Telemetry Techs vs. Nurses

justmanda · Sep 25, 2005

Who's better at reading rhythms?
I say the techs (I'm an LVN and a monitor tech by-the-by).
I hate nurses who can't tell the difference between a Wenckebach, a Mobitz II, or a dissociated AV freaking block.

At our hospital, we call them the Tele-nazis. They badger us all the time and, yes..they are just doing their jobs, but it is no less annoying to have your phone ring 20 times AFTER they have already told you the patient is in SVT HR in the 150s. I actually had one demand that I tell her what I was going to do about it...Uhh, just because the patient hasn't come out of that rythym doesn't mean I haven't initiating treatments. We respect your knowledge/skill at reading tele strips, respect our knowledge and ability to be able to handle the problem. And PLEASE, when you have notified us of a critical rythym, leave us alone and let us deal with it.

Jubei · Sep 25, 2005

Don't be so judgemental. If you have knowledge and training that your nurses don't, share it rather than hate.

That's what I'm doing! then you get these RN's and intern doctors

(sometimes residents) who think they know everything and blow you off because I'm just a tech. We have one long time doctor who can't tell the difference between freq PAC's and a 1st AV block. :nono:

Jubei · Sep 25, 2005

At our hospital, we call them the Tele-nazis. They badger us all the time and, yes..they are just doing their jobs, but it is no less annoying to have your phone ring 20 times AFTER they have already told you the patient is in SVT HR in the 150s. I actually had one demand that I tell her what I was going to do about it...Uhh, just because the patient hasn't come out of that rythym doesn't mean I haven't initiating treatments. We respect your knowledge/skill at reading tele strips, respect our knowledge and ability to be able to handle the problem. And PLEASE, when you have notified us of a critical rythym, leave us alone and let us deal with it.

Phones? Man I wish I could just phone the nurses rather than having them blow me off face to face.

I'd rather be a fascist tech than an old battle ax nurse.

DutchgirlRN, ASN, RN · Sep 25, 2005

Cuz', I hate being told I'm wrong about a strip WHEN I know I'm right concured by a 12 lead EKG reading.
:)

Strips can be very subjective. The final authority iis the physician taking care of the patient. If you want to be 100% right all the time go to medical school.

cardiacRN2006, ADN, RN · Sep 26, 2005

We don't have monitor techs at our hospital at all-and it's strictly a cardiac hospital. Nurses and PCT's alike are responsible for paying attention to the monitor. There are monitors in each nursing station and there is a nursing station for every 6 pts. I can't even begin to imagine someone else knowing more about my pts rhythms than me (if I were the RN that is). People will call you to tell you that you pt is in SVT? Weird. How do you not know that? I had a conversation about this with another hospital that has monitor techs-they freaked out that we didn't have them. What happens if they do this or what happens if they do that...... Well, if they aren't symptomatic then who really cares?? I mean going into A-fib is one thing-but who really cares if your pt has a PAC? So you have to watch every beat of their heart? Is someone going to go into the room and watch every breath that they take too? I mean, what happens if they stop breathing? I am around my pts enough that I would know more about them that someone watching 30 of them at a monitor. I as the tech know every one of my pts rhythms. My nurse knows them, too. Scary is the place when the monitor tech knows more then the nurse.

Remember, treat the pt, not the monitor.

justmanda · Sep 26, 2005

We don't have monitor techs at our hospital at all-and it's strictly a cardiac hospital. Nurses and PCT's alike are responsible for paying attention to the monitor. There are monitors in each nursing station and there is a nursing station for every 6 pts. I can't even begin to imagine someone else knowing more about my pts rhythms than me (if I were the RN that is). People will call you to tell you that you pt is in SVT? Weird. How do you not know that? I had a conversation about this with another hospital that has monitor techs-they freaked out that we didn't have them. What happens if they do this or what happens if they do that...... Well, if they aren't symptomatic then who really cares?? I mean going into A-fib is one thing-but who really cares if your pt has a PAC? So you have to watch every beat of their heart? Is someone going to go into the room and watch every breath that they take too? I mean, what happens if they stop breathing? I am around my pts enough that I would know more about them that someone watching 30 of them at a monitor. I as the tech know every one of my pts rhythms. My nurse knows them, too. Scary is the place when the monitor tech knows more then the nurse.
Remember, treat the pt, not the monitor.

So what are you going to do when a patient has 20 beats of V-tach and you didn't see it? And then, 15 minutes later, he has 15 more beats of V-tach and you were not at the monitor at the time? I check my patients rythms at the monitor station also, but I would not know if he had these incidents if the monitor tech didn't tell me unless I happened to be there watching at the time. Regardless if a patient is symptomatic with these specific incidents, they MUST be addressed and documented. Why? This patient is at risk for sudden death. What if he goes home, it was never addressed and has it again, only doesn't come out of the rhythm. And yes, when someone is put on telemetry, the doctor wants every beat of their heart to be monitored, if not...why even have telemetry? You ask me "How do you not know when your patient is in SVT?" My question is, how would you know they are if you were...1. Starting an IV (approximately 10 minutes) 2. Changing a diaper (takes about 10 minutes). 3. Taking a sample down to the lab (5 minutes). This is a long time for a patient to be in a potentially lethal arrythmia before you walk by the monitor to notice. I complained about the over-diligence of our Tele-nazis in my earlier post, but I think they are a VITAL member of the team and our patients need them at their posts. Scary is the hospital that has telemetry monitors unmanned (even for a few minutes).

justmanda · Sep 26, 2005

And one more thing. You said "Remember, treat the patient..not the monitor" That applies when the rhythm is, for example, artifact as opposed to the actual rhythm. Treating a patient's arrythmia IS treating the patient since it is a representation of the electrical activity of the heart.

