Knowledge Necessary for Review in Preparation for Telemetry Orientation

Leahr · Dec 7, 2007

I work in tele in Chicago, IL. It is a very busy place on days and afternoons. Nights are busy sometimes, but most of the patients are sleeping. Admissions are the thing you are busiest with. I just started 2 months ago, I like it and will stay for at least a year.

Hello there.... I am about to start my first RN job in Tele....
What is your Tele shift routine like? Please describe it in brief or detail. Any input will be of help. This will assist me in organization/ time management wise. By the way, I will work at nights. Thank you

al7139, ASN, RN · Dec 7, 2007

Hi there!

I am a new grad that is working on a tele/medicine unit. Here are some things that helped me:

As a student, the most pts I had was 4-5. Now, I usually have 5-6 on my shift (3p-11p), and when I have covered the occasional night I have had 7 pts.

I found that the most helpful organizational tools have come from asking the other nurses and my preceptors to explain their system. Everyone has a different way of organizing their shift, but I looked at lots of different ways, and used what I felt would work. Not everyones way worked for me, or mabye only a part of what someone else did was helpful. Also, don't let anyone tell you how to organize yourself. I had a preceptor for a few days that had a crazy system...she was there late every night charting, and I could not understand her system, but she kept trying to get me to do things her way! Drove me nuts!

Lots of nurses have created their own forms to use in addition to their "Kardexes", or the unit has a form the nurses use when handing off to the next shift. These have info like your assessment, blood sugars, results of any tests, procedures, pt info like code status, history, diagnosis, etc. We also will put things like next labs due, any precautions (isolation, fall risk), and list what PRN meds we gave and what time they were given. I have found them very helpful because they also have the previous shifts info on them.

I subscribe to the rule of keeping it simple. I use our units report sheets for the above reasons, and keep them stapled to the pts worksheets (the printout listing meds and procedures due on my shift. Any new orders I need to know about and follow through on I write on the back, and check off as I do them, or if it's a long list, I will take a copy of the order sheet (ours has 4 carbons) to use in the same way. Any labs due my shift I write on the front and highlight, so I can follow through with the CNA's who usually do blood draws to make sure they draw them on time. It also helps me to remember to check the results.

If I have a patient issue during my shift (like chest pain, or desaturation), I use the back of the sheet to write when it happened, what I did, and the outcome, as well as any calls to the MD, and orders. This way I have it documented for when I do my charting.

I don't know what your hospital has as far as worksheets, but mine lists the meds, dosage, any parameters, and times for admin. I look through them prior to getting report, and if for example, I have a po med that is only 1/2 tablet, or 5mls of a 10ml liquid, i highlight and circle it so I know to split the pill, measure the liquid, etc.

I also periodically check the charts for new med orders, and the computer, so I will not miss a med that is not on my worksheet. I am not perfect at this, and will occasionally be charting, and realize I missed something. Don't feel bad if it happens! Even the experienced nurses I work with occasionally miss something.

Another thing I do when I get report is to try to prioritize my patients based on the previous shift. Who is my most critical patient that I need to see first and check on more frequently? Who is having a hard time that may only need a few extra minutes of my time to educate them on what is happening to them? Are there customer service issues with family members or patients that may need some teaching? Is there anything I need to call the doc about before it becomes a problem at 0300?

Know your heart rhythms. Part of your job is to be able to analyse a tele strip. Most tele units have new nurse classes, but if you are not sure, call the tele monitor, or better yet, go spend a day with them while you are orienting. I learned more from them than the class since they are specialists and see it every day. Which rhythms are abnormal? Which can quickly lead to a fatal heart rhythm?

Lastly, know your heart meds. If you need it take your drug book to work. We have current ones on our unit, and we all use them.

