Do nurses on Med-Surg/Tele have to work in the tele room?

Mrs.D., BSN · Aug 15, 2020

Hmm. I’ve never heard of a tele room. I’m a medsurg RN from Massachusetts. Our unit is categorized as “medical cardiology/telemetry”, so I’m considered a tele nurse. Every RN on the 40-bed medsurg unit is a tele educated nurse (we have to pass a class). We have 3 monitors that encompass all patients in the middle and on both ends of the floor. We all monitor the tele for our own patients for the duration of the shift. We also will check on any patient if we happen to see something ugly and we happen to be in front of the monitors when it alarms.

We’ve had a TON of travel nurses since March, and we expect them to be able to do the same. Of course you can always ask questions if a strip is troubling you—I still do occasionally. But you should know all the dangerous stuff.

I’m assuming (please educate me if I’m wrong as I’m curious about this), that for your hospital there’s one RN that sits in a room with all of the tele monitors and... calls you if they see something bad? Is that right? Then you check on the patient and confirm what was found on the tele? Do you have to do any of the strips on your own patients, or do they do them all? I’d love that ?. So often it’s a false alarm and the leads need changing. Or they’ve been NSR for two weeks and don’t actually need tele monitoring, so it’s just one more needless thing to do. It’s such a pain in the butt.

brainsarecool, RN · Aug 15, 2020

Mrs. D, thank you so much! I had no idea how this worked since my current role is my first job out of nursing school. Yes on our floor there are two nurses that sit in a room all day ?and watch the tele monitors for the whole hospital (some ppl on different floors are also on the remote tele). They call us for any abnormalities and they print off strips 3x per 24 hours. Mostly we get calls all day telling us a lead is off haha. But they've also caught when someone was coding alone in a room! The tele room nurses *only* do tele and the floor nurses hate getting put in the tele room bc we usually don't know what we're doing and constantly bug the other nurse in there for reassurance.

So a follow up question... in our tele room, monitors are going off all the time for false alarms. Does that happen with you guys? How do you even manage to step away from the nurses station in that case?! How many patients do you have?

Thank you again!

Mrs.D., BSN · Aug 15, 2020

1 hour ago, brainsarecool said:
Mrs. D, thank you so much! I had no idea how this worked since my current role is my first job out of nursing school. Yes on our floor there are two nurses that sit in a room all day ?and watch the tele monitors for the whole hospital (some ppl on different floors are also on the remote tele). They call us for any abnormalities and they print off strips 3x per 24 hours. Mostly we get calls all day telling us a lead is off haha. But they've also caught when someone was coding alone in a room! The tele room nurses *only* do tele and the floor nurses hate getting put in the tele room bc we usually don't know what we're doing and constantly bug the other nurse in there for reassurance.
So a follow up question... in our tele room, monitors are going off all the time for false alarms. Does that happen with you guys? How do you even manage to step away from the nurses station in that case?! How many patients do you have?
Thank you again!

Eventually you learn the nuances of the lines and you can read any strip at 20 paces while continuing to walk past the monitor on your way to do something else LOL. If you plan to travel, I would just suck up the discomfort of not being a master of tele and volunteer in the tele room. When you travel, especially now, you’ll be lucky to have 3 shifts training before going live. You will be expected to have your nursing knowledge, but need to be trained to the floor and the hospital’s protocols. It’ll make you more confident to be fluent in tele!

False alarms happen often from patients removing leads, artifact, and parameters not being patient/condition specific. Technically, we’re supposed to adjust parameters and leads every AM. But really we do it when we first hear the alarm. It’s annoying, but doable.

For example, when we arrive in the AM, we print a strip (they’re formally assessed Q4h), and go over any “events” that are registered (Brady, tachy, Vtach, etc.). If I were to see that there are a thousand events for tachycardia of 121, and we know the patient becomes tachy every time he walks, I’m going to adjust the parameters to 125 or 130. Since I know his baseline, I only want the warning if he’s over 130.

Also, the alarms can be set for various volumes for the seriousness of the alarm, or even no volume—but the strip will light up yellow on the monitor if it happens. For example, without parameters being set, there will be an alarm for a high rate of PVCs. If this patient is known to have a ton of ectopy without issue or electrolyte imbalances (meaning his baseline and not something we are trying to fix), I can both set the threshold for what number of PVCs I want to receive an alarm for, but also make it so that there is no “alarm” noise, but rather 1 “beep” and a yellow box around his strip. So I can look up to the monitor if I hear the beep to see if I’m comfortable with the number of PVCs and how frequently those PVC bursts are happening.

It may sound like a lot, but you learn the software and figure it out over time. You have to play with it. Customize it how you’re comfortable, and also, there are a lot of monitors on our floor, so you can have one in view most of the time. I feel like the set up you have at your hospital gives the nurse less autonomy. The RNs in the tele room don’t know the patient, so I’m wondering how they can set the parameters correctly, or feel comfortable doing so ?. I could see where that would be more frustrating I think

We usually have 3-4 patients on the 7-7 shift, but can go to 5 if we’re swamped. April was like that with so many covid patients and nurses out for various reasons. Our hospital was paying over $5k/week for travelers, though, so they all came and saved the day. It made things a bit more bearable. 5 covid patients is no bueno.

Can you guys see the tele, or can only the tele room see the tele?

Dang this is long... I had coffee LOL.

Daisy4RN · Aug 15, 2020

I have worked tele at 2 different hospitals. Both had tele rooms staffed with 1 RN overseeing the techs who sat and read the monitors/screens, one of the facilities also had screens on the unit at the nurses station. Each RN had to take a 2 day 8hr class on EKG/cardiac and pass a written test with at least 80%, if you fail you get one more chance and then you have to start over, it wasnt easy. We also read our own strips and were responsible for appropriate interventions. We only worked the tele room if someone was sick etc (which I hated). If you are doing something similar I think you are OK saying you have Tele experience. They will probably ask for any certification you have re: classes (EKG interpretation, ACLS etc). If they have specific questions they will ask you.

Good luck!