect (luckily the pt was OK), with a B/P of 113/78 (dropped to 82/63). Which brings me to the next point:

3. Know your drugs and what they do/ how they act. The difference between a B blocker and an ACE inhibitor. Call the doc for parameters (hold this med if SBP less than ___, or heart rate less than___). Our docs are mostly good at giving us parameters, but if I have a doubt I will call to ask to hold a med or give later. Don't be afraid to look up a drug, even experienced nurses still do it.

4. Pay attention to labs. Your labs can tell you alot about whats going on with the pt, and they are not always symptomatic (i.e. low calcium, low/high potassium, BUN, Creat, H/H) and the docs are not always aware they are abnormal until you alert them. How do abnormal labs affect the heart?

5. Never take shortcuts when doing anything, it will bite you in the rear. Always do a thorough assessment, never assume your predecessor was thorough. This is especially true of bedbound patients. Be there to turn them, look at their skin (look at every inch of them!), help clean so you know you haven't missed anything. I once had a patient who was reported to me as having a "Red but blanchable area on the sacrum" and when I looked it was a stage II on it's way to becoming a stage III. Poor documentation/assessment made it a hospital acquired ulcer that we had to pay for...Need I say more?

I could go on, but if you want more advice send me a PM.

I will close by saying that it is most important to develop the sense of caring and trust with your patients. Show you care, be happy, and enjoy the rewards.

Amy

Thanks all!

The residency program at my facility is basically about 6 months of preceptorship, classes, and other things to help new graduates or nurses transitioning into a new unit. You can rotate through different units, but I will be doing the critical care track and going mostly to the telemetry/cardiac stepdown unit. I think I will be sitting with the monitor technicians for some of my training, which I think will be enormously beneficial.

Another other tips are greatly appreciated!

Wow! A six month residency? That's great! I got two weeks.

I'm really excited about it. For the first month until I take boards, I will be a PCT. GA BON doesn't offer a GN status like some states. Other than that there are classes, online content, and weekly checklists that have to be completed. The way they explained it is intense, but I wanted to push myself. I felt like this would help me transition from classroom to bedside better. I do well with patients; I'm just nervous!

Hi,

Good choice!

I am on a telemetry/medicine unit (our cardiac stepdown is PCU), and I love it!!! I started there right out of school, and have never looked back. I always thought that I would not enjoy cardiac patients, but I changed my mind after doing a clinical and preceptorship on the unit I work on. The patients are diverse and their problems challenging and interesting. The nurses are great and the MD's for the most part easy to work with (meaning if I have to call them, they are easy to get along with as long as it is a legit reason to call and I have all the info they need to give orders). I was very overwhelmed at first and did have days where I left work convinced it was a huge mistake to be a nurse and that my school and the state board were crazy for giving me a license and a degree, but it got easier, and the other nurses were very helpful. I learned by experience, and that did mean that I did make some mistakes at first...luckily I never hurt or killed anyone. It does happen but you learn and move on.

I don't know what you mean by residency program, but as long as you are willing to learn, and also realize that you do not know everything, and ask lots of questions, you will be fine.

In alot of ways, once you get to be a nurse, it is trial by fire, and you really have to stop, think, and get your data before you make a decision in care. The first time I had a patient with active chest pain, I had no idea what to do, and froze. Luckily, my preceptor was there, and helped me through the protocol (EKG, NTG, vitals, etc.). My first code was really scary, but I got through it with help, and I learned what to do in future codes.

Important things for me to know:

1. Know your basic rhythms. We have to be able to interpret basic tele strips, and to pay attemtion to changes, and potential problems. I have a good relationship with the tele monitors and will call them to get feed back on a wierd rhythm, and also to let them know about what we are doing (i.e. the patient went from sinus to a-fib, and the MD ordered a Cardizem drip. This way they know to look for problems with the rate/rhythm from the med, and also to be alert to the patient converting back to sinus). Also if a monitor calls you for an abnormal rhythm, go see the patient ASAP!

