monitor tech needing some nurse advice

[nightangel40222]

I am a fairly new Monitor Tech monitoring 3 different floors (ICU stepdown, monitored med surg, and bari) my problem is that I am still unsure of what is truly important and what isn't. Our standard HR alarms are set at 120/50, unless the pt is on a drkug that would necessitate those being changed or if they are chronically running high or low they are changed to avoid clogging up the alarm hx. However as a newbie when I call and alert that their patients HR is 121 I get "ugh big deal" basically. I don't understand. If you don't want me to call you and tell you, why not change the alarms. Currently, we alert the nurse once... Example if a patient's HR drops to 40 once, then after that we would not call if they dropped to anything above that... We only alert the nurses after that once they drop lower then their previous lowest HR. if that makes any sense. Changes in rhythm are always reported, at least by me because I would rather tell too much then not tell something that is critically important. Which I feel is a horrible practice but the attitude is well they have been told and they know... I do not feel like telling a nurse your patient's HR went up to 150x1 constitutes "knowing" the pt is tachy. We have several nurses that do not want to know anything about their patients past the strips that we print for them q8hours, which i feel is not often enough because a lot of change can happen in 8 hours. I feel like I drive the nurses crazy calling for everything but I have neither the experience nor the knowledge of the patients to know what is important and what is normal for that patient. Can any nurses point me in the right direction or point me toward some studying I could do on my own to gain some insight? I so badly want to do my job and do it well, but aside from one class on the tele monitors I am, as my grandmother says, "still wet behind the ears" lol

Thank you soo much in advance!!

[madwife2002, BSN, RN]

If the nurses dont want to be informed then that is their problem and their licence I would keep doing what you are doing. I would suggest that if a pt has a run of tachicardia it is probably more inportant to inform the RN, than a one off beat which is of no importance.

Document when and who you informed. Once you have been doing it a while things will settle and you will become more familiar with what you should report. If in doubt report.

I am one of those RN's who would rather be informed than not-pts go off quickly sometimes.

[JDougRN, BSN, RN]

Nightangel, don't worry, this will get easier with time. We LOVE our MTs on our floor, who by the way, have very similar duties to you. As far as calling for a high HR- HR can jump very fast for several reasons- Sometimes just getting OOB or on a bedpan can cause someone to go up- There really isn't anything us as nurses will get concerned about- Our MTs will watch a person who is tachy for 10-15 minutes, and then clue us in. I'm not talking about someone going into the 140s+- but 120-to 130 can happen easily. In our facility, we generally don't look at starting a drip untill a HR sustains 130 for 30 minutes, after we put oxygen on them, tuck them back into bed, ect.

Bradycardia is a bit more tricky- If it's the middle of the night, the patient is sleeping, dropping below 50 isn't a huge deal, as long as they are stable- anything below 45 for any amout of time is call worthy. Of course, follow your hospitals policy on calling, and if it isn't crystal clear, pester someone untill you get something clear to cover your butt. I'll be happy to answer any other questions you might have- Cause we love our MTs!

[Moneypitt]

First off you know to notify the nurse for a change in rythm and that is very good. Next you need to know parameters for individual patients. So......if a patient gets tachy (say 130 or >) notify the nurse. They can then explain what parameters the doctor has set and why. Anything over 150 is a potential disaster so do not be afraid to notify the nurse and document.

For bradycardia I would notify of any rate under 50 and again ask for parameter for notification. With that in mind I would still notify of any rate under 45 and document.

Also.....when you are not sure let the nurse know you are documenting that you notified them. Trust me on this.

[msmoll]

the advice you were given in the past responses are great! good luck

[juliaann]

Some nurses won't care when they should. That doesn't mean you don't call them anyway. :)

I was a monitor tech for about a year between being a CNA and my current job as a cardiovascular tech, and while it was fantastic experience (I am 100% confident of my rhythm analysis skillz now), it was often really miserable, because I got a lot of apathy from most of the nurses and CNAs. Patients would be off their monitors for HOURS after returning from a procedure or getting out of the shower, despite my insistent pages and phone calls (I had to beg for my potty breaks so I had no time to fix electrodes and put new patients on). I got yelled at and hung up on once for "bothering" a unit clerk when I called to ask her to send someone, anyone, in to check on patient who had suddenly gone into SVT @ ~ 190 bpm with no history of tachycardia, because when she asked if I had already paged the nurse for that patient I said "no, someone needs to go check on the patient NOW."

If you have paramaters for alert in place, you need to notify when a patient is out of those limits, regardless of the response you get. If the parameters seem like they could use some adjusting, talk to your nurse manager about it! As you get more experience you'll learn more about how sustained tachys and bradys are more significant than a little jump or fall, and what's "worth" notifying the nurse of. But if you have limits in place now, you should follow them or try to get them changed so that in the event of a code, liability won't fall to you. I've been called in to give statements on lawsuits regarding tele patients that have died while I've been monitoring them.

I kept a log of every phone call I made and page I placed, when pages were returned, what I asked them to do (fix leads, put a patient back on their tele, etc.), if it was a repeat call, and/or what I notified them of. I turned a copy in to my nurse manager every shift. That way your butt is covered if someone codes while off their monitor or the nurse says he/she wasn't aware of a significant rate or rhythm change and therefore didn't treat it.

Just have confidence in doing your job, you'll be fine! Being an MT can be an awesome job, but it can also be very frustrating, so don't let yourself get burned out! But if you do, come join me doing EKGs and assisting with stress tests and heart caths. :)

[MMayo]

You are having the anxieties about being new with an demanding job and greater responssibilities. the advice alrady given is good. telemetry class just puts the scare into you that anything other that normal sinus rhtym is bad and that teaching build anxiety. Your are experiencing the anceint phenomeon of "Killing the messenger of bad news." a monitor tech in essence is a reporter of bad news. The nurses don't want to hear about more problems with their patients. Nurses face the same challenge with physicians.

I have similar problems with the staff nurses as well. Some nurses are only worried about four critical rhythms: VTAC, VFIB, Asystole, and 2nd/3rd Blocks. Realize that not all clincial staff are trained or adequately experience in heart arrythmias. Nursing school does not do the subject justice. I have some good paramedics acting as my mentors. I have two years experience as a monitor tech and I overeacted as you are in the beginning. You are not doing anything wrong, but you don't have that feel for what is more appropriate in priorities. This EKG intution will come in time. Read about EKg materials and talk with the more resonsible nurses for input about getting experience.

To deal with the accountability issue, document your interactions with nurses: room #, patient name, time, nurses name, nurses verbal response & reaction, callback time. Treat each call even for the same patient and event until you get results. Don't give any of them slack, so document eveything. You are not responsible for the critical clinical decisions, the nurses are.

Avoid the unit clerks, they are just another variable in communication that you need to cut out. Talk only with the primary care nurse about first time rhythm chanages.

Get as much information about patietnts and their conditions. For instance, Cardiac patients typically recieve cardiac meds q4 or q6 hours. About an hour before for med is given, you will more likely see arrythmias typical for that patient. This arrhythmia is a norm for the paitent without treament. It is a conditon that the cardiac conditon that needs treatment. Don't ignore this change, but be aware of its cause. If the rhythm continues well past the cardiac med time, then push the effort and talk with the charge nurse.

My biggest problem is infomratin or the lack of. Many nurses rely on me to push the panic button at appropriate times when I do not information to work with. For intance, a patient is continually noisy or is experiencing some short runs of VTAC. Guess what the patient is not in their room and is at physical therapy. Get as much information as possible about your patient and the then the 2+2 will start to occur.