Telemetry Techs vs. Nurses

Specialties Cardiac

Updated:   Published

Who's better at reading rhythms?

I say the techs (I'm an LVN and a monitor tech by-the-by).

I hate nurses who can't tell the difference between a Wenckebach, a Mobitz II, or a dissociated AV freaking block.

We have two places for tele: my ward and ICU. ICU can watch both theirs and ours and we can only watch ours. But I know that when I watch tele, the nurses are relying on me to catch changes in their patients. I sti in my own room, with two monitors. I can have *thinks* 27 teles at once, and the nurses need me to know what's going on and alert them to changes.

A great example of that is at shift change. Maybe a nurse has been off for a few days and has never had this patient before. While they are getting report, the tele tech going off and the tele tech coming on are watching the rythms and if something happens, it's up to us to tell the nurses.

My feeling is this: once I've told the nurse what happened, it's in their hands. I appreciate it when they come dow to keep tabs on their patient, but if I don't hear back from them, I don't feel blown off. I feel like they have the problem in their hands and are dealing with it the way they have to :).

Perhaps the OP should be specific about what kind of nurses they read rhythms better than. Sure, a m/s nurse with 8 patients without monitors all over the place will need to rely on a tele tech. But as an ICU nurse, I knew every rhythm and caught them. If one of my patients went into a bad rhythm while I was in another room, it popped up on the screen. Even better than knowing the rhythms, nurses know the reason for the rhythm, and the treatment. Tele techs were hired for a reason, to do things the nurses don't have time to do, because they're too busy taking care of the patient. Wouldn't it be nice if you're job only entailed knowing rhythms............really hard that is :chuckle

Specializes in Med-surg, Critical Care.

I have worked in a hospital that did not use monitor techs, but rather, had decentralized nursing stations where the nurses sat to chart, prepare meds, do other paperwork, etc. There were 2 nurses per station. We were responsible for doing our own monitoring, and could customize our patients' boxes on the monitor so as not to confuse with another nurses' patients. It was very nice, we had just updated to a new system which was the most up-to-date technologically in our entire state.

I have recently moved, however, to a facility which utilizes monitor techs. It has been a difficult switch and I think I've made some of the techs nervous as I'm so used to watching my own monitors I am a frequent visitor over at the monitor station. I have found good on both sides of the fence. For one, it is nice to be able to watch your own monitors, make your own interpretations as it can be subjective at times. Our monitors at the first facility would alarm at every monitor on the floor if it were a critical alarm, just in case a nurse wasn't present at the one station, so someone would see it. We carried individual "cell" phones to use for contacting docs, family, etc., and another nurse would call us if a critical rhythm was noted and continued to alarm. It was very nice.

I have also found it nice to know that someone is watching the monitor continuously, though. Our monitor techs are not overbearing, at least on the nightshift anyway, and can be most helpful. I agree, they are very knowledgeable about the rhythms, but would you really want it any other way? I wouldn't want a tech sitting there who couldn't tell the difference between V-tach and SVT, or a CHB and Weinkebach. So I think it can go both ways, it just is what you are used to and prefer. I worked it both ways and found benefits to both.

This sums up your entire post..

you sound like a frustrated LPN who doesnt feel she gets the "respect" she deserves. You have to give it to get it.

"Phones? Man I wish I could just phone the nurses rather than having them blow me off face to face.

I'd rather be a fascist tech than an old battle ax nurse."

Specializes in cardiology, oncology, telephone triage.

"In nursing school, my fellow classmates got 2 days in class. Then, when we were hired, we had 2 days of orientation to cover rhythms."

_______

i'm jealous, that is 1.5 days more than i got in school and 2 days more than i received in orientation.

Specializes in CCU-ICU, Informatics.
It's their (my) JOB to tell you that the leads are off. You disliking it DOESN'T matter. Would you rather have us tell you that the pt is in V-fib when it could just be an artifact. Of course, if all 5 leads were on, we could distinguish the strip better.

As for for the batteries, I think your charge nurse, nursing manager, and MD WOULD WANT YOU TO REPLACE that battery....You know, just in case the pt codes and FOR LEGAL purposes, your unit's covered.

