Good for you for starting in tele. I know a lot of nurses say start in medsurg, but in my opinion, telemetry is the place to start. I started in Ortho when I first worked in the hospital and it drove me nuts not knowing the heart and the rhythms, so I moved to tele as soon as I could. It is such a logical move to go onto ICU after that as well. You already know how to read the monitor, probably have already had ACLS and have participated in a few Codes. All of that is a great prep for ICU. Not starting in medsurg you have missed the GI issues patients...you will probably need help with NG tubes, rectal tubes etc, but for me, I didn't feel bad about that one bit!!! hehe
I would know the basic protocols if I were you. Know your chest pain protocol backward and forward, be very organized when managing chest pain, charting exact times you give nitro and exact pain levels and blood pressures....etc. Being comfortable with that protocol will serve you well. Often, Cardiologists like to get an EKG before nitro is given so that the area of the heart that is effected can be indicated on the EKG. Find out if that is the practice at your institution.
Know your ACS protocol. Know the enzymes, when they peak and what they mean. Know what meds are given post MI and why they are given.
Concentrate on your main population and know those protocols (or order sets). Do you have pacer patients? Post CABs?
Know where your emergency equipment is. Learn how to use your defibrillator. Where are your emergency intubation trays, your emergent chest tube trays, your temporary pacer. Are there CPR masks with bags in your rooms? When a code happens on your unit, even if it isn't your patient, get involved, watch what happens, do compressions if you need to, go get emergency equipment....you will learn a ton just by observing.
Also, be prepared, when you take report, think about what you will need to tell the Code team in the event of a code, because when everyone rushes to your patient's room, YOU are the expert. So I would definitely know the pt's history, why they are there and their general status. Who is consulted on the case?
I think you are very smart starting in telemetry. Congratulations!
Hang in there, it will be well worth it.