Telemetry....Critical Care?

turnforthenurse, MSN, NP · Mar 6, 2012

Telemetry fits into the progressive care/transitional care/step-down care units, but there are some mixed med-surg/telemetry units and those aren't the same thing, at least not at my hospital. The med-surg unit at my hospital has telemetry but if a patient becomes unstable they are either transferred to my unit (progressive) or to the ICU.

From the AACN:

Progressive care is considered to be at the less acute end of the critical care continuum. Patients in progressive care are moderately stable or stable with a high potential of becoming unstable.
* CVP monitoring may be required, but arterial catheters are not typical with these patients.
* Frequent intravenous medication titration is not typical with these patients.
* Chronic mechanical ventilation is not uncommon, but frequent mechanical ventilation changes are not typical with these patients.
* These patients require intermediate nursing vigilance.

These units are known as intermediate care units, direct observation units, step-down units, telemetry units and transitional care units.

You can sit for the PCCN exam whereas ICU nurses can sit for the CCRN exam.

simonemyheart · Mar 7, 2012

Thank you so much!!! I wasn't for sure if telemetry qualified as critical care b/c I am a new grad and the hospital I am at is a 112 bed facility. Our ICU holds 8 pts, we often have their overflow pt's.

We don't have trauma pt's, we transfer them out. I feel as though we basically have the same pt's the only difference is that in the ICU they have more monitors (and only 2 pt's when I have 5-6 in the same condition as their pt's).

turnforthenurse, MSN, NP · Mar 7, 2012

Do you have drips? We can have certain drips on my floor: heparin, protonix, octreotide, cardizem, amio, dobutamine (but those patients are usually transferred from ICU and will be coming off that drip), dopamine (those patients are usually transferred to ICU, though not always), and NTG (we can only only titrate to chest pain, not BP). We can also push BP/cardiac meds (dig, hydralazine, labatelol, adenosine, cardizem) whereas the med-surg/tele floor cannot. We will sometimes get med-surg nurses to help us out if we are short-staffed, but they cannot work with the drips or push those cardiac meds. We do not get trauma patients, either.

Welcome to progressive care! I love the unit I work on and I especially love cardiac - it's the "heart" of nursing! :lol2: You learn a lot on these types of floors and keeps you on your toes :)

simonemyheart · Mar 7, 2012

we do - heparin, protonix, cardizem, dig, hydralazine, labateolol, andensione, octreotide........crazy enough we do not do amiodaronene drips. we can start amiodarone but the pt is then moved to icu.

as far as dobutamine and dopamine - we only do those if it part of the the icu overflow b/c we then have extra monitors transferred to our unit. our unit is literally steps away from icu. then we may only have 3-4 pt's.

pt's on monitor in m/s can not be on any drips, they are transferred to our unit. we have a monitor tech 24 hrs a day whereas in icu they do not have techs so the nurses have to be quite diligent in monitoring pt's themselves.

if a m/s nurse floats to our floor they cannot take pt's on drips, bipap, stroke, a-fib, or on seizure precautions. we do not take s/p cabg its, or any pt directly after any heart procedure. after chest tubes are removed they are transferred to our unit.

[color=#ee82ee]as i am typing this i realize why we are not critical care :) i'm just a nut job!!!!

it funny that i ended up in cardiac b/c i hated the heart all during school and would tell my husband how i would never be a cardiac nurse....funny how things work out. i have become quite engrossed by it.

thank you for the warm welcome into the "heart" of nursing!!!!!!!!