UM Review RN, ASN, RN · Sep 26, 2005

Treating a patient's arrythmia IS treating the patient since it is a representation of the electrical activity of the heart.

In most cases, I agree. However, if your patient has a pacemaker, there's just nothing like actually eyeballing the patient.

I didn't want to jump into this thread because of the very question the OP posed. Like you could have one without the other. Or like nurses and MTs are on different sides.

We're on the same team. We have the same goal--to get the patient better.

Certain aspects of certain personalities will always irritate certain people, but the fact remains--our focus is on the patient, not oneupmanship.

Tweety, BSN, RN · Sep 26, 2005

Phones? Man I wish I could just phone the nurses rather than having them blow me off face to face.
I'd rather be a fascist tech than an old battle ax nurse.

Maybe the aren't blowing you off. You give the information, then it's the nurses job to take care of it. Sometimes the tech tells me "you're patient's in bigeminy!!!"...."Thank you," and then go about my business. That's not a blow off.

If you ever feel a nurse or MD is endangering a patient by their lack of knowledge and action, I hope in addition to your judgement, you follow the chain of command and do what's best for the patient.

No need to be a nazi or a battleaxe. Work shouldn't be a war.

cardiacRN2006, ADN, RN · Sep 26, 2005

So what are you going to do when a patient has 20 beats of V-tach and you didn't see it? And then, 15 minutes later, he has 15 more beats of V-tach and you were not at the monitor at the time? I check my patients rythms at the monitor station also, but I would not know if he had these incidents if the monitor tech didn't tell me unless I happened to be there watching at the time. Regardless if a patient is symptomatic with these specific incidents, they MUST be addressed and documented. Why? This patient is at risk for sudden death. What if he goes home, it was never addressed and has it again, only doesn't come out of the rhythm. And yes, when someone is put on telemetry, the doctor wants every beat of their heart to be monitored, if not...why even have telemetry? You ask me "How do you not know when your patient is in SVT?" My question is, how would you know they are if you were...1. Starting an IV (approximately 10 minutes) 2. Changing a diaper (takes about 10 minutes). 3. Taking a sample down to the lab (5 minutes). This is a long time for a patient to be in a potentially lethal arrythmia before you walk by the monitor to notice. I complained about the over-diligence of our Tele-nazis in my earlier post, but I think they are a VITAL member of the team and our patients need them at their posts. Scary is the hospital that has telemetry monitors unmanned (even for a few minutes).

That's funny, no one has ever missed V-tach, or SVT or any problamatic arrythmia. That's because we watch our patients and we have monitors everywhere. If I was stuck in some room where are the other nurses on the floor? They are watching the monitors. We have low ratios for both nurses and techs, and we are in out pts rooms watching them. We have never had a monitor tech in the history of out hospital (none of the hositals in our chain) and we never will. The interpretation of the monitors is the nurses job and priority. It works for us, and I can hear the V-tach alarm from any room. Our hospital is quiet and set up around pt care. Every room is private. To be honest, it takes me about 30 seconds to tube samples to the labs. When the nurses start IV's they don't go and hide in a room and close the door. I can see all the nurses and they let people know where they are. Like I said, no monitor techs, never a missed problem, and the lowest mortality rates in town. All that and the nurses actually know all of their pt, not just some of it.

BTW out monitors have full disclosure-every beat is recorded for those people who need to see it-but none of our docs or CV surgeons seem to mind one bit not having a monitor tech, and every single pt is on tele.

Nurseboy1 · Sep 29, 2005

On my telemetry unit that I work on as a secondary unit, we have individual monitors for each patient in their room, and in every room there is a large monitor that displays all of the patients on the unit. No matter where you are on the unit you can see any patient's rhythm at any time.

MQ Edna · Sep 30, 2005

Jubei said:

It's their (my) JOB to tell you that the leads are off. You disliking it DOESN'T matter. Would you rather have us tell you that the pt is in V-fib when it could just be an artifact. Of course, if all 5 leads were on, we could distinguish the strip better.
As for for the batteries, I think your charge nurse, nursing manager, and MD WOULD WANT YOU TO REPLACE that battery....You know, just in case the pt codes and FOR LEGAL purposes, your unit's covered.

I'm an LVN and a tele tech too....but my gosh, I do NOT have the cocky un-necessarily rude attitude you do. Chill out, if you don't look at strips for a month or so you begin to forget things, sorry we don't all have photographic memories like you. As long as a nurse can tell that the pt. has some sort of ectopy and is not in sinus, there are others (nurses, techs, etc) that can tell exactly what the rhythm is.