Med Surg nurse being given Tele Patients

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sevensonnets

975 Posts

You should take an EKG class and work on learning basic rhythm interpretation. Make sure you are BLS proficient and what your role is in any cardiac emergency. Not all rhythm changes are an emergency. If the monitor tech notifies you of something that has the potential to go south, there are no doubt many people around you who are ACLS trained to intervene while you do what you DO know is in your scope of practice as an RN: vitals, assessment, call a code or RR, and calling the doctor.

Sour Lemon

5,016 Posts

Has 13 years experience.

The med/surg positions I've held all required floating to tele. To be honest, tele rhythms were never my strong point, and I always dreaded being floated there.

You have my sympathy, but I think you'll find more of the same if you leave this job for another. And they can certainly fire you, just as easily as you can quit.

MunoRN, RN

8,058 Posts

Specializes in Critical Care. Has 10 years experience.

What you are describing sounds more like medical telemetry than progressive care telemetry.  Don't get too caught up on them being on telemetry, that's not necessarily what defines their nursing acuity.

10 hours ago, LovingLife123 said:

Why on earth would it be out of your scope of practice?  A RN is a RN with licensing.  I’m not licensed as a specific specialty of nurse.  I have certain certifications in addition to my license, but you are not licensed as a Med/Surg nurse.

I don’t understand you being upset at being floated to a tele floor.  A med surg nurse should have a basic understanding of an ekg and different heart rates.  
 
Am I missing something?  I’m in ICU where all of my patients are on monitors and monitored by me, but I’ve floated to cardiac floors where pt are on tele and there’s a separate area where patients are monitored and the tele room calls you if they see something.  Then you go and look at your monitor and determine if a physician needs to be called.

I understand it might be out of your comfort zone, but every RN in my facility completes an ekg interpretation course every year.  You should know the basics.

Maybe there is no "Tele Room" where a monitor tech watches the monitors at all times, which frees the nurse to go see the patient and verify VS, heart rate and rhythm via auscultation and checking pulses and any actual distress.

Not every Tele situation has a monitor tech on duty.  I worked on a floor that had Tele and the nurses had to take turns watching the monitor.  First, we had no specific EKG interpretation  classes when we first started having monitored patients.  Next, who has time to sit in front of a monitor for more than a very brief interlude?  

Some nurses love Tele and are knowledgeable about numerous rhythms/arrhythmias, others not.  If OP is only working 2 shifts per month and she is not learning EKG's, I understand her dis-ease at being assigned to Tele.  Especially because she told them from the start that she was not comfortable with cardiac monitoring.

Knowing the basics is a lot different different than knowing  the more complicated and unusual rhythms.

6 hours ago, sevensonnets said:

You should take an EKG class and work on learning basic rhythm interpretation. Make sure you are BLS proficient and what your role is in any cardiac emergency. Not all rhythm changes are an emergency. If the monitor tech notifies you of something that has the potential to go south, there are no doubt many people around you who are ACLS trained to intervene while you do what you DO know is in your scope of practice as an RN: vitals, assessment, call a code or RR, and calling the doctor.

no doubt, huh?  You must work at Dreams Fulfilled Medical Center, LOL.

I think OP is perfectly justified in feeling she has been badly used, by both the job and by her employer.

OP, get the ACLS education so you will feel confident.  Also, learn EKG backwards and forwards.  Best wishes to you.  You won't get any sympathy here on the Board or even any real comprehension  of your work environment because lovinglife123 works in a different type setting and can't understand what you are trying to explain.

sevensonnets

975 Posts

Actually, Kooky Korky, I've been working in CVICU for 42 years, working for the last 26 of those years in the same hospital. I'm not of the 'things don't go my way so I'll cut and run' mentality. If a nurse knows they are going to be exposed to an experience they know little about, it's up to them to dig in and learn about whatever it is they fear, and gain some confidence. A telemetry monitor is not a thing to fear.

socal212, CNA

45 Posts

Has 6 years experience.

I work for Banner in AZ.  In all the hospitals I've worked at, med-surg nurses have always been assigned patients on remote telemetry.  Never progressive care patients, but med-surg status with remote tele orders.  

caliotter3

38,333 Posts

This is an enlightening thread to some of us. Thanks for bringing this question OP.

Thanks everyone.  Just to clarify, I'm not talking about me having an issue with accepting patients who are on remote tele, that's pretty basic in med/surg. I'm saying, as a med surg nurse, I've been given PROGRESSIVE CARE patients but we've always used term "tele" and "progressive care" interchangeably. 

This stemmed form me being informed that this was against the nursing practice act and you can get in a lot of trouble to caring for a progressive care patient as a med surg RN.  In actuality, these patients aren't really that much different than what I'm used to. 

I had a patient who was on a cardiac drip that I refused after report and they changed the nurse and they tried to give me a post op CABG patient and that was also stopped.  So I was over reacting a little bit but I still think it was worth it to ask to get a conversation going. 

For me, my question is answered.  It's impossible to harm someone from asking a question, but it's possible if you don't . You should always feel safe and confident asking questions and if you're ever in a working environment where they look down on that, leave that place immediately.

socal212, CNA

45 Posts

Has 6 years experience.

Yeah I’ve always been under the impression that med surg nurses weren’t supposed to take a tele assignment. That’s why we just spent weeks and weeks upskilling med surg nurses to PCU, and PCU nurses to the ICU. I’m sorry. I would find that very frustrating especially when the answer isn’t readily available. 

Specializes in SCRN. Has 9 years experience.
18 hours ago, Morning Glory said:

We don’t have yearly ekg learning although I wish we did. In our med Surg, we also get called from the monitor tech and we reach out to the doctor but we don’t analyze them. Again, I’m probably just overthinking this but it doesn’t seem right caring for progressive care patients with no experience. If I have the impression that this is just that I’m not comfortable with handling a patient on remote tele, I screwed up in explaining this. This is an issue of a med Surg nurse being give. Progressive care patients 

You could take some CEU classes of EKG interpretation yourself, to be more comfortable with the tele strips. We all learn new things, why not improve your understanding of heart rhythms?

I do not think floating medsurg to tele (progressive) unit is a big deal or out of scope of practice.

Specializes in Med-surg, school nursing.. Has 10 years experience.

I worked on a med-surg floor for 9 years and the majority of our patients were tele. Most unnecessary, but the hospitalist would order it on EVERYONE. Drove me crazy. But it certainly wasn't out of my scope. Granted, our tele patients were monitored by a monitor tech who watched their rhythms and contacted us if something was wonky. 

If you are worried, you could take a refresher on rhythms (I have always sucked at rhythms) to boost your confidence.