Telemetry/ IMCU Advice please!

HouTx, BSN, MSN, EdD · May 1, 2015

CONGRATULATIONS on your new job.

IMO, you are starting in the most challenging area in any hospital. It is usually the one with the most staff turnover. You'll definitely have to "lace up your skates" and be prepared to work hard. But, I can absolutely assure you that if you can work in MedSurg/Tele, you can work ANYWHERE in acute care. Nurse managers know this, so if you decide to make a change in a couple of years it probably won't be difficult.

The patient population is very interesting - multi-system illness is the rule rather than the exception. I usually advise new grads to focus on developing a deep understanding of the underlying pathophys and treatment protocols for the 'top 5' (most frequent) diagnoses for your new unit. Your nurse manager, preceptor or educator can tell you what these are. You will also be caring for a wide variety of patients, but if you feel confident with the care of those primary diagnoses, you will have a much easier and more successful transition.

Don't get too stressed about telemetry.... you've already been exposed to EKG rhythm interpretation in school. Telemetry units have designated monitor techs who do the 'watching'.... they'll let you know if anything hinky is going on. You'll be offered an opportunity to take additional EKG classes. But until you are fully competent, no one is going to expect you to take full accountability for managing unstable cardiac arrhythmias.

You've got this. We've got your back. Be sure to check in regularly and let us know how you're doing.

Lev, MSN, RN, NP · May 1, 2015

Ratio is 5:1 and all the nurses on the floor were stating its a busy floor.
I am going to start orientation really soon classes first for a month and then 3 month preceptorship.
Can people suggest tips for everything new grad. I know I have a lot of learning to do.
Any tips based on developing a good relationship with the preceptor, other nurses, and manager. I tend to be shy and I do not want them to think I am rude or being a loof.
Any books I can read on everything telemetry?
What pts to exptect> I am thinking possible MI pts or post Mi, stroke pts, post cardiac cath-- I am probably missing types of pts, please name them!
I really want to start strong!
Also, please break down the whole preceptorship process. How will my first day be like? Would it be appropriate to ask the preceptor the culture of the floor? New grad turnover rate? What those new grads that left early needed to improve on? When will they typically expect me to be on my own with them shadowing me? I know its a total of 4 months precepting.
Most common meds?

You will get all sorts of patients, not just cardiac patients and stroke patients. GI bleeds, respiratory distress, you may get post op patients (if the unit takes surgical patients), electrolyte imbalances, ETOH withdrawal/DT, pancreatitis, bacteremia, seizures, pneumonia, etc

As far ask asking preceptor about unit culture.. This are things to observe and ask about once you've picked up on certain things. Or just make statements about things you've observed and confirm with her. I wouldn't ask such questions straight out at the beginning.

4 months is enough orientation. That ratio is high if they are true IMC patients.

You can ask your preceptor about meds on the unit. Your unit orientation packet may include a list of common meds.

You will have a rhythm class that will teach you what you need to know. Take ACLS as soon as you can.

ckarnes · Jul 23, 2015

How is it going? I'm starting on the same type of unit next week and am nervous, scared, and extremely excited lol

txnursetrb26 · Aug 8, 2015

I started as a GN in IMU/Tele. Our max ratio is 5:1, but we limit the patient:nurse ratio for certain gtts (cardene, insulin, etc). Still here, kicking 1.5 years later, and it's been an amazing experience. We get 18 hour post op CABG and AVRs, stroke, MI, ETOH, falls, trauma, gi bleed, pretty much everything PP said. Every now and then a suicidal pt too. It's a very interesting mish mash of pts. Never a dull night for me and always an opportunity to learn still. One thing I hear the seasoned nurses on my floor say a lot is don't freak out because tele called to say your pt had 4 beats of vtac. Assess your pt first before all else. Take notes and try not to ask the same question repeatedly because to some people, that indicates that you aren't retaining the information. But don't do anything you're unsure of either just because you feel like you can't ask. It's a rough but very enlightening few months and I wish you the best!

Quiller · May 15, 2016

"Telemetry units have designated monitor techs who do the 'watching'.... they'll let you know if anything hinky is going on."

Whoa now. I work PRN as a monitor tech while I'm in nursing school and I can honestly tell you...that's not always true. Every night I'm looking at 30-50 strips (a full tele floor plus random tele patients from other floors I was assigned) and I miss things...probably because it's not humanely possible to watch 50 strips simultaneously.

Then, as with all hospitals, when things go wrong with one patient, they go wrong with like four patients at once. I can't call four people at one time and the floors I'm watching have the exact monitors I look at on the floor for the nurses to see.

I prioritize. I'm going to call a nurse whose patient suddenly developed a second degree block (which is hard to catch if you're just looking at the monitor in passing) before I call the one whose patient went into afib (because that's pretty recognizable). I'm going to call in someone that has a run of vtach before I call for someone who took the leads off.

So...if it's a rhythm that's going to kill them, I'll call when I see it. If it's a rhythm that's different than normal, I'll call after I finish the lethal rhythms but that may be a few minutes. If a patient on a cardiac floor changes rhythms at the same time as a person on a non-cardiac floor and both changes have the same acuity level, I call the non-cardiac nurse first.

Depending on how full the units are and who's working, it can be awhile before I call.