I need some tips...First nursing Job in Telemetry

zacarias, ASN, RN · Jul 18, 2005

Only four shifts and then you are on your own? Are you sure about this? That is pretty much unheard of for a new grad. Is this a large hospital you're working at?

I would look up and understand how beta-blockers, calcium channel-blockers, and ace-inhibitors work. Remember that most beta-blockers end in "lol" as in "atenolol, propranolol." Also, ace-inhibitors end in "pril" as in "lisinopril, ramopril." Will you be taking care of post-op bypass patients?

As you work day to day, you will notice that the docs on your unit order the same drugs day in and day out and occasionally you will see a new one. At first, write these ones down and look them up when you get home. You will pretty soon be pretty versed in cardiac meds.

The orientation thing concerns me but I know you're doing team nursing instead of primary nursing. Although I don't see how that should matter regarding orientation time.

ShayRN · Jul 18, 2005

Ummmm, WOW! Four shifts? That is UNREAL for a new grad. We give our experienced nurses 4 weeks. Our new grads are on orientation as nurse interns for 3-4 weeks, once they pass their boards the RN orientation is 12 full weeks. Not including time in critical care classes (provided and paid for by the hospital.)

To answer your question: Learn your strips so that you can look at them and KNOW right away that what you are looking at isn't normal. The most requested labs I get from the docs are K+ and Mag levels when a patient has VTach, cardiac enzymes, proBNP levels and BUN/Creatinine levels. They need the kidney functions when they are trying to decide whether or not to cath a patient. ALSO, keep in mind when the patient is in with chest pain chances are pretty good they will be stressed, so I never give them cafffinee products once they get to my unit. No meds the morning of a stress that will affect the heart in any way, if you give them a beta-blocker or something similar it will not give them an accurate read of what is happening when the heart is under stress.

carachel2 · Jul 18, 2005

I would RUN away from that job. 4 shifts is barely enough to teach a seasoned nurse the ropes of that particular unit, the dr's, the normal's,etc. You are putting yourself and your license in serious jeapordy, not to mention that you willl be very dependent on the LVN who is likely to have years of experience and will be second guessing your every move.

Go to the nursing office/education department and demand a proper orientation. As a new grad orienting to CCU I had three MONTHS of classroom education and preceptorship.

mye614 · Jul 18, 2005

I might have misunderstood it but I will definitely check with my Nursing Director on how long exactly my orientation is. I swear when I was interviewed I thought I was told 12 weeks of orientation then we had our 2 weeks in class new grad program. Then when I ask the other new grads they told me 4 shifts only. I will definitely reconfirm this. If after 4 shifts, they insist that I be on my own even if I feel unsafe and unsure, I will run as fast as I can because I dont want to jeopardize my career and mhy license. I will keep you guys posted. Thanks for all your feedback.

mye614 · Jul 18, 2005

Hi, Its me again!

For all you guys who works in a cardiac/med-surg unit.....WHAT IS AGOOD ORIENTATION FOR A NEW GRAD NURSE? CAN YOU GUYS DESCRIBE TO ME WHAT IS BEING DONE DURING THE ORIENTATION PHASE AND WHAT IS EXPECTED FROM THE NEW GRAD AND PRECEPTOR? I REALLY WANT TO KEEP THIS JOB I HAVE BUT I ALSO WANT TO HAVE A JUSTIFIED ORIENTATION. AND ALSO AT LEAST I KNOW WHAT TO ASK AND TELL MY NURSING DIRECTOR WHEN I APPROACH HER ABOUT MY ORIENTATION...THANK YOU AGAIN........................

carachel2 · Jul 18, 2005

Well, way back 10 yrs ago when I oriented in CCU (which I know is diff. from tele, but still this was hospital wide for new grads) we had a 3 month orientation that consisted of:

-ACLS training

-EKG training (12 lead and quick tele)

-A once or twice a week class (like one on Acute Coronary Syndromes,etc)

We were paired with an RN who was a TRAINED preceptor (i.e. not just "you'll be working with Jodie tonight"). We worked that persons schedule for the next three months. At our hospital, these are RN's who *enjoy* teaching and who have taken preceptor classes.

-I remember my 1st week or so the RN and I "buddy" cared for our patients. I gradually took on more and more responsibility. The big thing with a preceptor relationship is you have to be with a.) someone who knows basic principles of adult learning and how to teach your criitical thinking skills and b.)you have to be working in a unit that understands the learning process and therefore does not think "hmmm...we have two RN's working together so let's increase their patient workload."

I was on orientation for three months and this could have been extended had my preceptor felt I needed more time OR if I still felt I needed more time.

From what I hear (at my hospital) and from I read via email and from looking at the classifieds in various nursing journals, programs like this (and even more extensive these days) are the NORM and expected at most hospitals.

