Med Surg or Tele? How is it decided

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Hello AN! It's been a long while since I've been on here. Anyways, I finally was able to make the switch to my first acute position in a Med Surg/Tele unit after working in LTC for the past 2 years. I only got 3 days of orientation but I hit the ground running and absolutely love it. It's a new challenge everyday, but the support I have is incredible. Besides that point, I was wondering when they give out assignments, how is it chosen who gets Medical patients and who gets Tele that day? Some weeks I've been Medical and others I've been Tele. I notice that if we have LVNs on the floor, they'll automatically be Medical. I asked my charge nurse once but we were so busy there was no time to talk. It seems like it's chosen randomly at my place. How is it done at yours? Just wondering

Specializes in Critical Care, Float Pool Nursing.
Don't you have to be telemetry qualified/certified there along with ACLS, PALS, EKG experience to interpret the tele? I think we decide telemetry by:

1. Something real bad could happen real fast to this pt- tele yes

2. Patient is sick and I have no doubts that he will live through the day/night with standard care- tele no

ACLS and PALS to be allowed to read tele? Lol, no.

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I just have to ask, who interprets and acts on the cardiac information provided by telemetry? I didn't know telemetry RN's didn't need ACLS and EKG interpretation qualification, I would think that would be a key concept in the entire telemetry process.

I'd like to know this too.

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All I needed to read tele was a basic telemetry class at one place, and a little more advanced class at another employer. Still don't have my ACLS completed.

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Specializes in Public Health, TB.
I just have to ask, who interprets and acts on the cardiac information provided by telemetry? I didn't know telemetry RN's didn't need ACLS and EKG interpretation qualification, I would think that would be a key concept in the entire telemetry process. We remove our dying pt's from monitorring to allow a more quite and peaceful passing for the individual and family without all the alarms.

Often the tele techs, who monitor the monitors, will notice a change, notify the RN who notifies the doc. If they need some sort of intervention, they get transferred to a higher level of care.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.
I just have to ask, who interprets and acts on the cardiac information provided by telemetry? I didn't know telemetry RN's didn't need ACLS and EKG interpretation qualification, I would think that would be a key concept in the entire telemetry process. We remove our dying pt's from monitorring to allow a more quite and peaceful passing for the individual and family without all the alarms.

I work in a cardiac progressive care floor and we are required to have training in ekg interpretation and acls within 6 months of hire. But honestly any changes that happens is usually noticed by the telemetry tech first. If the patient coverts to afib it's not likely that I, the primary rn, will be the first person to find out.

Ekgs are basically interpreted by the techs and acls really is for emergency. And those are usually pretty basic, vfib or pulse less vtach, shock them. If their heart rate is too fast we usually push lopressor or start them on a cardizem/amiodarone gtt as per doctor orders. Rarely do we actually do so an emergent cardioversion or pacing (at least it hasn't been happening during my shifts).

And official interpretation of ekgs are done by doctors. I can look at a 12 lead and suspect a STEMI but I can't outright say it as it isn't in my scope of practice to diagnose. As always before jumping the gun on rhythm interventions, we usually notify the doctor to see what they want done. In my patient population, It's not unusual to have patients with hr in the high 40s to 50s nor a patient with HR in the 150s. Vfib and pulse less vtach we would follow the acls protocol right away but for tachy and Brady we can usually notify doctor who will put in orders for meds or gtts that fix them up right away. It's only when they're super unstable that we've done the acls protocol.

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Specializes in Family Medicine, Tele/Cardiac, Camp.

We didn't have ekg or tele techs at my last hospital. We didn't have LVN's either. And medical and tele weren't considered mutually exclusive. All the tele strip printing and interpreting was done by the RN's at least every 4 hours or more frequently depending on the patient. If we saw something that seemed off we would print a strip, get an ekg and call the MD. But in order to care for tele patients, once someone was hired for the position, they had to have a class in telemetry training and receive ACLS. It was also strongly encouraged we attend courses in advanced EKG interpretation, although most people didn't unless they had been there for a long time or were extremely interested in learning how to locate MI, axis deviation, etc. based on the ekg.

I worked on a tele unit, but occasionally we'd get patients without tele. These were given to nurses who hadn't had the training/ACLS yet, floats from other floors, or equally distributed among those of us who had.

I think every facility is probably a little bit different in terms of how they determine staffing and training for tele units and nurses caring for tele patients.

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"Often the tele techs, who monitor the monitors, will notice a change, notify the RN who notifies the doc. If they need some sort of intervention, they get transferred to a higher level of care."

