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Telemetry nightmare

Hi I am a new grad and have been working on the tele floor for about 4.5 mos. The other day ER sent up a patient with COPD exacab., who was on nonrebreather 100% 02. patients heart rate was 120's at admission to our floor. 02 sats were ok 93% but you could see patient was using accesary muscles paged DR for orders no call back page Dr again no call back. Patients heart rate was steadily climbing I decided to call a rapid response. They stabilized the patient and I was told there were not enough ICU nurses to take care of the patient. I had 3 other patients at this time and I had spent 2 hours in this patients room. Dr had called back during the rapid response ( patients hr had gone up to 170's but the monitor was reading 220). Then Dr alled back and ordered stat ABG's patients PH 7.14 and C02 was like 100 finally they transferred to ICU. Where the patient should have gone in the first place.

Then yesterday I had 6 patients. One was on the call light constantly for pain meds, I was in her room at least 10 or more times. The other patient Dr decided to cardiovert in room. I was in her room for an hour setting up and recovering. Then another patient complained of pain gave Dilaudid, ( which patient had taken before) about 2 hours later patient complained of Nausau gave Anzemet. Patient had had a CABG x3 about a month ago, came in with difficulty breathing and leg swelling. He was a diabetic bs were 177,176 on my shift. Well as I was trying to start a bad IV on another patient Dr ordered pacer wires out on yet another patient. This was at 1445 my shift was supposed to be over at 1530. and I had only charted on two of my six patients. Well I was trying to wrap up a few things on my other patients and then I was planning on pulling pacer wires and then chart. Well the above mentioned gentleman was found unresponsive in the room. We called the operator to call a rapid response and the operator wasn't picking up so we called a code. well they worked on him for quite a while I froze and the Er doc screamed at me. ( I am not ACLS certified yet) I was going to take the class in the spring. I ended up in the hallway crying. we dont have enough support on our floor my manager is leaving in the middle of Jan the prior manager walked off the job. I just found this out yesterday and two of our nurses have left in the past 2 weeks ( one had been there over 10 years)/ Needless to say I did not pull the pacer wires. My manager told me not to. So the nurse today will probably be mad. I ended up punching out at 1745 over two hours after my shift. I was going to try and stay on this floor for two years to get the experience. Dont know if I can do it any suggestions?

UM Review RN, ASN, RN

Specializes in Utilization Management.

O. M. G!!!

I've been a tele nurse for years and that kind of load would probably drive ME off tele!

Here are a few of the differences.

  • A new grad would NEVER be given a patient load that complex.
  • We don't do much, if any, external pacing on our unit.
  • We rarely, if ever, cardiovert on the floor, and both that and external pacing are usually done in the Cath Lab or in ICU.
  • No one yells at anyone during a Code.
  • Our nurses help one another in a patient crisis, so you can get a minute to chart. Or we'll help you in other ways, like answering your lights or doing your chart checks or something.

Now I'm curious: What kind of orientation and preceptorship did you have?

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt.

i am so sorry you had such a bad time of it.

this, people, is why i feel that telemetry units/stepdown units are not a particularly good place for new grads to start out. i worked on one for 5 years and this kind of shift happens more than you would think on tele units. note to self: questions to add to my bank of interview questions. . .how long have you been the nurse manager, and what is the turnover rate of nurses for your unit?

to the op. . .did i get it right, that this was happening on a day shift? you didn't mention, but where was the charge nurse or nurse manager/supervisor while all this was going on? i am so, so, sorry you are finding yourself in this position. if it is getting too difficult for you to tolerate try to see if you can transfer to a med/surg unit of the hospital. you may be able to do that at 6 months of employment (this is based on your actual day of hire). try to work within the system first. otherwise, you may have no choice but to look for another job.

I was on orientation for 12 weeks. My preceptor would leave me alone quite a bit, I ended up trying to figure things out for myself. My manager was in the room during the code and she did help me set up for the cardioversion and stayed in the room during it. This was the day shift. I agree that maybe this is not the best place for a new grad. I am scared I am going to lose my liscence. Also the ABG's on the above mentioned patient were horrible, PH 7.10 and CO2 108. The patient didnt have a respiratory history as far as we knew and the ICU nurse was trying to figure out why this patient went into respiratory acidosis.

