Telemetry Scare

shhhh · Mar 8, 2011

Your facility should only require you to learn all the very common rhythms starting out like you are now. You shouldn't be expected to interept the really hairy looking stuff right off the bat.

If you're like me, measuring the complexes and calcuating the rate is easy, but figuring out if it's a second degree heart block or third degree heart block was tough for me to wrap my head around. A neat thing I found online that I've found useful as a refresher was this website: http://www.skillstat.com/Flash/ECG_Sim_022505.html

I've told interns about it before and they've all said it helped them learn quicker and felt it helped them pass the EKG exam all of them are required to pass during our hopsital's ICU internship.

Also, remember that there should be a tele tech on the unit, too. They're a serious wealth of knowledge and they can teach you a lot. So, don't feel so nervous; if you learn how to calculate your strip correctly and learn the most common rhythms, then that should be enough to start out with. You'll do fine! Heart rhythms are a lot of fun once you get the hang of it. :)

gigglymo · Mar 8, 2011

I worked nights on tele as a new grad and loved it. It was actually less scary for me because the patients were monitored, so you always had a pretty good idea of what was going on with them.

Most important things I learned -

1. Treat the patient, not the monitor!

2. I was always taught to come onto shift, get report, peek at the monitor, then go do a quick round. This way, if you have a weak battery on a tele pack, or a lead that's loose, you'll know right away, not an hour and a half later after you get done with assessments and bathroom breaks and meds and sprite requests and chest pain and sleeping pills and... :)

3. Don't be afraid to ask questions! If you don't know something - ask. If you think you don't know something - ask. If you see someone doing something that you haven't done before - ask to watch. Or help. Or do it, with guidance.

4. Make friends with your nurse aides, LPNS, unit secretaries, janitorial staff, pharmacy techs, radiology people, etc. etc. etc. They are the ones who make the unit flow nicely - and they're also the ones who are going to help you out when you need stat amio, a room cleaned for an admit, a patient needing to go to the bathroom, and an emergency chest x-ray...all at the same time.

5. Get excited! You've worked so hard for this - you're a NURSE! With a JOB! I loved the patients I took care of on tele - I hope you do too. Good luck with your job! You're going to do great. :)

netglow, ASN, RN · Mar 8, 2011

Instant ECG

great take along app for your itouch.

Jamie P.M., RN · Mar 8, 2011

Thanks Shhh..this is very helpful. I will check out your recommended website and keep you posted =)

Jamie P.M., RN · Mar 8, 2011

Thanks Onaclearday and gigglymo!! will keep you posted on my journey :)

delilas · Mar 8, 2011

Tele's a great tool when used right. I think the worst I see is nurses get used to the dinging at the station and don't check what its for (one of my clinicals, it alarmed as vtach, and was ignored. I went to check on the patient and sure enough, they transitioned into vfib (which FINALLY brought someone in) in as I was checking them and began to code). Artifact does cause a lot of alarms, but its always worth the time to check the patient and really judge how they are =]

I liked this game as well when I was learning:

http://nobelprize.org/educational/medicine/ecg/

It teaches lead placement and the like as well as some rhythms.

Congrats on the job! I'm sure you'll do great.

casi, ASN, RN · Mar 8, 2011

The best part of tele is you'll never be surprised when you walk in on a dead patient, and when you do walk in on a dead patient they are still warm.

Learning tele really isn't super difficult. What helped me the most was knowing the physiology behind the rhythm.

mama_d, BSN, RN · Mar 8, 2011

The best part of tele is you'll never be surprised when you walk in on a dead patient, and when you do walk in on a dead patient they are still warm.

This is why I hate getting pulled to the medical floor...I can't see the rhythms up there all nice and pretty! Makes me nervous.

OP...look into getting ACLS certified ASAP. It'll make you more comfortable. Also, I've been working tele for years now and I still have a cheat sheet tucked in with my badge with the different blocks on it. I rarely need it anymore, but it's great to refer to when needed.

You'll be amazed at what you get comfortable dealing with. The only ones who still bother me are when we get those third degree heart blocks over the weekend that we're babysitting until they can get a pacer placed, and the sick sinus syndrome pts that you watch bounce all over from the 30's to 160's and back again.

ChristineN, BSN, RN · Mar 8, 2011

Tele scared me too as a new grad, I flat out refused to consider working on a tele floor to avoid it. 3 years later, I'm taking the tele certification class at work and wondering why I waited so long. I've had various co-workers explain little bits to me hear and there and it really isn't that bad. Also, I love working on tele floors and knowing as my pt starts to go south I can just put them on tele and watch them on my floor for a bit instead of transferring them right away.

Hopefully your educator and co-workers will be supportive. Good luck

Faeriewand, ASN, RN · Mar 8, 2011

Thanks for the links to learn more about cardiac rhythms! I'm not a tele nurse but I'm always looking to learn more. :)

Many of my friends started on tele and they just love it. When I float to telemetry I always check in with the monitor tech and get the best education on rhythms! Good luck!

3dayRN · Mar 8, 2011

I work with telemetry monitors also. I hate being floated to another floor without monitors. Once you get used to them, and you will, you will not want to be without the monitors. Absolutely treat the patient not the monitor. Also, no big deal to get a second opinion about what you are seeing. There's always going to be some "strange" rhythm that needs a second opinion.