It seems to me that you have some underlying issues about your job or how you feel about your role in the unit becuase you are coming across a little hostile. I am a coronary intensive care nurse and know my rhythms in and out but I sit and look at a monitor a lot more than the average nurse. As with any aspect of nursing experience is your best friend.

Who's better at reading rhythms?

I say the techs (I'm an LVN and a monitor tech by-the-by).

I hate nurses who can't tell the difference between a Wenckebach, a Mobitz II, or a dissociated AV freaking block.

I say, usually the tech who has had the training to read them. That's because if she/he is trained, they specialize in this and this is all they do. Nurses have a general training and can't really specialize in anything, because there is a lot of ground that she is supposed to cover and know. I have had the training, and as the nurse, I still can't sit down and say "this is this" because my mind is overwehlmed with lab values, medication side effects, disease symptoms, patient concerns, doctor-nurse communication and overall politics of working in an institution.

Specializes in Nursing assistant.

dear Jube1:

You know alot about what you know alot about....I would die to be as smart as you are...

Wisdom is understanding that though you are proficient in you area, the nurses and doctors know the big picture. You respond to the monitor accurately and urgently, and they need that info from you, but their response to that info is based on alot more: a broader education and a whole butt load of been there done that.

Once upon a time, I was a monitor tech at a Level 1 trauma center. Our telemetry unit was located in the CICU, consisted of 2-3 techs, monitoring well over 100 patients on multiple floors including ICU's.

The criteria to become tech was basically passing the hospital's telemetry test. Not an easy task. Few could do it outside of that 3-4 month telemetry course, but some could. I did it. A lot of the techs were EMT's as well with ACLS and the telemetry course. Some had no other credentials than a tele course, but had years experience with patient's rhythms. Other's were in-transition through other medical programs.

I never recall telemetry techs calling a nurse to inform them that their patients "JUST HAD A PAC!" or "BIGEMINY!" .. we made documentation of it and that floor received a faxed copy of our telemetry report near the end of shift. Techs watched so much more than rhythms. Sp02, NBP, ABP, TBlood, or anything that could be placed in the room came up in the patients window at our monitors, including multiple leads. We observed everything, not just ectopy, but axis deviation, ST changes, Long QT, ect. We could "trend review" blood pressure and oxygen sats for up to 48 hours on our system.

However, we did often call in regards to leads and batteries. Nurses hated this. But here's why: We often struggled with "4 West" --- the nurses on that floor seemed to feel that they were adequete enough to watch their patients and had that entire "I know more about this patient that you do attitude" --- So I came on to shift one day, and the tech leaving informed me that multiple patients were off their leads, as usual. She reconnected as many leads as she could before she went home. Some leads came back off. I called and called. Eventually their secretary told me "Yeah, they're aware of it" and hung up. I finally got relief a couple hours later and took a break and headed down to 4 West. One of the patients was a younger woman. I went into her room, and she was dead. Full code. Seemed she had been dead for probably well over an hour. Diagnosis, Brugada syndrome.

It's not always the critical care patients who code.

I'm not saying technicians are more knowledagable than nurses. Just remember, they sit their and interpert cardiac rhythms for hours on end and become familar with each patient through their vital signs. They only know what they see on the screen, and if it's changed, they are going to inform you. If the leads are off, they are going to inform you. They have a job to do too, and a nursing supervisor to answer just as you do, and they can't do their jobs if the patient's leads are off, or the battery is dead.

Ultimately, the liability falls on the bedside nurse. Techs know this and are their to help cover your tail. Some nurses without prior experience with monitor tech's are very stand-offish to the idea. Why? If you are truly interested in that patient's well-being, then I would suspect you would agree that two sets of eyes are better than one, especially when one set is a constant. Nurses who have experienced telemtetry techs seem to embrace them.

