Telemetry - why is it so hard?

[KalipsoRed]

I have been reading treads for the last few months and I'm wondering if anyone else has noticed that Telemetry seems to be the type of floor nursing that sucks the most? I realize that ICU and stepdown units are hard and you have to think a lot, but it just seems to me that telemetry nursing has the highest turn over. I work telemetry and there are honestly 3 or 4 women out of a group of 20 who actually like their job. The rest of us are constantly trying to figure out a way to get a different job.

I have friends who work in L&D, Oncology, Pediatrics, the NNICU, and ICU and we all started on our chosen floors as new grads. We all agree that initially the responsibility of being in control of someone's health was a very large problem for us when we started on our floors and that anxiety ran rampent because of it, but I'm still feeling overwhelmed while my friends are not. Of course I'm doing TONS better now than I was 10 months ago, but I still feel like I see more nurses who 'hate' telemetry than any other floor setting I know. I chose to go to a telemetry unit because my friends that worked ER said it was the place to start if you wanted to go to ER nursing.

What are the opinions out there? Are there any managers out there or anyone with statistics that can verify this assumption? And for those in the ER, is telemetry the best place to start if you are wanting to be an ER nurse?

Thanks

[chicookie, BSN, RN]

Well, first off I think most people go into Med-Surg Telemetry hating it already. Telemetry floors have not so good reps and most people do it just to get the experience to go where they want to go. So they see the job as a burden more than they want it. Which as we all know someone who does it and sees it as a burden is going to not like it.

I have a like-hate relationship now. Its hard when I see 6 pts a day. I might see one person almost all day and another patient only see them once or twice. Plus depending on the telemetry floor, the type of patients are different. For those that love geriatrics that is fine, but I HATE IT! I rather deal with a younger population. And unfortunately we do have alot of that on my floor. Those are the days that make my eye twitch.

Then there are days when I have mostly surgical patients, so out of my 6 patients 3 are discharged in a matter of 3 hours and then I get thrown 3 admits. That is alot of paperwork and time so my other 3 patients are left alone and usually these 3 are my older patients that need to be watched more closely........

Its like controled Choas. You are never done.

[SoundofMusic]

On tele you have to know your heart rhythms and arrhythmias, and be prepared to DO something if one of them goes awry. It's like being on edge a lot. You are also badgered a lot by telemetry "monitoring" folks who call you every 5 minutes if someone's monitor is off, unstuck, not functioning properly because the person has pulled it off, thrown it on the floor, lost in in the blankets, or whatever.

It seems these folks are just at a higher risk of coding overall. Not like ICU, but you never know. It takes frequent monitoring, assessment of the patient, frequent vitals, etc. Lots and lots of BP meds, issues, etc. You will just CHASE blood pressure problems all day long.

It's wearing.

[FireStarterRN, BSN, RN]

I enjoy working tele. I hadn't heard it was harder. We have fewer pts than med/surg and they are interesting.

You have a lot of turnover in tele. Cath pts coming and going. You have a lot of meds, lots of diabetics. It's fast paced.

I enjoy working with the cardiologists and enjoy telemetry. The cardiologists where I work are easy to work with and interesting people.

[PG-15, ASN, BSN, MSN, RN, APN, NP]

I enjoy working tele. I hadn't heard it was harder. We have fewer pts than med/surg and they are interesting.

You have a lot of turnover in tele. Cath pts coming and going. You have a lot of meds, lots of diabetics. It's fast paced.

I enjoy working with the cardiologists and enjoy telemetry. The cardiologists where I work are easy to work with and interesting people.

What would you suggest for a new grad starting in the telemetry department. I had an interview yesterday, my first by the way very difficult to get a job in NJ right now. It looks very promising however. How can I prepare myself for orientation and work. Is there any books you would recommend. Thanks for your help.

[FireStarterRN, BSN, RN]

I think you should take a basic EKG class in order to begin to understand the electrical system of the heart. Find a good class. The first one I took was a 5 class series and was excellent. Once you've gotten a good grasp of the heart rhythms, consider taking classes that cover cardiac nursing that go into depth regarding the heart.

[oramar]

I remember going through something like the author of this thread describes. I was and still am fascinated by everything to do with cardiology. However, it is the very imperative of cardiac problems that threw me. So many problems must be addressed NOW or else. I really like to think a moment or two before I react but arythmias and pulmonary edemas and acute CHFs can't wait for thinking. It is very stressful. If you keep doing it you get better and better at identifying and reacting to problems quickly.

