So I have my floor and preceptor, now what?

[sgalvin07]

So, I've finally made it to the place I once thought would never get here. I'm moving on to role transition (after I pass my huge ATI test next Monday.....here's to being positive). Hopefully I'm not looking too far into the future, but I feel confident about my last ATI test, which is the only thing standing between me and role transition.

Got placed on a medical telemetry floor (thankfully at the hospital I work at, so convenient). Basically the floor is split in half, AB is medical telemetry CD is surgical telemetry. All of my clinicals have been on TCU floors but seem so different then here at my hospital. As a clinical student though, I feel like my exposure to the floor, the conditions, the knowledge, the true inner workings of the unit have been a little covered up. Have always had the feeling of "only knowing what I need to know" to get through clinical as a student.

Since I'm moving off into telemetry in terms of role transition I feel like my knowledge level is going to need to be a little higher than it has in the past. What do you guys suggest I brush up on, read about, study, expect?!?!?

Clearly every pt. is on a monitor, so I'm sure that I'll need to brush up on my EKG strips, etc. Are there any good books that lay it out in the "any idiot could do this" style. Simple, to the point, and easy to understand. In my searches I've found that there are some that are too vague, and some that go further in depth then I will likely ever need to know. I need a good middle ground.

All of my clinical TCU floors seemed to be overflow units. (my school/clinicals are in Kentucky, and I'm an Ohio guy so I was lucky enough to get them to place me in a hospital of the Ohio side for role transition). They tended to get people from other "at capacity" floors and put them on monitors that didn't truly need it, but because it's a telemetry floor and they have policies they monitored them regardless. Doesn't seem to be like that in my role transition unit, so I'm just wondering what the "normal" telemetry disease processes are, if there is even a normal. Just trying to figure out what I should focus on as I brush up my skills over my two week break. As always, thanks in advance

[NCRNMDM, ASN, RN]

I've never worked telemetry, but I did some work in a major ED at a large medical center, and I know the types of patients we sent to telemetry. There were multiple telemetry floors at the hospital I worked at prior to nursing school (there had to be, it was a 700+ bed facility), and each telemetry unit took different patients. It sounds like your facility is just a big conglomerate of all the telemetry patients in the house, so I will try to give you an extensive example of the types of patients you might see. Anyone who was having chest pain, but not an acute MI, who seemed slightly unstable (yet not unstable enough to land an ICU bed) went to telemetry. The patients who had just had open heart surgery, or were recovering from an MI, a CVA, AAA repair, stent placement, etc, went to telemetry beds after being moved from ICU. Patients who presented to the ED in SVT (which resolved in the ED), with asymptomatic (or slightly symptomatic) bradycardia/tachycardia, or other heart issues went to telemetry (provided that they were stable enough). The telemetry floors at this facility took patients on some pretty heavy-duty drips, too, so it wasn't uncommon to see a patient on nitroglycerine, or a low-dose pressor on the telemetry floor. Of course, if they had to be intubated, they went straight to ICU, or if their condition became so critical that they needed to be one-to-one or needed more invasive monitoring (like a PA line, ventilator, ICP bolt, etc). You definitely need to know how to interpret cardiac rhythms. You need to know how to identify atrial flutter and fibrillation, sinus tachycardia and bradycardia, SVT, ventricular fibrillation and ventricular tachycardia, first, second, and third degree AV block, asystole, PEA, and torsades. You should try to get ACLS certified if you can, as this would help you tremendously during code situations. If you can't get ACLS, learn the drugs given during a code, learn how to do effective CPR, learn to ventilate the patient effectively, and get an idea of what your role would be during an arrest. Also, learn to note subtle changes in your patient's condition. This might be a slight drop in BP, a slight elevation in heart rate or respiratory rate, a slight drop in oxygen saturation, etc. These slight changes can be the harbingers of disaster later in the shift, and if you notice them when they aren't major, you can watch that patient more closely and sometimes avert disaster. Also, become familiar with doing 12 lead EKGs, as you will end up doing your fair share of these. Also keep in mind that just because a patient is on telemetry doesn't mean that their other needs aren't tended too. If they are post-surgical, know how to empty their drains, change their dressings, and set up PCA pumps. If they are medical, know their medications, their diagnosis, and any pertinent history and lab work. As with any medical unit, you can expect to be giving blood at some point (especially if you are working with surgical patients) so get comfortable with that. In my area, a lot of post-op patients get IV fluids with KCL, so we have to keep a close watch on their potassium levels, and the IV site. If potassium infiltrates, bad things happen. There are a lot of considerations to keep in mind, and there are a lot of things you will still have to learn. It will be a fun experience, but it may seem a bit overwhelming at first. No matter what happens, keep your head up, learn something new each shift, and enjoy the experience!

[Nurse SMS, MSN, RN]

My hospital has utilized its telemetry floors as overflow as well, so basically you see a bit of everything. Any patient who has had cardiac issues or is at risk for them seems able to land there. LOTS of nursing home patients, as the physicians like that telemetry floors seem to have a bit better staffing and better monitoring. Lots of diabetes - brush up on how that affects the kidneys and heart. Lots of postops. Lots of pneumonia. Lots of total care.

As you said, review EKG strips, common cardiac drugs, assessments and priority interventions. Take a good drug book or app with you to transition or make sure you know how to access the one on the computer if they have that. And if you don't have a good "brain sheet" yet to help you with organization of your day start looking into that. It saved my life during transition. Good luck!