New Grad Starting on Telemetry - Some questions

kaylee. · Feb 18, 2014

If its a step-down tele (not a med-surg tele) then usually it is considered 'progressive care' which falls under the umbrella of critical care. Mine is a step down, very challenging floor, i have definitely struggled through my 8 months as a new grad. But the successes are rewarding.

Each little battle of overcoming a mistake by approaching it better the next time is a great feeling. I know this sounds cliche, but the mistakes are crucial for improvement. I have made many many little ones, a handful of moderate ones, and a couple semi-serious to serious ones that have changed my perspective completely!

If there is one thing to say, it would b keep your charge in the know when ur patient's status changes. If your patient starts desatting, stabilize them and stay with them while you call and respiratory and the charge, and let them b involved in the changes; and they will be grateful.

Also, when doing so, don't check out from the situation, be engaged, continue to contribute input on the next steps. And so u can leave the shift knowing that u had a difficult night, and u took appropriate steps, and that u saw it all the way through.

The first RRT i had, i didnt know what to do, and was not as involved and i felt out of the loop. But the second time, i learned from it... i got the charge involved, but also took the lead in talking to the docs and RRT nurses. So i felt like it was a little triump.

Sorry if i went on a tangent from the original questions...that was just a rosy optimistic picture after a good shift :) i have had many gloomy ones!

Another thing about preparing. Get a few good resources. The AACN's "Essentials of Progressive Care Nursing" is awesome! They are about to come out with a new edition from the current 2010. But in terms of studying, i had this whole study plan in place for before i started, but it went out the window when i got going bc for me i realized the best learning has been after i experience the real situation. Once u deal with a clinical situation go into the books afterward, when you can apply it and it really clicks. So i am trying to take studying day by day.

A random example, after my first Peripheral Arterial Occlusion (an emergent situation) i hadn't even thought to study that yet, but it made a lot of sense to dive in right there. I feel like if i had even bothered studying it beforehand i would not have been able to get it fully....

Good luck to you. Stay optimistic, and don't let the mixed reviews on AN.com freak you out. I have had the most abundant experience in tele ...the good, and the bad...They say if u can do tele/step down, you can go anywhere and do well.

ann915 · Feb 19, 2014

Thank you so much for sharing your experience and input! This was very helpful indeed :) Despite hearing how challenging and hectic the Telemetry Unit can be, I also hear it is a great place to learn as a new nurse because there is so much going on with the patients there and that there are many skills to learn that you can also apply to other hospital floors. And although excited and grateful for this wonderful opportunity, I'm still nervous, since this will be my very first RN job and I'm fresh out of school - it's the whole, "I'm not a student anymore, now an RN..." and the "What if I hurt someone..." nervous feelings. But, I also hear the real learning begins once your nursing career begins. So, I want to do and learn all I can to become a competent and reliable nurse. Gotta remain positive and very determined :)

And thanks for clarifying what category Telemetry falls under. I was a bit confused, some say it's Critical Care, and others say it isn't - and then I went and looked on the AACN website and noticed that Telemetry was a selection on the "Which Unit do you work in" section. So it just really depends on the unit and the kind of patients that come in. I see, I see...

Anyways, thanks again! I really appreciate it [:

an1991

greyL · Feb 21, 2014

I work in a cardiac progressive care unit, which is considered a step-down from our actual progressive care unit, but our hospital still considers it as critical care. It's good that you took a rhythm interpretation class. It might be good to find a list of common cardiac medications and learn about those.

And does your floor to drips like nitro, cardizem, etc.? Study that too.

But the best thing to do is write things down that you weren't sure about or didn't know while you were precepting and study them on your days off.

Good luck to you! And feel free to PM me for any questions. I've been in CPCU for 6 months now.

HouTx, BSN, MSN, EdD · Feb 24, 2014

Most adult M/S units in my organization have telemetry capability - no matter what types of dx they care for. Cardiac arrhythmias are a complication of many different types of underlying conditions. Arrhythmia is seldom an admitting dx & they will probably end up as the easiest issues to deal with. I would advise 'digging in' to master the physiology & care paths for the most common dx & understanding the arrhythmia as a "sign and symptom" of the disease process.

ann915 · Feb 25, 2014

I work in a cardiac progressive care unit, which is considered a step-down from our actual progressive care unit, but our hospital still considers it as critical care. It's good that you took a rhythm interpretation class. It might be good to find a list of common cardiac medications and learn about those.
And does your floor to drips like nitro, cardizem, etc.? Study that too.
But the best thing to do is write things down that you weren't sure about or didn't know while you were precepting and study them on your days off.
Good luck to you! And feel free to PM me for any questions. I've been in CPCU for 6 months now.

Thanks greyL for the advice and help! I really appreciate it :] And I do believe that the floor I'll be working on does the drips of the medications you mentioned above (I remember my manager talking about that during our interview when I asked what the acuity of the floor was). So, I'll definitely be looking and brushing up on those meds :) Thanks again! I'll keep everything you mentioned in mind.

ann915 · Feb 25, 2014

Most adult M/S units in my organization have telemetry capability - no matter what types of dx they care for. Cardiac arrhythmias are a complication of many different types of underlying conditions. Arrhythmia is seldom an admitting dx & they will probably end up as the easiest issues to deal with. I would advise 'digging in' to master the physiology & care paths for the most common dx & understanding the arrhythmia as a "sign and symptom" of the disease process.

Ah, I see! I'll be reviewing and brushing up on those then. I know that the hospital I'll be working at has an Electrocardiography class that goes into detail with cardiac physiology and anatomy, as well as arrhythmias that occur, coming up soon. So I'll definitely be looking into that class as well - and other cardiac and critical care classes that is offered there. Thanks for your input! I really appreciate it :)

sunshine15229 · Feb 26, 2014

I also recently accepted a position on a progressive care unit/tele/ little bit of everything, and I am nervous as well. Its so hard as a new grad to hear that now the real learning begins. I plan to review dysrhythmias, cardiac meds, some common heart procedures as well as vents and trachs.

ann915 · Mar 1, 2014

I also recently accepted a position on a progressive care unit/tele/ little bit of everything, and I am nervous as well. Its so hard as a new grad to hear that now the real learning begins. I plan to review dysrhythmias, cardiac meds, some common heart procedures as well as vents and trachs.

Yeah. I agree. It's really nerve-wrecking - I'm here with you and many new graduates out there. But, when in doubt, we just got to hang in there and maintain a positive attitude - and tell ourselves we can do it! :] I was told by one of the nurses at my orientation that one of the most important things for us new nurses to do is to be kind to ourselves and maintain good self-care. Learn, learn, and learn. Ask a lot of questions, even when they seem silly. And most importantly, ask for help if you don't feel comfortable with a task. :)

nursefrances, BSN, RN · Mar 2, 2014

All good advice here.

My first job was on tele. I worked there 3 1/2 years. Our unit did not do IV drips, that was the CVU unit close by.

Some of the patients on our unit (in addition to what was already mentioned) were patients with CHF, MI/observation for MI, CAD, patients plan for a heart catheterization. We received patients s/p heart cath if they did not have an intervention. Some floors receive patients after a heart cath and have to remove a sheath. If this is true on your floor you will be trained on groin management.

The experience I received on the tele unit was priceless. I think it is a great place for a new grad to start because you still have the med-surg component with more of a specialty (cardiac).

Good luck to you.