[kanzi monkey]

I like tele because I like how conceptual it is--and yet it gives a "real-time" picture of the heart's electrical conductivity. I had a minor surgery the other day, and as I was groggily awaking from anaesthesia, I focused on my bedside monitor--hmm, respirations are 8, better breath more, and uh..yeah..that looks like sinus rhythm :)

I have been doing rotations in primary care, and often I hear odd heart sounds--lots of sinus arrhythmias, occasional 3rd or 4th sounds, sometimes brady or tachy without any apparent reason. When I have tele patients, I remind myself that the more people who are on a cardiac monitor, the more people you will find have some abnormal rhythm at some point. I had a patient with a history of transient pre-syncope and shortness of breath NOS; this was her diagnosis after a full work-up. She was my patient because she'd had a total knee replacement. The first time she got out of bed with PT, her HR skyrocketed, her BP plummeted, and she nearly passed out and became SOB. Once back in bed and with oxygen, she appeared pale and tired, but otherwise comfortable and mentating normally. She was in SVT (per EKG); after medical consultation, it was determined that it was an incidental episode, and no further actions were taken. I couldn't help but wondering if her history of near-fainting and SOB not-otherwise-specified was just her going into transient episodes of SVT.

The point is the acuity of a tele patient solely depends on WHY a person is on tele--if they are on a monitor because they have an extensive cardiac history, or had a huge EBL in the OR, they are probably more stable than a patient who is on r/o for MI, or is symptomatic in any way.

Don't know if that helps.

-Kan

[LittleWing21, RN]

You are also badgered a lot by telemetry "monitoring" folks who call you every 5 minutes if someone's monitor is off, unstuck, not functioning properly because the person has pulled it off, thrown it on the floor, lost in in the blankets, or whatever.

YES!!! So annoying, especially since I work on a neuro/med unit where many of our pt's are CRAZY..it's just one more thing for them to pull off. You have to constantly answer those calls, fix the leads, get the new batteries, print and read the strips, etc, etc. Just added tasks to an already full workload.

On the plus side, it can be really nice to know whats going on with your pt. I had a guy the other night who had surgery, and only THEN did they discover he had 1st deg av block so he came to our monitored floor instead of back to a gen unit. Then the next night, when I had him, he developed a-fib with some long pauses....which I watched him do! Stat EKG and cardiac enzymes ordered, all that jazz. Sort of neat! Plus, he'll get early treatment (anti-coags and all) which may help prevent potential problems.

In the end, despite the hassle, I do like the monitors. My mom, also an RN, thinks its crazy that we have up to 6 monitored pts though (I'm not a fan of that either!! ).

[SummerGarden, BSN, MSN, RN]

the tele unit is hard because there is so much to know and do! however, like the positive posters pointed out those of us who make it will be excellent valuable nurses!!!! i absolutely love the learning curve. do not get me wrong, at times i am frustrated with the amount of knowledge i need to have to be average at this job, but my attitude is such that i am learning a lot in a short amount of time and am not disappointed. in fact, i agree with the posters that attitude is everything. for example, i have no problem with geriatrics and see the benefits with working with this population. in fact, i want to be an er nurse too but the floor was not hiring new grads when i graduated so here i am.

i am not disappointed with the work because i think if i were working on a floor without the type of patients i have now, i would think i was missing out and will have a harder time transitioning into the er when i have a chance. most of the people who are triaged onto the floors from the er are cardiac complications so we are gaining the experience we will need in our future. some of the benefit that associates with the er and icu include critical drips, blood administration, ekgs, cardiac markers, telemetry monitoring ... etc. and i am doing it all!

one er nurse of 20+++++++ years informed me that many of the good er nurses have tele and medical surgical backgrounds. the er nurses who she believes have problems for years are those with no medical surgical or tele backgrounds prior to er nursing. many of the new grads she felt were unable to think quickly on their feet or apply basic nursing interventions quickly because he/she has trouble seeing the big picture. the big picture, she says, comes with experience... that cannot be taught/trained. also the skills we gain such as our time management and prioritization will improve and be of value when we transfer. thus, i am told that we are blessed especially with our 4-6 critically ill patients.

-fellow future er nurse

[Spidey's mom, ADN, BSN, RN]

YES!!! So annoying, especially since I work on a neuro/med unit where many of our pt's are CRAZY..it's just one more thing for them to pull off. You have to constantly answer those calls, fix the leads, get the new batteries, print and read the strips, etc, etc. Just added tasks to an already full workload.

On the plus side, it can be really nice to know whats going on with your pt. I had a guy the other night who had surgery, and only THEN did they discover he had 1st deg av block so he came to our monitored floor instead of back to a gen unit. Then the next night, when I had him, he developed a-fib with some long pauses....which I watched him do! Stat EKG and cardiac enzymes ordered, all that jazz. Sort of neat! Plus, he'll get early treatment (anti-coags and all) which may help prevent potential problems.

In the end, despite the hassle, I do like the monitors. My mom, also an RN, thinks its crazy that we have up to 6 monitored pts though (I'm not a fan of that either!! ).

Someone needs to invent a better technology for monitoring . . . . one that isn't so easily dislodged.

steph

[KalipsoRed]

Someone needs to invent a better technology for monitoring . . . . one that isn't so easily dislodged.

I totally agree!!! I've been talking to my brother in law (he is a computer engineer) about leads and our "portable monotoring system". I want to develop something that has a computer chip in the lead sticker. Something that will transmit to a box in the room or something so that the whole thing can be wireless.