How does cardiac tele compare with med-surg?

[Joe NightingMale]

I have an opportunity to leave my night shift med-surg unit and join a cardiac telemetry unit on the night shift. I'm wondering if it will be an improvement though.

The cardiac tele position is at a better hospital than mine. I'd have somewhat fewer patients. It'd be closer to ICU than what I'm doing now. They're mostly post-cardiac surgery patients from the ICU. The place I work at now is pretty bad, pretty broke.

But they have twice as many admissions and discharges as we do, on average. They have lots of post-cardiac cath patients with Q15-30 minute vitals, and transplant patients with tons of meds. And a lot of post-surgery patients with PCAs, which makes me wonder if pain management becomes a major problem.

On my med-surg floor we very rarely have things like PCAs, post-surgery, or post-cardiac cath patients. We have lots of contact isolation and complete patients, but our patients do tend to be stable. We do seem to get plenty of drug-seekers and people with some psych issues. And we get the demanding pain management patients pretty frequently.

I guess I'm trying to determine if this cardiac floor is going to be worse than my med-surg floor. I was really hoping for an ICU or ER position, but so far this cardiac position is the only one I've interviewed for. If they offer it to me, I'm not sure if I should accept or not...

[nurse raven]

I've only worked this unit as a nurse, so I can't compare the two. I do like it though, our ratio is slightly lower and it is faster paced - the nights always go by fast for me. I think it has been a great place to learn about a variety of diseases and treatments. Also, I've learn alot with regards to assessments - things can really change quickly with these folks. Over all, I am really glad I started here instead of a lower acuity unit.

Thanks for sharing your experience.....And also, i have a feeling that higher acuity units are not physically as heavy as general med-surg wards. So nurses get more time to do their actual nursing assessments...

[Do-over, ASN, RN]

And also, i have a feeling that higher acuity units are not physically as heavy as general med-surg wards. So nurses get more time to do their actual nursing assessments...

Again, I've only been in the one unit, but I know I never feel as though I have enough time for all the things i want/need to get done =) We get our share of complete-care / relly confused, etc. but probably not quite as much.

Still fairly new though, so hopefully that will get better.

[surferbettycrocker]

i have to chime in and say for the record 'higher acuity' units can very much be labor intensive. med/surg is 'sometimes' where step downs/tele floors get their business

"s/p total hip then went into rapid afib' or some other such procedure then had 'ekg changes' or 'chest pain and + trops' after. or poor grandpa with dementia who has 'history of cardiac dz'

cards is a catch all. then you have heavy patient + higher acuity patients and hopefully one who is ready to 'step up' to floor or home not down to the unit.

[SnowShoeRN]

Gotta agree with surferbettycrocker on this one. Excellent points. Higher acuity does not *always* mean less patients and more time to chart and/or spend with patients. The thing with cardiac and/or med-surg tele is that we *do* get the patients who have both general med-surg concerns AND a cardiac complication (or 2 or 3 or 8). Whereas, perhaps, floors exclusive to cardiac surgery may be less likely to get patients who have originally been admitted for something else entirely. ICU is another story.

Nurseraven, I've worked both med-surg and cardiac/step-down but never ICU. I basically stand by what I said in my response to the OP and also what surferbettycrocker just said. As for your thought:

".....And also, i have a feeling that higher acuity units are not physically as heavy as general med-surg wards. So nurses get more time to do their actual nursing assessments..."

The reason nurses get assigned less patients on higher acuity floors is because the patients' needs are more numerous and/or more complicated. 5 med-surg patients may easily equal 2 ICU/Step-down patients in terms of time spent with the patient doing the education, med-passing, dressing-changes, and assessments. Not to mention charting.

Med-surg is a great place to get your feet wet, so to speak, but it's hard to say that this floor or that floor will always be harder or busier or whatever because that depends so much on the patients, staffing, and general area. I've had relatively easy shifts on cardiac and really hellish shifts on med-surg. But, in general, my cardiac/med-surg tele assignments have usually been busier and much more complicated for me.

[nurse raven]

gotta agree with surferbettycrocker on this one. excellent points. higher acuity does not *always* mean less patients and more time to chart and/or spend with patients. the thing with cardiac and/or med-surg tele is that we *do* get the patients who have both general med-surg concerns and a cardiac complication (or 2 or 3 or 8). whereas, perhaps, floors exclusive to cardiac surgery may be less likely to get patients who have originally been admitted for something else entirely. icu is another story.

nurseraven, i've worked both med-surg and cardiac/step-down but never icu. i basically stand by what i said in my response to the op and also what surferbettycrocker just said. as for your thought:

".....and also, i have a feeling that higher acuity units are not physically as heavy as general med-surg wards. so nurses get more time to do their actual nursing assessments..."

the reason nurses get assigned less patients on higher acuity floors is because the patients' needs are more numerous and/or more complicated. 5 med-surg patients may easily equal 2 icu/step-down patients in terms of time spent with the patient doing the education, med-passing, dressing-changes, and assessments. not to mention charting.

med-surg is a great place to get your feet wet, so to speak, but it's hard to say that this floor or that floor will always be harder or busier or whatever because that depends so much on the patients, staffing, and general area. i've had relatively easy shifts on cardiac and really hellish shifts on med-surg. but, in general, my cardiac/med-surg tele assignments have usually been busier and much more complicated for me.

thanks for the info.....but i didnt get my question answered yet....i love to have complicated assignments rather than routine things cuz that is how we learn and grow; however, these days the units are over crowded, there are patients in hallways, staff lounges; and in addition nurses work shortstaffed most of the time.....which makes things hectic. not only that, on general wards, you have to walk so much cuz one patient is in one corner and another is in another corner.

all i wanted to know was that do nurses feel relieved from these stressors when they work in higher acuity units or not???