Why is there a need for RN's there? Just have the tech call the doc. Our tele pt's are already at a higher level of care requiring RN's with a higher level of training. We are even trying remote SCU where SCU RN's are remotely monitoring pt's. I take a certain pride in my training and abilities to be able to give a doc a solid SBAR especially the R. We like to challenge each other where I work with looking @ EKG's and seeing what we see.

Honestly I believe ACLS, PALS, and EKG interpretation should be required of all RN's (and they are not long courses). Maybe even taught in RN school?

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I think I missed something. You got 3 days orientation on MedSurg/Tele after working in LTC and now you are asking AN nurses how the assignment is made out?

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When a patient is on telemetry, a rhythm change could be noted that requires the administration of IV antiarrhythmics, vasopressors, etc. LVN's usually are not covered to give them.

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Specializes in Public Health, TB.
"Often the tele techs, who monitor the monitors, will notice a change, notify the RN who notifies the doc. If they need some sort of intervention, they get transferred to a higher level of care."

Why is there a need for RN's there? Just have the tech call the doc. Our tele pt's are already at a higher level of care requiring RN's with a higher level of training. We are even trying remote SCU where SCU RN's are remotely monitoring pt's. I take a certain pride in my training and abilities to be able to give a doc a solid SBAR especially the R. We like to challenge each other where I work with looking @ EKG's and seeing what we see.

Honestly I believe ACLS, PALS, and EKG interpretation should be required of all RN's (and they are not long courses). Maybe even taught in RN school?

The RN will assess the patient, check vital signs, review meds and labs, and then notify the MD/PA/NP. Sorry, I thought that was a given.

The tech could call the doctor, but they may be monitoring 30 other patients but never lay eyes on them, are not familiar with the patient's meds and labs, and they can't take orders for meds.

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"Often the tele techs, who monitor the monitors, will notice a change, notify the RN who notifies the doc. If they need some sort of intervention, they get transferred to a higher level of care."

Why is there a need for RN's there? Just have the tech call the doc. Our tele pt's are already at a higher level of care requiring RN's with a higher level of training. We are even trying remote SCU where SCU RN's are remotely monitoring pt's. I take a certain pride in my training and abilities to be able to give a doc a solid SBAR especially the R. We like to challenge each other where I work with looking @ EKG's and seeing what we see.

Honestly I believe ACLS, PALS, and EKG interpretation should be required of all RN's (and they are not long courses). Maybe even taught in RN school?

I woke up thinking about "Often the tele techs, who monitor the monitors, will notice a change, notify the RN, who notifies the doc. If they need some sort of intervention they get transferred to a higher level of care." What about nursing assessment of the patient's rhythm, assessment of patient signs and symptoms, and prompt, early interventions to prevent a worsening clinical situation. It sounds as though the nurses don't know anything about taking care of patients with arrhythmias. And what's even worse, they don't even know what they don't know, and think the above situation is fine.

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.
"Often the tele techs, who monitor the monitors, will notice a change, notify the RN who notifies the doc. If they need some sort of intervention, they get transferred to a higher level of care."

Why is there a need for RN's there? Just have the tech call the doc. Our tele pt's are already at a higher level of care requiring RN's with a higher level of training. We are even trying remote SCU where SCU RN's are remotely monitoring pt's. I take a certain pride in my training and abilities to be able to give a doc a solid SBAR especially the R. We like to challenge each other where I work with looking @ EKG's and seeing what we see.

Honestly I believe ACLS, PALS, and EKG interpretation should be required of all RN's (and they are not long courses). Maybe even taught in RN school?

Well for starters a tele techs scope of practice is completely different from an RNs. And I don't understand how this prevents the primary RN from giving a solid SBAR. The tele tech is basically an extra set of eyes or an arrhythmias alarm. They still report to me when there's a change from baseline which prompts me to go assess the patient and notify the doctor with the SBAR. I'm still going to be looking at the strip with every assessment or if there's a report of deviation.

My unit has the telemetry monitors for my entire hospital barring the ICUs who do their own monitoring. The tele techs are there to monitor everyone on my floor and the rest of the hospital who require monitoring but not the level of care provided by my floor. And honestly I don't ever get any pediatric patients. I am only adult population so having PALS won't really help me where I work. I can see where acls should be required in all inpatient areas as a patient can code at any times but I would think that at areas such as a clinic, bls is adequate. They're not gonna have access to a crash cart that has all the protocol drugs. They're basically gonna be doing aed and cpr until an ambulance comes.

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