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt.

shortsteph12. . .one of the problems I saw with stepdowns is that they are dumping grounds for patients who either can't get into the ICU because there are no beds available, or the docs aren't quite sure exactly what's going on with the patient to begin with, so they stick them on telemetry and "watch" them (actually, the nurses end up watching them). When the defecation hits the ventilation, it's usually while they're on the telemetry unit. As I said, I worked on a stepdown for 5 years and then was promoted to supervision in the same hospital, so I was also able to see what was going on in the ICU and ER as well that contributed to these kinds of situations. We had doctors who would refuse to transfer their patients out of ICU when they no longer needed to be there, as well as doctors who refused to release telemetry on patients who were stable and their EKG status not even being addressed in the doctor's progress notes! That left patients in Limbo Land over on telemetry. And, the real wild card is that you just never know who is going to go sour on you.

I forgot to ask, did any of the other staff nurses come running to help you out during these crises?

Honestly, kiddo, I'd hate to see you walk away from the months you've already put into this job. On the other hand, I do understand the panic you're feeling right now and the fear of making a fatal error. Is this the first time it's been this bad in the last 4 and a half months? If so, that's probably a good sign. I don't like that you were screamed at during a code by a doctor. If anyone should have their crap together, it should be an ER doc and there is no reason for that kind of behavior. It gives the rest of the people in the code a reason to get nasty as well. The most laid back codes I ever saw were in the CCU where, as an observer, you would never know a code was going on, it was that calm and controlled.

Well, you are the one in the situation. Was this typical? Do you think it's likely to recur again and again? What's going through your mind about this?

christvs, DNP, RN, NP

Specializes in ACNP-BC.

Oh my! That is not fair for you to get such complex patients as a new grad. Were the other nurses helping you out at all? They need to be helping you out and not letting you "drown." I agree that once you hit your 6 month mark, try to switch to a more stable med/surg unit where you have more support and feel more in control. I'm a new RN as well, and have been on my tele unit for 5.5 months now. But I honestly feel very supported by the other nurses on my unit, and I rarely if ever get complex pts like that to take care of. I don't feel overwhelmed at all on my unit because I feel like the charge nurses are usually looking at for me when they make out the assignment, for which I'm grateful. I think if you worked hard to graduate from nursing school & pass NCLEX then you deserve a job that treats you well.


I don't know about switching to a "stable" med-surg unit - I'm a new grad on a tele unit also, just 4 weeks "on my own" after 7 weeks of preceptorship (I am "older" so my NM thought I could handle it ...)

I do consider myself lucky that I am on this tele floor - one patient and her family had told me how wonderful this floor is compared to our med-surg floor - where all the nurses were complaining to them - the patients and their families' ! - that they (the nurses) were overworked and understaffed - and I was just quietly doing my job ....

Honestly, I'm just glad that I am on this floor, where the majority have patience and are willing to teach (as I told them, I didnt' learn everything in ischool). And I have gotten the assignment of "heavy" patients, but have also asked for help doing it. I know at this point I am learning a lot, and will NEVER consider going to med-surg!!!

christvs, DNP, RN, NP

Specializes in ACNP-BC.

I don't know about switching to a "stable" med-surg unit - I'm a new grad on a tele unit also, just 4 weeks "on my own" after 7 weeks of preceptorship (I am "older" so my NM thought I could handle it ...)

I do consider myself lucky that I am on this tele floor - one patient and her family had told me how wonderful this floor is compared to our med-surg floor - where all the nurses were complaining to them - the patients and their families' ! - that they (the nurses) were overworked and understaffed - and I was just quietly doing my job ....

Honestly, I'm just glad that I am on this floor, where the majority have patience and are willing to teach (as I told them, I didnt' learn everything in ischool). And I have gotten the assignment of "heavy" patients, but have also asked for help doing it. I know at this point I am learning a lot, and will NEVER consider going to med-surg!!!

