Starting in Tele...!!

al7139, ASN, RN · May 11, 2009

Hi!

Congrats on your new job. I have worked in Tele since I graduated in 2007, and I LOVE it. It is stressful, but always a challenge, and I am never bored.

As a new grad it is really scary to be a "real" nurse. I quickly realized how much they don't teach you in school. I had to learn lots of stuff on the job, but I had my preceptor there so it wasn't so bad (FYI, you will never know everything so you will always be learning).

Here is my advice based on my own experience:

1. If you don't know, ask.

2. If you are not sure, or have never done a procedure, get help.

3. Make friends with your telemetry monitors. I am always calling them if I see a wierd rhythm to get confirmation that I am right.

4. Know your basic rhythms as well as the abnormals like afib/flutter, heart blocks, etc. Your EKG class will help you with this. In addition to my EKG class, I spent a shift with the monitors to reinforce what I learned. If you are not schaeduled to do this, ask to do it. I learned alot from them, they are specially trained to see things we may miss.

5. Know your basic disease processes like CHF,COPD, diabetes, acute MI, STEMI, GI bleed, and stroke. You get all kinds of patients in telemetry, not just heart specific.

6. Know basic classes of heart meds; beta blockers, ACE inhibitors, calcium channel blockers. Know anticoagulants, insulins. Also know drips your patient may be on like NTG, amio, dopamine, dobutamine, heparin. Diuretics like lasix are important as well.

7. When you give antihypertensives like lopressor, toprol, or coreg, ALWAYS check B/P and apical pulse before you give it, you don't want to give it if the pt has a low B/P or pulse. Ask your docs for parameters if they are not already ordered (they will often say hold med if B/P is less than, or pulse is less than). Keep in mind that diuretics and IV pain meds will lower B/P also so be careful if you have to give these.

8. Assess your patients! Do not ever take the previous shifts assessment for granted! Not that they are not doing a thorough assessment, but they could miss something or the patients condition could change (I once had a nurse report a red sacrum to me, and when I looked, it was a stage II ulcer). Always check vitals too. I look at vitals at the beginning of every shift, and follow up with the CNA's for updates.

9. If you need to call a doc, have all the info they need at hand, they hate when we have to look something up (this is where your patho will come in handy). Be ready to state the reason you are calling, the reason the patient is here, the current vitals, pertinent labs, any other important info (eg chest pain, gave 3 doses nitro, no relief in pain).

10. Realize you are learning. It's not going to happen overnight, but with every day you will learn something new. Be proactive. Ask to have the other nurses get you to learn a new skill, or do a procedure. Ask lots of questions and don't worry that you are being annoying. We all started out this way.

11. Get organized. Develop a brain sheet to help you with meds treatments, assessments, etc. It takes time to perfect it, but I have seen some good ones on this site.

12. Don't get stuck on getting your tasks done. Take the time to stop, listen to your patients and family, educate them, and develop the critical thinking skills you need to spot the potential problems that could arise.

I could go on, but I won't.

Good luck in your career, let me know if you have any more questions.

Amy

ssk123 · May 12, 2009

Wonderful advice, I wish I had gotten it when I first started on a tele floor:yeah:

Crux1024 · May 12, 2009

Thank you so much Amy! You rock. lol.

I'll be sure to try and throughly read and understand the subjects/topics you have outlined. :) I just really dont want to be unprepared!

sjsch · May 13, 2009

Great advice al7139~

I will never forget my first week with patients as a new grad on a tele floor. Everything was high drama (from my perspective!)...I was not used to the different alarms and found myself running for anything and everything... One day as I was running past my managers office on my way to a bathroom alarm, she poked her head out the door and yelled "Run Forrest, Run!!"

I had to learn to calm down a bit.

I also had to learn to take care of myself...the "fifth patient" ...

I had to learn there are twenty four hours in a day, and I'm only there for twelve of them.

I still ask questions, clarify procedures, and seek the advice of the many mentors around me, and I try to offer the same for others.

Look for opportunities to learn.

Get yourself a good critical care or cardiac nursing resource book and keep it handy.

If you know someone is going for a procedure the next day, read up on it when you get home. Prepare yourself so you can better prepare your patients.

Best of luck to ya!

al7139, ASN, RN · May 15, 2009

Hi again,

One other thing I thought about is to get ACLS certified ASAP even if it is not required. Invaluable if your patient codes. BLS is fine, but ACLS gives you so much more knowledge.

Amy

al7139, ASN, RN · May 15, 2009

I told you I could go on and on!!!

If your tele alarm goes off, go check on the patient. You may have just come from the room, and most likely they are alright, but you never know, and it really does sometimes happen in an instant when they crash. I once had a patient who I saw to pass meds and was talking, etc. who was in v-fib 5 minutes after I left the room. We called a code, gave drugs and defib x 2 got her back and to ICU. She came back to the floor the next day fine. Had we ignored the alarm and the monitor's call she would not have made it. I would rather explain why I rush to the room and ask if they are OK then have a patient die.

AMy

ICUr_Scrubs · May 15, 2009

Thanks I found this info very interesting. Although I'm about to start my 2nd semester of nursing school, I'm starting think about my specialty. Can anyone tell the number of patient you typically have?

al7139, ASN, RN · May 17, 2009

To snowflake07:

On my tele unit we typically are 5-6 patients on my shift (evenings 3-11pm) and days, and the night shift is usually a 7 patient assignment.

Amy

sjsch · May 19, 2009

Caifornia has state mandated patient ratios based on acuity. telemetry is typically 4:1, med surge is 5:1. Some hospitals out here combine MS/tele which means you can have up to 5:1 but the acuity should not be that high.

My unit has 3 or 4:1 depending on acuity (LVADS, transplants, etc will be 3)...

I love that about California!