[Five&Two Will Do]

It's a step on the way to the ICU if that's what you'd like to do. Or even CCU :)

I work night shift on a unit that was originally intended for cardiac patients only, but now we have turned into more of an ICU overflow with about 75% of our patients being cardiac. I have 3-4 patients a night, sometimes I will get an admission but usually discharges are done on days.

We get post-CABG patients, post-cath sheath pulls, pacemakers,r/o MI/Chest pain, unstable CHF, sepsis patients, renal failure. Sometimes we get patients they don't have room for anywhere else and it's justified because they have "hx of afib".

I don't think that it's "worse" than med-surg. It's just different. Try it, you might like it :)

Sounds like the telemetry floor that I worked on LOL. I love the variety and that is why I came to an MICU when I got the chance. I love it very much. The heart is amazing:up:

[SnowShoeRN]

all i wanted to know was that do nurses feel relieved from these stressors when they work in higher acuity units or not???

for me personally, not at all. best of luck to you.

[PacoUSA, BSN, RN]

I had to revive this thread as I have worked in both med/surg/tele (msT) and cardiac/tele (cT) and can speak to both experiences.

By far, I love cT much more. My unit has an on-site tele tech whereas my old msT unit was remote. The patients are different too, my cT unit has a lot more walkie talkies yet the msT unit had more totals and a wider variety of conditions ... but then again we got a LOT more dementia patients. That unit was known as the dumping ground so we used to see everything and anything. Once we had a patient come in with a diagnosis of "homelessness" ... I mean, seriously??? The one thing I love about working on a cT unit is that I no longer deal with ETOH withdrawal patients. Our unit specifically does not take them, and I am grateful. They are probably the patients I dislike to take care of the most for different reasons (2nd being the dementia patients that try to get out of bed very 5 minutes). I would love to eventually work in CCU or CTICU so I feel focusing on cT would be more beneficial for me and for anyone else with this goal.

Another side benefit for me on working cT over msT is getting away from the micromanagement on my old unit. This is only specific to my experience tho. I now work under a manager not breathing down my neck and lambasting me for finding an alcohol pad under my patient's bed or for forgetting to label an IV site with date, time, gauge AND initials or for not placing a special 'wash hands with soap and water' sign outside a C. diff patient room. High turnover? You bet! Not dealing with this now is a huge breath of fresh air!

Curious to hear from the OP and hear an update.

ETA: I saw your most recent posts, OP. Looks like you're now in case management ... good for you!

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[michlynn, BSN, RN]

I work in cardiac/tele and have also floated to the other med/surg floors in our hospital as it is a requirement when other floors are short staffed and I prefer my floor over the general med/surg floor. I like it because it is more specialized compared to some of the other floors so we really only take patients that have a cardiac related admission. We mainly take pre/post cath, icd/pacemakers, chf, PE/DVT, pericarditis, TAVR, etc. We do have a hallway that can take "step down" patients that are on higher doses of cardiac gtt's, bipap and things of that sort but we do not take vents, IABP's, patients on pressers, or post open hearts. I guess my floor would be considered more invasive cardiology, there's another floor in the hospital that takes the surgical cardio patients. I think it would be a good change for you especially if you'd like maybe switch to an ICU some day. Employers like seeing the telemetry experience on a resume.

[evastone, BSN, RN]

I'm a fairly new nurse working on a tele unit an I can get a mix of different patients at times. Yes, most of them are on monitors but it doesn't mean they don't have other conditions to deal with. I'm enjoying the experience and the knowledge I am gaining (cardiac and medsurg). Based on what I'm seeing in this forum though, telemetry units vary greatly depending on the hospital. Mine is cardiac oriented but I see plenty other conditions as well because they have a cardiac hx.

[blackvans1234]

Cardiac Telemetry (also called stepdown where I work) is a ''higher acuity'' unit. However it is less acute than Critical Care.

If you want to work in critical care someday, stepdown is a step in the right direction (pun intended).

Stepdown will often get the Rapid response patients from the MedSurg units. They will also get the postop Rapid Afib / hypotensive / something isnt right postoperatively patients.

So you may see some similar patients.

My two cents!

[Heartnurse24]

HI Joe,

I am a new nurse and have been working on a med/surg telemetry unit for almost a year. My patients are identical to what you described and I don't feel as though it is a real telemetry unit. We aren't allowed to do drips. (It's more of a "pt has a hx of afib environment and they are 89 yrs old! smh ) I, too am looking for a step up but can't decide if I should move to ER nursing or a "real" tele floor. I would say follow your gut and what you would aspire to do. Good luck.