New grad needing advice on how to start strong in telemetry

[MjusticeRN]

Hello everyone,

I'm a recent new grad of Kent State University who just passed my state board examination last week. I'm most thrilled, but now I'm worried becuase I start my new job on a telemetry floor (night shift) Aug. 3rd. Other than my clinical experience through Kent State, I have never worked a clinical related or even any kind of hospital job for that matter. I worked in the restaurant industry all throughout college. I'm really worried that I'm going to be completely clueless and not catch on fast enough as a new telemetry nurse. I'm really afraid that I'm going to make the nurses I work with wonder if I really went to nursing school. Any advice that anyone can give me in regard to how to excel on my floor? Any tips on how to adapt quickly and become proficient in my position as quickly as possible? I have no problem taking material home to study to further my knowledge and competence, and I will push myself hard to meet the expectations set before me. Any advice from anyone out there on how they survived their first couple of weeks and even months as a newly hired and novice (if that, lol) level nurse?

[Lunah, MSN, RN]

Are they going to give you classes like EKG rhythm interpretation, ACLS, etc? If not, seek those out ASAP! But I'm sure they'll provide something ... how long is your orientation?

Also, a great book I recommend: "Rapid Interpretation of EKGs" by Dale Dubin. My favorite (for EKGs, that is ... I not THAT much of a nerd! ). I think it's in the 6th edition now.

Congrats on the graduation, passing boards, and the new job!! :)

[MjusticeRN]

Thanks so much LunahRN!

They will be giving me EKG interpretation classes and ACLS as a part of my orientation, though I'm not sure when. I have my 3- week schedule of orientation with a preceptor. I think orientation will last at least 6 weeks, and longer if I ask for an extension, which I think I will do to be safe. I'm going to have to look into that rapid interpretation of EKGs book- sounds like something that will give me the competitive edge. Thanks again so much for your reply and advice... you didn't have to take time out of your day to do that, but you did and that's awesome. take care and God bless!

[Lunah, MSN, RN]

Hey, no problem! I just hit my one-year mark last week, so I know what "new" feels like!

[chicookie, BSN, RN]

Telemetry is not all that bad. I thought it was quite easy but then again we have a clerk on the floor that always watches the monitor. I don't really really deal alot with it other then print out my strips and make sure they are normal. And usually I don't even do that. The clerk does.

My advice is be quick on your feet. Don't go with a know it all attitude and watch alot. I adjusted rather quickly because at the end of each shift I would write down everything I did right and things I saw other nurses do that made sense I would write it down. before my shift I would reread my notes and keep adding on to them. Then I remembered when I was on the floor. It helped me alot.

[MjusticeRN]

wow, thanks a lot chicookie. That's some excellent advice... I'm going to take notes during my shift on things that I want to learn better/remember. I actually read that somewhere else too- I think in a book or something, so thanks for the pointer. With those tips I should be able to adapt with less stress. thanks so much!

[spongebob6286, BSN, RN]

ecg scares me alot. but after a year in MS, i would like to pursue working in ICU. best of luck to you on your new job

[⚕annanonymous⚕]

Learning strips was so much easier on the floor than in school. The nurses make it more real world than instructors do. The more you analyze them, the better you'll get. You won't be expected to be a pro right away! ACLS will teach you quite a bit. Google for the "skillstat" website also for some examples.

[CMF_Dennen]

MjusticeRN,

First, congrats on making it into school, graduating, passing boards, and landing a job. Try to remember this on days that you feel like giving up. I'm 8 months out and work on cardiac stepdown and believe me there are plenty of days you will feel like giving up. Looks like you are probably a few weeks into your orientation so my suggestion is definitely ask questions. Please please please if you don't understand something such as using IV pumps just ask. Accept that you are not going to know or feel comfortable for a few months. Don't let other newbie's deceive you: some of them put up a front like they know everything and end up making you feel stupid and actually they have no clue.

Some of my biggest tips/suggestions: Hit the ground running. When you have a skill jump right in and have your preceptor or whoever is orienting you let you do it and then have them watch. Even if you've never done it before. You may not see that particular skill or procedure done again until after orientation or longer so don't let it get wasted by having your preceptor do it and say that you can do it next time. Ask your preceptor to quiz you on rhythms. Take a few strips home each night and interpret them and hand them back to him or her to check. EKG made easy book is cheap and basic. It'll get you through the first few months. Know about your basic cardiac drugs or common ones that you'll give but try to understanding the actual class of cardiac drug. That way you'll be able to say ok i've never given this drug but i know that its a beta blocker so i know what it'll do. Knowing the class of drug will take you further than knowing actual drugs but try to know common drugs like metoprolol, coreg, amiodarone, etc. You'll probably have chest tubes on your floor so make sure you understand how to assist with putting tubes in, maintaining, and then how to assist when removing. Try to let the people you are working with know that you want first dibs on starting IV's, performing trach care, hanging drips (if your unit does that), or any other skill. Make sure you know what to do in case a patient codes: know where to get the crash cart, what to do if it happens, how the bed comes apart to set up for CPR, what to document if you're the recorder in a code, etc.

I know the first few weeks you're just trying to get used to working at the hospital, the new people, being an actual nurse etc. But definitely make use of your time while on orientation. Ask questions even if you know the answer. Question things as simple as why is this patient on a heparin drip. Sometimes its easy to say ok my patient is on a heparin drip i have to check the PTT in 6 hours etc but you forget to question well why are they on that anyways. Just be confident in yourself and be secure enough to accept that you may feel stupid, other people will make you feel stupid, maybe even nursing assistants. Just think of it as when you started working in a restaurant . When you first started you didn't know alot but if you worked there for a year or so you knew everyone, where everything was, who to stay away from, who to go to in case of a situation. Same concept. Good luck and take time for yourself.

[MjusticeRN]

Dear CMF_Dennen,

Thank you so much for your reply! you took time out of your day to type all of that advice... you have helped me greatly already. It's nice to know also that you are relatively new to the field as well. I will be printing out your thread and taking your advice to heart (no pun intented... ha ha corny joke I know). Thanks again so much and hope your career is treating you well. Take care!

[Diaper, RN]

I'm not very good at reading strips but after taking PALS and ACLS, it helps me a lot ! I'd recommend to take PALS too.

[Diaper, RN]

Apart from reading EKG, the patients in telemetry can be quite unstable. I took care of a patient few weeks ago, he was alert, oriented. Few weeks ago, he deterioated and died on the next night. My advice is, always do a thorough assessment and vitals. If there's a change in patient's condition, call the MD right away and always listen to the patient's concern as well. Good luck.