New Grad Tele Advice

Ruby Vee, BSN · May 7, 2017

I just landed a job on a tele floor and I wanted to see if anyone had any advice as for books/references they used as their go-to as Tele nurses.
I have already taken ACLS and I have an EKG measuring card that attaches to my badge. I was trying to find the best quick guide for common dx seen in Tele (I know it is very wide range, but I wanted to find stuff I would see the most to get a little prepared).
Also, if there are any new grad tele nurses or nurses that started in tele, did you have Tele specific training in the classroom, or did they expect you to know that information previously?
Thank you!

I started on tele about 40 years ago. There was classroom training, and we had to pass a rhythm test before we were allowed on the floor. If you've passed ACLS, you can probably pass the rhythm test. You'll have a great opportunity to develop your ECG skills and learn from your colleagues.

I don't have any specific book recommendations -- mine would be outdated now anyway -- but know your coronary arteries and your circulation. Understand that a RV MI causes THESE issues and how they're different from THOSE issues caused by an infarct in a different location. I went to Barnes & Noble a few years ago hoping to pick up an ACLS manual to review for a recertification I was SURE wasn't due until next year. I didn't find the AHA manual, but there are some other books out there entitled "Pass ACLS" or "ACLS for Idiots" or something similar that cover a bit more than your ACLS manual does. It might be worth browsing for one of those.

Also, learn the theory of pacing and how to analyze a paced rhythm strip. The sooner you learn that (and the more thoroughly you learn it) the better off you'll be. I work with some seasoned nurses who cannot explain pacing to their orientees (and at 4AM I'm sometimes one of them). If you get a preceptor who cannot explain it, you'll be ahead of the game. And if you get a preceptor who CAN explain it, especially in a manner that can be understood without copious notes, you'll be even further ahead.

Good luck and congratulations on your new job. You are going to learn so much!

barcode120x, RN, NP · May 7, 2017

I started as a new grad on tele a year and a half ago. We didn't have really any tele training aside from knowing/obtaining your 12-lead EKG course. Nothing was "expected," but many things needed to be learned working on the job. My hospital provided a long new grad orientation which included I think it was a 2 week long critical care course which definitely provided tons of information for you as a tele nurse. If there is a critical care course offered at your work for free or if you are willing to pay, I'd highly recommend taking that course. Aside from that, there aren't any books that you need to buy/know or any other classes. Just your 12 lead EKG and your ACLS should suffice with your new grad orientation (hopefully).

Common diagnosis for tele patients? Well telemetry's main focus is the heart so you will probably see a lot of A-Fibs, blocks, pacemakers in regards to rhythms. In terms of diagnosis, well yeah it is very broad, but on an average night most people will have at least one chest pain patient. CHF/SOB/PNA are also very common.

Purple_roses · May 9, 2017

I'm a new grad on Tele. We have to go through classroom training before being allowed on the floor. I was offered the position at the end of my interview, and I asked my manager if she'd recommend any resources for me to study in the mean time (while I was still finishing up school). She told me to relax, focus on passing my last classes, and to focus on studying and passing NCLEX; she said that I'll learn everything I need to know on the job, and that they don't expect me to come in knowing everything there is to know. It was very relieving.

That being said, I'm still brushing up on EKGs. And I'll take Ruby Vee's advice and learn about pacing before orientation starts. But I don't think a tele floor would expect a new grad to know more than what was learned in our critical care courses. I suppose it depends on the hospital though.

Good luck and congrats on the job!

bellini · May 9, 2017

I would recommend "Basic Arrhythmias" by Gail Walraven. A 7th edition is now out.All editions provide hundreds of rhythm strips to interpret.

Mavrick, BSN, RN · May 11, 2017

As fun as interpreting rhythm strips are, an oldie but a goodie is "Always treat the patient, not the monitor". No matter what you think is happening on the monitor, physically check your patient before bringing in any firepower. That bugaboo "artifact" rhythm has fooled many a good tele nurse.

The relative importance of a dysrhythmia correlates to the effect it has on cardiac output. Some people can handle Bigeminy or even short runs of VT others, not so much.

C'mon all you great tele nurses out there. Help the new grad out!

guest042302019, BSN, RN · May 13, 2017

Learn to Read ECGs – ECG Academy Home Page, A cardiologist teach the very basics all the way to the super cool stuff. I love the videos and it's reasonably priced!