I'm just saying it may very well be a good idea for her to take a position on another unit that either has way more support to offer to new nurses or that has more stable patients to take care of. That's great that you like your job and have support. I feel like I can always get help when I ask for it too. But think about how it must feel to find yourself stuck on a unit without much support at all, and one in which heavy patients you are not ready for are given to you without anyone there to back you up. That is not a good situation for anyone to be in, much less a new nurse. If it were me, I would not be happy nor feel safe there, so to me, it would make sense to want to find another position taking care of more stable patients. And I also think that not all med/surg units are crazy places to work. I think it depends on your area, the hospital, the particular unit, the management on the unit, the nurse-pt ratios, acuity of the pts on that unit, your experience level, ability, etc.. I've floated to many of our med/surg units in my hospital and know that there are 3 of them I'd never want to be on, but that 3 others are really cool places to be. So yes, it is possible to be happy on a med/surg unit, provided it is the right fit for you.


i'm new also and working on telemetry/stepdown... it's aweful... like you, i am scared to lose my license on this unit.... it suckssssssssssssssssssssssss.........ahhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh....................


Specializes in Cardiac Step Down, PICU.

I'm in the same boat. I graduated in May 05. I was told I would be working on a telemtry/stepdown unit. Well I'm not getting very many cardiac patients but I am geting alot of MICU overflow. It's crazy busy and I worry about losing my license every day. Many nurses have quit in the past 4 months since I have been there. I feel like I fell for the bait and switch. I was promised cardiac step-down and have found myself on the dumping ground. So far I love being a nurse...just hate where I am working. I'm putting in my 6 months then re-evaluating...posibbly transferring??? Great thing about nursing there are MANY opportunities out there :)

Good Luck to you


Nightcrawler, BSN, RN

Specializes in Cardiothoracic Transplant Telemetry.

I am sorry for your horrible, horrible day. I too work tele in a tertiary hospital where we have very sick patients, and we often have people on the floor with external pacing.

I may have been confused, but were you saying that the nurses on the floor pull pacer wires? At our hospital it is either the docs or the cardio-thoracic teams advance practice nurse that pulls wires due to the chances of tamponade, floor nurses merely monitor afterwards, and enforce flat bedrest for 3 hours. I would NOT be comfrotable with pulling the wires myself!!!!!

That said, if you are going to stay in that unit you need to get yourself into ACLS asap!!!!! It will help your confidence, and keep you from being in a situation where you are yelled at. In our unit a new grad is required to have ACLS within 6 months of hire, and if there is a code within that time, the new grad is ONLY there to report on the patient and the occurrences leading up to the code, and the ACLS nurses on the floor do everything else!!! If your co-workers won't support you in a code situation, then perhaps you should reevaluate continuing to work there.

thanks to everyone for replying. I am considering switching to the ortho/bariatric floor if possible. Yesterday I worked and it wasnt too bad in fact word got around that " one of the new nurses had a really bad day." one of the night nurses said "I hope its not stephanie." she thanked me for comming in. Shes been a nurse for 16 years, supposidly new ratios have started I should never have 6 patients again. According to the organization that controls magnet status tele should be 4/5 ratio. We are so shorthanded on nurses on our floor, on Weds or Thurs only one nurse is scheduled for days. Which means lots of floaters from other floors or angency nurses. I am afraid what it will be like without a manager. Its nice to know I am not alone in this boat....

yes the nurses on our floor do pull pacer wires. I thought thats all I need is a patient to cardiac tamponade or go into torsades... The docs always come up right before change of shift and order us to pull pacer wires and chest tubes. I will take ACLS in march when it is offered. I think I will feel much better than.

I've been a nurse since 06/04 and started out in ccu & pccu (telementry step-down unit). I stayed 14 months and finally decided there had to be a better position somewhere. Our floor was a mixture of everything possible--almost anything but cardiac--more like a nursing home in many ways. Lots of people that were just waiting for Jesus to take 'em home although extraordinary methods being used to sustain life. Very depressing, mudaine--not at all what I had envisioned. Not to mention, the nurses on the unit were not kind to new grads. Went home exhausted, scared and crying many mornings after long night shifts. Finally decided that I was going to try something different b/c I would never know if they wasn't something better out there if I didn't at least try. In Sept went to the ER--love it! More skill oriented. People smile, thank you, and go home--not everyone is dying or critical. Use my nursing skills--don't just clean poop, struggle to keep people in there beds or put in an occasional iv, or hang feeding tubes. Additionally, the nurses are much more helpful & understanding of the struggles of being a new nurse. More team work which includes the docs.

