Telemetry nightmare - page 2

Hi I am a new grad and have been working on the tele floor for about 4.5 mos. The other day ER sent up a patient with COPD exacab., who was on nonrebreather 100% 02. patients heart rate was 120's at... Read More

  1. by   TOMMYSWIFE
    I've been a nurse since 06/04 and started out in ccu & pccu (telementry step-down unit). I stayed 14 months and finally decided there had to be a better position somewhere. Our floor was a mixture of everything possible--almost anything but cardiac--more like a nursing home in many ways. Lots of people that were just waiting for Jesus to take 'em home although extraordinary methods being used to sustain life. Very depressing, mudaine--not at all what I had envisioned. Not to mention, the nurses on the unit were not kind to new grads. Went home exhausted, scared and crying many mornings after long night shifts. Finally decided that I was going to try something different b/c I would never know if they wasn't something better out there if I didn't at least try. In Sept went to the ER--love it! More skill oriented. People smile, thank you, and go home--not everyone is dying or critical. Use my nursing skills--don't just clean poop, struggle to keep people in there beds or put in an occasional iv, or hang feeding tubes. Additionally, the nurses are much more helpful & understanding of the struggles of being a new nurse. More team work which includes the docs.

    In short, if you're not happy, try something different. There is too many options available to nurses to be stuck in an unhappy situation after all that education. Don't give up---move!!!
  2. by   chef2rn

    Hey, I'm a New Grad (well 6 months out--RN II next pay period, God help us!) on a mixed Med-Surg/Tele Unit. On my unit we can't take tele patients unless we are ACLS certified. Take the time to do it ASAP--it's invaluable. I haven't had your kind of experience, although there is definitely chaos & we have our own set of problems.

    I offer the following advice, but I am older new grad (37), with a pretty high level of confidence in myself (not neccessarily in my nursing skills), and a history of working in high end restaurant kitchens, which are their own special brand of hell. In other words, I don't take much ****, I don't take it personally, and I am very good at working with teams and asking for what I need. I am also very direct & (mostly) very diplomatic -- both learned skills.

    Things to remember: 1) (All together now!) There is a nursing shortage--if you have to, go find another job where you will be supported & will be able to learn without burning out immediately; 2) learn to say, "No." I say "no" in several ways: "I am a new grad, and am uncomfortable with that;" "This assignment is beyond my skills, I am going to fill out an assignment-under-protest." Call the nursing supervisor and say that the acuity level is inapprpriate for the skill level, and let them share some of the responsibility. I've had nights with a full patient load (5 pts--thank you California Nurses Assoc!)) 2 of which are restrained & on ETOH withdrawals (and both admitted on my shift), 1 dying from CHF (a DNR, but actively dying & needed my attention more than the others), 1 post-op & one getting blood on contact precautions with only another new grad & a float (both with full pt loads) no charge, no aide, no CSA, and a first year resident writing orders. I've called the Supe and said, "So you are aware that I am a new grad, this is my patient load, this is who is on the floor? I feel this is an unsafe situation. Patient safety is jeopardized, are you going to do anything about it? Who can I call for a resource?"

    Remember that our first priorities are patient safety, but PROTECT YOUR LICENSE!! DOCUMENT EVERYTHING!! Every phone call, ("2225 Call to MD, awaiting return call. 2240 2nd call to MD awaiting return call. 2245 rapid response called, pt stabilized, MD aware. STAT ABGs per MD order...etc") If you're in a place where you can't maintain patient safety, and no one will back you up, get out.

    If an MD screams at you, learn to hold up your hand and say "Stop, you are screaming at me." That's all you have to say. Let them try to justify it or have a tantrum, but at that point they should just stop. You may be scared or shaking, but they won't hit you & they can't fire you. Go to your charge or manager or supe and have them document the MDs behavior. Complain loudly about that to the administration. We've made our prima donna cardiologist go to anger mgmt classes, write apologies, etc. He may not change, but at least it wastes his time.

    Also, if I am constantly in a room for pain meds, I call the doc & say that the patient's pain is not satisfactorily controlled & can I have orders for a LA med & something for breakthrough or a PCA if appropriate. Alternatively, I may negotiate with the pt that I will give them their PRNs as often as scheduled & they don't need to call. I will still assess every time, but it keeps them off the light. We're a public hospital, so we get a lot of those patients. I don't care if they're med seeking as long as their resp rate is safe & there are no other contraindications to medicating them. It's not my job to get them unaddicted. That's for rehab.

    I disagree that tele/step-down is not appropriate for new grads, but it sounds like your unit is.

    My co-workers and I are super supportive of each other, but the administration sucks. I make them pay for every second of my overtime, every missed break/lunch that is due to short staffing & not my flawed time management. If a med is late because I was too busy cleaning **** off the floor & doing a complete bed bath/linen change down the hall, I chart that as the reason. (We have electronic med administration, so we have to justify all our late meds.)

    One of the older nurses today advised me to get out now, move around, don't feel obligated to stay. He said mobility was easier at the beginning of his career.

    Good luck!