2. Know your vitals. Your NA's may get vitals, but I don't always rely on them to recognize a problem ( they are often not trained to alert the nurses to abnormal vitals, just to do them). I also ALWAYS do a set if I have to give a B/P med or an antiarrhythmic (B/P, apical pulse, overall condition of the patient), even if vitals were obtained an hour ago, since things can change quickly. Learn from my newbie mistake! I once bottomed out a patient because I gave lopressor and lasix at the same time, not thinking about the potential effect (luckily the pt was OK), with a B/P of 113/78 (dropped to 82/63). Which brings me to the next point:

3. Know your drugs and what they do/ how they act. The difference between a B blocker and an ACE inhibitor. Call the doc for parameters (hold this med if SBP less than ___, or heart rate less than___). Our docs are mostly good at giving us parameters, but if I have a doubt I will call to ask to hold a med or give later. Don't be afraid to look up a drug, even experienced nurses still do it.

4. Pay attention to labs. Your labs can tell you alot about whats going on with the pt, and they are not always symptomatic (i.e. low calcium, low/high potassium, BUN, Creat, H/H) and the docs are not always aware they are abnormal until you alert them. How do abnormal labs affect the heart?

5. Never take shortcuts when doing anything, it will bite you in the rear. Always do a thorough assessment, never assume your predecessor was thorough. This is especially true of bedbound patients. Be there to turn them, look at their skin (look at every inch of them!), help clean so you know you haven't missed anything. I once had a patient who was reported to me as having a "Red but blanchable area on the sacrum" and when I looked it was a stage II on it's way to becoming a stage III. Poor documentation/assessment made it a hospital acquired ulcer that we had to pay for...Need I say more?

I could go on, but if you want more advice send me a PM.

I will close by saying that it is most important to develop the sense of caring and trust with your patients. Show you care, be happy, and enjoy the rewards.

Amy

:yeahthat:

A couple of things I would add:

Learn as much as you can. If presented with a disease process you have no idea about (happens a lot...) look it up. Learn to make yourself a better nurse. Whether that's meds, advanced rhythm interpretation, things that may be more ICU focused can help you be a better tele nurse.

Be willing to jump in and help, especially when you're in your preceptorship.

See the procedures that your floor performs. If you recover folks post-PCI, go to the cath lab to see what goes on. CABG patients? Head to the OR to see a surgery. Seeing the procedure live will give you a much better conception of what is happening to your patient.

I'm sure there's more, but those things have helped me in my career. 2 years and counting, all in tele.

Cheers,

Tom

Good for you. I had a 6 month preceptorship and it was great. Could of used a year but I was fine at 6 months..my hospital paid for my accn, bls,acls and phlebotomy and ekg class. and a arrythmia class...so nice

I love my patients and the nurses i work with are the best. 3-12 hour nights in a row are the best..this is from a med tech who worked 5 8 hr nights for years...enjoy and print out the reply from spatialized,,,good info

I graduated in May and have been working on a telemetry unit since July 08. Originally I wanted to work on med-surg because that's the area I was most familiar with. But there was nothing available that would fit my life at the time, so I went for the tele position. At first I was scared...we have to watch our own monitors (what I wouldn't give for a monitor tech!!!) and I was so intimidated by that. But after doing it for a while I actually came to appreciate the monitors for the simple fact that they alert you immediately to changes. Yes, there are a lot of false alarms but as long as you always check your patient, you can't go wrong. We also carry beepers that alarm with certain rhythm changes and my god they can be SO annoying but there have been times where they have been helpful. They are just more annoying than helpful and you have to make sure you don't become immune to the beeping and buzzing and just silence it without looking. I've seen people do that and that's not a habit I want to get into.

Good luck!

Please let us know how you are doing. You sound really excited and up for the challenge. Don't let things like tests, checklists, etc. intimidate you! Just remember, you are new at this, but you know more than you think you do from your school experience. I had to take dosage tests, get skills checked off, and show overall competency to get off orientation, but went through it all fine. The other nurses were great at helping, and I started with several other new grads. We got each other through the rough spots.

Tom had great advice, to jump in, observe or help when you can, and if you are not assigned to spend time in the cath lab, OR, or tele monitoring, ask to do it. My day spent in tele with the monitors was invaluable to my experience. The monitors were great; they quizzed me on rhythms by printing out strips that showed everything, and now I can spot the bad ones, and have a good relationship with the monitors, so I can call them with questions.

Also, if your hospital offers in-service training, or there is a seminar related to your specialty, go! You will learn so much from them.

Amy