I would go back (tomorrow) and clarify the terms of your training and your contract with the person who hired you. Hopefully you have misunderstood. Let us know how it goes.

mye614 · Jul 19, 2005

Well, way back 10 yrs ago when I oriented in CCU (which I know is diff. from tele, but still this was hospital wide for new grads) we had a 3 month orientation that consisted of:
-ACLS training
-EKG training (12 lead and quick tele)
-A once or twice a week class (like one on Acute Coronary Syndromes,etc)
We were paired with an RN who was a TRAINED preceptor (i.e. not just "you'll be working with Jodie tonight"). We worked that persons schedule for the next three months. At our hospital, these are RN's who *enjoy* teaching and who have taken preceptor classes.
-I remember my 1st week or so the RN and I "buddy" cared for our patients. I gradually took on more and more responsibility. The big thing with a preceptor relationship is you have to be with a.) someone who knows basic principles of adult learning and how to teach your criitical thinking skills and b.)you have to be working in a unit that understands the learning process and therefore does not think "hmmm...we have two RN's working together so let's increase their patient workload."
I was on orientation for three months and this could have been extended had my preceptor felt I needed more time OR if I still felt I needed more time.
From what I hear (at my hospital) and from I read via email and from looking at the classifieds in various nursing journals, programs like this (and even more extensive these days) are the NORM and expected at most hospitals.
I would go back (tomorrow) and clarify the terms of your training and your contract with the person who hired you. Hopefully you have misunderstood. Let us know how it goes.

Thank you. I will definitely talk to my nursing director when I go back to work this wednesday and clarify things with her. As far as I know the RN who is precepting me has gone through preceptor class. I was also told that I will be going to a basic dysrhytmia class and also an ACLS class sometime soon. Yesterday when I started, the RN basically showed me how she does her job from taking reports to checking the IV meds she has to give that day and calling the Doctors for critical labs. She also let me do some of the IV pushes (morphine, solumedrol) and then hand some IV bags (antibiotics and NaCl with 20 of kCL). Then one of the other nurses asked her if I could start an IV access for one of the other patients. I'll let you guys know what my director of nursing tell me tomorrow. Oh, can you guys suggests questions to ask her??? Thanks, again :)

Bluespruce · Jul 31, 2005

Hello,
I just started my first nursing job today in Telemetry/Med-surg unit. I'm a new grad and never had any experience working in a hospital except from my nursing school (in which we did not really have a lot of clinical exposure). My preceptor was great today. I'll be working nights and will be caring for 8 patients once I'm done with my orientation ( 4 shifts then I'm all alone...as what I was told). I'll be working as a team with 1 LPN and 1 Nurse Tech. My question is do you guys think 4 shifts of orientation is good enough? And also can you guys tell me the most common cardiac drugs used in the Telemetry? What sort of assessments should I do and what should I be looking for in my patient's labs? I did not find my first day to be tough, but I sort of felt overwhelmed. I guess my biggest fear is not knowing what to do when my patient's condition go bad and what to do from there. Most of the patients we had today had CHF, Pneumonia, Multiple PE's and GI bleed.
Thank you! Oh, one more thing..Can you guys suggest a report sheet that I can use throughout my shift?????
:wink2:

I start work on tele unit in early Sept at a large metropolitan hospital. I believe I get a week long ECG class as well as an orientation class (maybe almost a week) & then I think I have a preceptorship, which might be a few months or so. I believe that this is fairly standard in my area. If you're working at a smaller hospital this may not be the case for you. I'm sure it'll be scary & hard, but chances are you're not the first to have to start out this way. I'd make sure to ask all the questions you think you need to & basically you'll have to do a lot of learning on the job, which I think they'd have to expect from a new grad cuz you don't get it all down pat in 4 days. Maybe if you asked your supervisor if it was ok to have a 'go to' nurse who'd sort of have a lighter load & be there for u to ask questions of would be a good idea. Granted this person would almost be like a preceptor but you'd be a little more autonomous at the time. Also, they shouldn't start u out too soon with a completely full pt load because of the learning curve - I'd guess. At least that's what my hospital told me they'd do with me.

Indy, LPN, LVN · Aug 12, 2005

I've finished my 2nd day on orientation, on my first nursing job. It's a telemetry floor. I wouldn't have taken the job if only 4 shifts of orientation were offered. It's hard work, sick people, drips, procedures and frequent vital signs coming out of your ears. I ran my patootie off on two patients and can't imagine being told a couple days later that I was on my own. Ugh.

PeaceonearthRN · Mar 8, 2009

Funny, I worked somewhere once where they only offered the telemetry class every couple of months; if they were short staffed, which they always were because people kept quitting, they offered it every 9 months. No, I do not work there anymore. Responsible hospitals offer preceptor classes, cover all the important stuff and do not throw people on the floor to learn and then berate them. AMEN

Nantucket1979 · Mar 12, 2009

I also just started on a tele floor as a new grad. I am almost done with my first week which is classroom work and then I get 6-8 weeks of orientation with a trained preceptor. If I only got 4 days of orientation I would run fast and far. I hope that there was a miscommunication and you get more orientation. Good luck.