By the way, the hospital I worked for never really used those pesky old-school monitor boxes that printed out actualy rhythm strips. It was a flat-screen monitor with patient windows, you could pull up a patient window and get about an 8-lead view along with all vital signs, respirations, sats, and anything else in real-time. It had a "wave review" option and you could see every single heartbeat that patient experienced in the last 48 hours, including all alarms, 99% of them artifact, as well as trend reviewd for all other vital signs. Good technology.

very interesting, exciting and challenging events in your discussions.

despite the conflict, I think that these areas are good for nurses who are interested. Keeps one alert. I am also learning from your discussions.

Telemetry techs, R.Ns, LPNs, we all are there for the patients well-being.

Be good.

i think one thing that is forgotten is just because the strip says the heart is doing this or that via electrical stuff, does not mean the heart is physicaly doing this or that. as a tech your job is to inform the nurse of what you see thats it. a lot of odd strips show say VT but the tele is picking up 2 beats for every one real beat. so if the nurse went and checked out the patient and come back and said no he/she is not in VT you the tech will get mad and say the nurse is wrong. even if you are right as the tech. who are you to say anything to the nurse. it is the nurse that is responsible for the patient not you. if the nurse does not know what he/she is doing so be it. your job is only to inform. if the nurse missed something or miss read something it is the doctor that will say something not the tech. if there is a real danger to the patient the tech should inform the manager. JUST INFORM. look at it this way if you argue with the nurse you are interfering with their job and taking away from the patient weather your right or wrong in the end the patient suffers because you want the nurse to know you are right. if my tech kept trying to argue with me weather i am right or wrong they are distracting me from giving my patients the best care i can. with that scenario the tech would no longer be benifical to patient care but, become a obstruction and need to be removed. dont get me wrong i love the tech's i am working with. but i dont tell the doctor his/her diagnosis is wrong. just inform the doc of what i see and did, i dont argue with his findings just report mine. if there is an issue of competency there are steps that can be taken none of which involve arguing with that person. all you can and should do is report it via talking to the manager and/or doing a incident report "again reporting-informing not arguing" do you fill the nusre needs to tell you your right. thats not part of either of your jobs. is it possible your wrong and the nurse is right? was this rhythm expected due to disease proccess or medications? is the pt going in for a pacer later or other procedure? all of these questions are for the nurse to review not you as the tech. if you just do your job there is no reason to hate. maybe it can be a pain but still no reason to hate. as far as the leads falling off well why bother the nurse with this. tell him/her that problem and let it be. if they dont fix it just make out an incident report. that will help the patient more than arguing. if its not worth making out an incident report then its not about patient safty its about your ego. if the nurse knows you will report whatever happens or didnt happen i am sure they will be more receptive when you inform them of a potential problem. problem fixed with out ever having to get mad. seems to me your not arguing about the patients condition just about you being right and the nurse being wrong. i mean viewing the 12 lead just to see if you were right. did you look to see if the patient was in distress or just look at the 12 lead to see if you were right? hell even doctors dont agree with eachother. one might come in to do a consult but the primary doctor does not agree with their findings, the consulting doc. does not argue with the primary doc. to prove he/she is right, just reports what they are interpreting as should you. a discussion of the findings is good, but its the primary care giver that has the final say and you should respect that and not interfer with their conclusions.

I kept getting repeated calls on one patient about his leads being off. Kept replying I was working on it. Fact was, I was chasing the man down the hall, trying to get some clothes on him (his bare behind and bare other bits were a bit distracting to others in the hospital.) Trying to get the bleeding stopped from his pulled out IV. Frankly, his IV leads weren't my first priority. And if I say I'm working on it, I'm working on it. Stopping me repeatedly to tell me his leads are off is just making it take longer. So then they call and tell me that if I don't immediately put his leads back on, they're calling a code to the room. I thanked her and said I looked forward to having the code team's help. Perhaps the ER doctor will be able to convince him that his member should be covered when he's standing in front of the elevators.

That said, I've sat in front of monitors watching looooooong pauses and knowing who's on the floor they're calling to check on the patient, and knowing that nurse is too lazy to get out of her chair and check the patient. (I've seen the nurse call into the room on the call light system and ask the patient to put their own lead on.) So I get the frustration. But when they say "wooh is working on it," well y'all know me. And you know I take care of my patients, so believe me when I say, "I'm working on it!"

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