In short, if you're not happy, try something different. There is too many options available to nurses to be stuck in an unhappy situation after all that education. Don't give up---move!!!


Hey, I'm a New Grad (well 6 months out--RN II next pay period, God help us!) on a mixed Med-Surg/Tele Unit. On my unit we can't take tele patients unless we are ACLS certified. Take the time to do it ASAP--it's invaluable. I haven't had your kind of experience, although there is definitely chaos & we have our own set of problems.

I offer the following advice, but I am older new grad (37), with a pretty high level of confidence in myself (not neccessarily in my nursing skills), and a history of working in high end restaurant kitchens, which are their own special brand of hell. In other words, I don't take much ****, I don't take it personally, and I am very good at working with teams and asking for what I need. I am also very direct & (mostly) very diplomatic -- both learned skills.

Things to remember: 1) (All together now!) There is a nursing shortage--if you have to, go find another job where you will be supported & will be able to learn without burning out immediately; 2) learn to say, "No." I say "no" in several ways: "I am a new grad, and am uncomfortable with that;" "This assignment is beyond my skills, I am going to fill out an assignment-under-protest." Call the nursing supervisor and say that the acuity level is inapprpriate for the skill level, and let them share some of the responsibility. I've had nights with a full patient load (5 pts--thank you California Nurses Assoc!)) 2 of which are restrained & on ETOH withdrawals (and both admitted on my shift), 1 dying from CHF (a DNR, but actively dying & needed my attention more than the others), 1 post-op & one getting blood on contact precautions with only another new grad & a float (both with full pt loads) no charge, no aide, no CSA, and a first year resident writing orders. I've called the Supe and said, "So you are aware that I am a new grad, this is my patient load, this is who is on the floor? I feel this is an unsafe situation. Patient safety is jeopardized, are you going to do anything about it? Who can I call for a resource?"

Remember that our first priorities are patient safety, but PROTECT YOUR LICENSE!! DOCUMENT EVERYTHING!! Every phone call, ("2225 Call to MD, awaiting return call. 2240 2nd call to MD awaiting return call. 2245 rapid response called, pt stabilized, MD aware. STAT ABGs per MD order...etc") If you're in a place where you can't maintain patient safety, and no one will back you up, get out.

If an MD screams at you, learn to hold up your hand and say "Stop, you are screaming at me." That's all you have to say. Let them try to justify it or have a tantrum, but at that point they should just stop. You may be scared or shaking, but they won't hit you & they can't fire you. Go to your charge or manager or supe and have them document the MDs behavior. Complain loudly about that to the administration. We've made our prima donna cardiologist go to anger mgmt classes, write apologies, etc. He may not change, but at least it wastes his time.

Also, if I am constantly in a room for pain meds, I call the doc & say that the patient's pain is not satisfactorily controlled & can I have orders for a LA med & something for breakthrough or a PCA if appropriate. Alternatively, I may negotiate with the pt that I will give them their PRNs as often as scheduled & they don't need to call. I will still assess every time, but it keeps them off the light. We're a public hospital, so we get a lot of those patients. I don't care if they're med seeking as long as their resp rate is safe & there are no other contraindications to medicating them. It's not my job to get them unaddicted. That's for rehab.

I disagree that tele/step-down is not appropriate for new grads, but it sounds like your unit is.

My co-workers and I are super supportive of each other, but the administration sucks. I make them pay for every second of my overtime, every missed break/lunch that is due to short staffing & not my flawed time management. If a med is late because I was too busy cleaning **** off the floor & doing a complete bed bath/linen change down the hall, I chart that as the reason. (We have electronic med administration, so we have to justify all our late meds.)

One of the older nurses today advised me to get out now, move around, don't feel obligated to stay. He said mobility was easier at the beginning of his career.

Good luck!

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