Is it normal to get trained in telemetry in a new grad program for a med-surg unit by way of power point modules? We had to complete these modules within 10 hours on our own - then take a multiple choice rhythm strip test after a day of cardiac rhythm review in class. After this - we are considered sufficient to carry a pager for the patients on the med-surg floor to monitor and assess their dysrhythmias every shift and as the alarms go off.
I just don't feel ready to be comfortable to assess patients with EKGS despite this quick training. It feels rushed.
Anyone have advice on this topic? Aren't there EKG certification classes that should be taken before officially signing off on this type of skill - not just getting through a powerpoints and a multiple choice test?
You are right - VFIB and VTACH are pretty easy to interpret -- I was just using them as an example.
And yes -- the heart blocks and PACs are more of a concern to try to interpret so that you ensure you know what is what -- and how to read them correctly. T
hey didn't go over any treatments with us -- just a quick review of the different rhythms - and then a multiple choice test.
Last week - three of the patients on my floor needed the Rapid Response Team brought in -- one of which was mine. This patient needed to go to the ICU -- keep in mind I did make all the proper assessments throughout the day -- and actions were taken to improve the patient's condition -- but ultimately -- she still needed to be taken to the ICU as her condition began to decline again.
I am thinking this new grad program is not worth risking my license if the training is this rushed! My license and patient safety comes first. Period.
If you were not taught treatment and intervention for arrhythmias, what are you supposed to do when one occurs?
I did many basic ekg trainings as a baby ED nurse but I didn't understand jack about rhythms until I took ACLS. Defintely recommended even if it's not required for your floor.
If you do take ACLS, keep in mind that you are generally expected to teach yourself all of the material for the course prior to attending. The 'education' part on day 1 (of a 2 day course) for the first time that someone is certifying is very rushed, in my opinion. I don't think I could have passed the course if I had taken it without already having learned EKG interpretation (and all of the treatment algorithms) prior to the class.
My hospital offers a more extensive EKG interpretation course that is optional for med-surg nurses and required for progressive and intensive care nurses. I'd talk to your educator about what options your hospital has.
While I worked on a med-surg unit for my first 20 months as an RN, we had patients who were monitored by telemetry but I was not expected to interpret the strips. If I was notified by the telemetry monitor of an arrhythmia, I was expected to assess the patient (including VS) then notify the physician, call RRT or call a code, depending on the rhythm. (So although I didn't have to verify the rhythm by assessing a strip myself, I did have to know which rhythms were serious enough to require a code and which required RRT or a simple notification of the attending or PA.) It was up to the person/team notified to perform most interventions, including ordering a 12-lead EKG to confirm the rhythm (though obviously if the patient was pulseless the med-surg RNs/NAs began compressions while also calling the code or if the patient was experiencing symptoms such as shortness of breath, dizziness, etc. we also took steps like applying oxygen, assisting the patient back to bed, etc. without waiting for RRT or a code team to arrive).
When I moved to a progressive care unit, I was expected to interpret strips myself (with the telemetry monitoring team for back up), and I had to certify in ACLS.
(My brief experience on a unit with high turnover and multiple travel RNs lead me to leave that position after only a couple months off orientation. I just didn't feel it was safe to care for 7 or 8 patients, and while our ratio was supposed to be 1:6 on that unit, it was not unusual for it to be 7 or 8. The hospital I moved to had an average patient load of 1:5 and sometimes 1:6, never more, for their med-surg nurses.)
There are plenty of CEU courses for ekg rhythm interpretation that you could take. ACCN offers an online EKG interpretation course too. I personally have learned the most by asking my fellow coworkers about various rhythms when I was a new graduate. I would also pull up various cardiac related videos online on a regular basis.
Learn your basics first. normal sinus rhythm. sinus tachycardia. bradycardia. atrial fib. atrial flutter. SVT. v.tach. v.fib. what do PVCs look like? what do PACs look like? learn various heart blocks (1st degree AV block, 2nd degree heart blocks, 3rd degree heart block). when you learn each one review on interventions. if you have your pathology book from nursing school, review the cardiac chapters.
I also use to carry a cheat sheet for Basic Cardiac Rhythms. here is the information that is on it:
SR R-R regular; one P wave for every QRS, HR 60-100
SB R-R regular; one P wave for every QRS, HR
ST R-R regular; one P wave for every QRS, HR >100
SA R-R irregular; P, QRS, T present
1st degree AVB R-R regular, one P wave for every QRS, PR >0.20
2nd degree AVB, type I ( Winkebach) R-R irregular, progressive longer PR, then a P with a dropped QRS
2nd degree AVB, type II (mobitz) R-R irregular, PRI remains the same, then P with dropped QRS
3rd degree AVB P-P regular, R-R regular but no communication with P & QRS
BBB QRS >0.12
A.fib R-R irregular, P waves not seen, controlled rate if 100
a.flutter sometimes R-R irregular, sawtooth P waves
PJC premature early beat with no P, upside down P, short PRI
PAC early QRS, P & T wave sometimes on top of each other
PVC QRS complex wide >0.12 and premature
V-fib no organized electrical activity. NO PULSE
V-tach regular wide tall QRS complex, can be pulseless
Junctional R-R regular but no P wave, PR
Junctional Tachycardia HR >100, no P wave, P wave inverted, or P wave is behind QRS, PRI
Well, to be honest we covered the EKG training in about 24 hours (2 classes) for paramedic class. There's a lot of basic ones. I would just start practicing rhythm strips. What do I have here? What do I have there? I think that's kind of the best route after you get the basics.
Been there,done that, ASN, RN
7,241 Posts
If you were not taught treatment and intervention for arrhythmias, what are you supposed to do when one occurs?