As a new nurse, use your preceptor for help. Also accept that everything will take you longer than the nurse who has been there for 10 years. You will not leave on time for a while. I have been on my unit for 6 months, and while I feel like I am finally getting my organization down, I still have times where I am there late to finish up. You work on a cardiac unit, things happen that get you behind.

Do the best you can, and you will be fine.

I hope this helps you, and I hope you enjoy tele as much as I do!

Good luck!

Amy

Diary/Dairy, RN · Dec 7, 2007

*Diagnoses, Conditions, Complications CHF, CAD, Angina, MI, CABG, Diabetes, HTN,

*Medications Cardiac meds - Lopressor, Sotalol, Coreg, Digoxin, Diltiazem, Amiodarone, morphine, nitroglycerine, Lasix, potassium, aldactone, statins ie lovastatin and simvastatin, mevacor, glipizide/glucotrol and other PO diabetes medication, meds for depression/anxiety, in short, everything! :)

*Labs, Procedures BNP, CBC, CMP/BMP, Lipids, Cardiac enzymes,

*Nursing Skills IV insertion, foley insertions, VS

*Classes that assist the Tele nurse EKG class

*Organization/ "Brain" Sheet for Time Management I use a 3 column approach - column 1 - neuro, resp, CV, GI, GU column 2 - IVs, drips, mobility, history, blood sugars. column 3 a timeline to keep straight when I need to get things done.

*Tools in your pockets before the shift starts Calipers, pens of multiple colors, I like a carpujet,

*Most important change of shift report information

What did you do - what was the result - generally organization as if you were trying to tell a story, something that makes sense

Good luck to you .

mrod, LPN, LVN · Dec 7, 2007

In addition to above response:

*

Diagnoses, Conditions, Complications COPD, (the heart and lungs are married), Diabetes, HTN, hypotension, a-fib, brady/tachycardia

*Medications Cardiac meds - remember O2 is as drug as well and is used often not only for CHF but for chest pain

*Labs, Procedures BUN and creatine, glucose and CBG, D-Dimer, know your code status of your patient!

*Nursing Skills CP assessment and your basic and advanced interventions

*Classes that assist the Tele nurse CPR, ACLS and all in-services

*Organization/ "Brain" Sheet for Time Management Get strips as soon as you get in and take a peek at your chart. Get a system that works for you, everyone is different. We get a report sheet printed when we come in. Some people use one sheet for all pts and some use a seperate sheet for each person. Some peopole write down vital signs and assessment on their sheets and others carry the flowsheet with them. Look at your MAR's when you start so you won't miss a med later on. Play around with it and watch other people to get an idea of things.

*Tools in your pockets before the shift starts IV caps, piggyback caps, flushes, alcohol swabs, sharpie, scissors

*Most important change of shift report information

code status, positive or negative MI, abnormal labs, tests and labs coming up or next day, IV drips running

It takes a little bit but I found that orientation is a prime opportunity to discover what could and could not work for you and then try it out. Good luck!

cpnegrad07 · Dec 7, 2007

here is a form that may help you get organized: (its format may not come thru, but you can fix that.)

name:

PAIN_______________________

PAIN MEDS:_____________________

NEURO: O x______

RESP:______________O2?____Sats:_____L:____

LungSounds:_________________

ChestTubes:__________________

C/V:Rhythm____________Rate__

I/Vs________________________

I/Vmeds_____________________

GI:_________________________

LBM_______ NPO?____Diabetic?___

B/S________________________

GU:________________________

BRP?____Foley____

SKIN:_______________________

Turn?_______________________

Ambulation?_________________

Ted/Scd_____________________

LABS________________________

Procedures___________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Hi there!
I am a new grad that is working on a tele/medicine unit. Here are some things that helped me:
As a student, the most pts I had was 4-5. Now, I usually have 5-6 on my shift (3p-11p), and when I have covered the occasional night I have had 7 pts.
I found that the most helpful organizational tools have come from asking the other nurses and my preceptors to explain their system. Everyone has a different way of organizing their shift, but I looked at lots of different ways, and used what I felt would work. Not everyones way worked for me, or mabye only a part of what someone else did was helpful. Also, don't let anyone tell you how to organize yourself. I had a preceptor for a few days that had a crazy system...she was there late every night charting, and I could not understand her system, but she kept trying to get me to do things her way! Drove me nuts!
Lots of nurses have created their own forms to use in addition to their "Kardexes", or the unit has a form the nurses use when handing off to the next shift. These have info like your assessment, blood sugars, results of any tests, procedures, pt info like code status, history, diagnosis, etc. We also will put things like next labs due, any precautions (isolation, fall risk), and list what PRN meds we gave and what time they were given. I have found them very helpful because they also have the previous shifts info on them.
I subscribe to the rule of keeping it simple. I use our units report sheets for the above reasons, and keep them stapled to the pts worksheets (the printout listing meds and procedures due on my shift. Any new orders I need to know about and follow through on I write on the back, and check off as I do them, or if it's a long list, I will take a copy of the order sheet (ours has 4 carbons) to use in the same way. Any labs due my shift I write on the front and highlight, so I can follow through with the CNA's who usually do blood draws to make sure they draw them on time. It also helps me to remember to check the results.
If I have a patient issue during my shift (like chest pain, or desaturation), I use the back of the sheet to write when it happened, what I did, and the outcome, as well as any calls to the MD, and orders. This way I have it documented for when I do my charting.
I don't know what your hospital has as far as worksheets, but mine lists the meds, dosage, any parameters, and times for admin. I look through them prior to getting report, and if for example, I have a po med that is only 1/2 tablet, or 5mls of a 10ml liquid, i highlight and circle it so I know to split the pill, measure the liquid, etc.
I also periodically check the charts for new med orders, and the computer, so I will not miss a med that is not on my worksheet. I am not perfect at this, and will occasionally be charting, and realize I missed something. Don't feel bad if it happens! Even the experienced nurses I work with occasionally miss something.
Another thing I do when I get report is to try to prioritize my patients based on the previous shift. Who is my most critical patient that I need to see first and check on more frequently? Who is having a hard time that may only need a few extra minutes of my time to educate them on what is happening to them? Are there customer service issues with family members or patients that may need some teaching? Is there anything I need to call the doc about before it becomes a problem at 0300?
Know your heart rhythms. Part of your job is to be able to analyse a tele strip. Most tele units have new nurse classes, but if you are not sure, call the tele monitor, or better yet, go spend a day with them while you are orienting. I learned more from them than the class since they are specialists and see it every day. Which rhythms are abnormal? Which can quickly lead to a fatal heart rhythm?
Lastly, know your heart meds. If you need it take your drug book to work. We have current ones on our unit, and we all use them.
As a new nurse, use your preceptor for help. Also accept that everything will take you longer than the nurse who has been there for 10 years. You will not leave on time for a while. I have been on my unit for 6 months, and while I feel like I am finally getting my organization down, I still have times where I am there late to finish up. You work on a cardiac unit, things happen that get you behind.
Do the best you can, and you will be fine.
I hope this helps you, and I hope you enjoy tele as much as I do!
Good luck!
Amy

shellsgogreen · Dec 8, 2007

i also created my own form that i write report on from the last shift, and after my assessment, and as i'm checking the charts, i add impt info.

i work better if i write everything down at the moment, as it's still all so new, and i'm always worried i will miss something.

at the start of each shift, i also print out all the rhythm strips for my patients.

this week i had a patient who not only pulled her monitor apart, she yanked out the batteries. :uhoh21:

once you start, you will develop a routine that feels right to you...best of luck!

Skeletor · Mar 25, 2011

Although these posts are a few years old, they are a great resource for today's nurses.

:tku: to all who have posted.

retronovice · Mar 25, 2011

Just curious--what's the difference between a telemetry unit and a CCU?