Working on a telemetry/med-surg unit as a new grad

Blackheartednurse · Jan 19, 2011

To it is a perfect combination of the floor for new grads.You will be not only learning the med-surg conditions and skills but also different cardiac drips,strips,heart surgeries.Did I say I envy you LOL. I think in general that med-surg nurses are the best nurses (please some dont be offended) and work the hardest. I used to briefly work on a telemetry and always considered med-surg patients (that came to our floor when there was no place for them on the med-surg unit) and to me they were like the most physically demanding!!! I think cardiac nurses have a better opportunity to combine theory with the skills since their patients dont have all those drains,tube feedings,bladder irrigations,I saw a lot of nurses who work on a cardiac floor having a down time whearas med-surg nurses were running like a chicken with a the head cut off.Cardiac floors are usually not that smelly and have more cleaner patients (like I mentioned no drains,etc).However the med-surg have a lot of more hands-on skills.I noticed that some cardiac nurses were struggling with suctioning the patients,etc...So you have a perfect combo on your floor.

April, RN, BSN, RN · Jan 19, 2011

A tele unit can be a great place for a new grad. However, whether or not a unit is good for a new grad has more to do with the environment rather than the patient population. Why are new grads on the unit struggling and shedding tears? Are they not given enough orientation? Are they being supported by the other nurses and manager? Are they given too many patients? I would look into those answers before considering being one of those new grads. You don't want to be set up for failure.

nursej22, MSN, RN · Jan 19, 2011

Congrats on graduating and best wishes in your new position.

In my experience, our cardiac floor has very little down time, and we are usually running our buns off. But I do work 3-11, which has the most admits and transfers in.

My typical shift is being interrupted during report by the arrival of a new pt (we only get to block out 15 minutes at the beginning of shift) or by another discipline asking me about a pt I haven't seen yet. So I gather what I feel is essential, and try to pick up what I can within the first hour, if possible.

I prioritize who I will see first, if no lights are ringing. I see really sick first, then confused with tubes, walkie-talkies last. Assessments can be very condensed and focused, initially. Can the pt converse easily and cogently? Are they warm and pink? Any pain? IV working? Move on to the next. I try to eyeball everyone in the first hour if possible.

Not unusual to have a discharge when I hit the floor. Gather their paperwork, remove tele and IV. Review discharge with pt and family, run them out to the car.

Grab fingersticks before dinner, pass ac meds. If I don't have an aide, potty and up in chair for meal. Finish med pass. And it's time for the transfer from cardiac recovery to arrive.

Grab a few minutes to chart, check labs, check for new orders, page docs prn.

by now it 7 pm and possibly a new admit. The aides have done the second set of VS, so will have to address any issues with those. Visitors are asking for updates, when is MD coming (he's not) and when is test or discharge scheduled for tomorrow (it's not).

Time to start the next med pass and fingersticks. Please, let all my IVs still be working!

Between phone calls, missing meds, unclear or inappropriate orders, 9 o'clock meds can take until 10:30. Throw in there, prn meds, tube feedings, dressing changes, phone calls, turning and changing patients, falls, crashing patients and codes.

Oh look, it's 11 pm, hello night shift and thank you for coming.

Time to chart, eat and pee.

Wash and repeat.

Caffeine_IV · Jan 19, 2011

You have the basics down as far as what needs to be done during your shift however you must take into account the things that go wrong and pop up during that time

-IVs infiltrate/leak

-new admissions

Time spent calling the doctor and writing orders for:

-patient having runs of this or that on the monitor

-pain not managed

-vitals out of whack

-meds for that agitated lady that won't keep her monitor on

Time spent

-Fetching blankets, ice and drinks

-toileting patients while the CNA is busy (thats if you have one at all)

-listening to complaints

nurseroo · Jan 19, 2011

Hi there.. I am a supervisor for a super fast paced tele floor. I think the best thing in being a new grad is your new. No bad habits...They are super easy to pick up until you mess up big. Nights will give you the ability to really work on time management skills. That, I think, is the hardest thing to accomplish. (keep post it notes with you.) Often, a patient will ask for something, but when you walk out of the room it goes into nursing never never land because 5 other people want something else from you. They always say waitressess make great nurses...Anyway, take advantage of the nights. Your admission skills will be good at night. Discharge starts at admission..teaching..ect.. keep that in mind. Hopefully you will have a great preceptor that will show you the right way of doing things. Policies are there for a reason...doesn't make things easy, but keeps you with a license. So best of luck to you. I am still learning something everyday. The day you think you have it all is the day you need to find a new job!

Mags_RN, BSN · Jan 19, 2011

i started as a new grad on a telemetry unit just this September. I passed my nclex in july. And i really love it. I have worked on this unit for the past 3 years almost as a PCT prior to being an RN.

What really helped me become more comfortable with this new position is just going through orientation and taking care of different scenarios of patients.

As with cardiac monitoring, there are protocols for everything such as rhythm changes, cardiac gtts, and best of all there is the support of your floor - nurses working beside you, your charge nurse, nursing educator and google at times.

know your antiarrhythmic, bp meds, know your heart anatomy (its helpful when you get report from a cardiac cath rn to know where exactly they put in stents), know your rhythms strips, know everything about CHF.

And a pt being on a tele unit doesn't quite mean that their main concern is cardiac, theres plenty of psych/overdoses, renal failure/htn etc. but mostly chf, afib, and syncope. and of course mainly the elderly.

you'll learn your institutions protocols and things will just be much clearer then. but most of all, it just comes with time and experience. If I'm not sure of something or something just doesnt seem right I ask the nurse sitting next to me, and i always think, if this was happening to me , would i want my rn to worry about my condition.

if your have spare time offer help getting lights or helping another rn that is really behind passing meds, completing her admission or discharge, helping others and working as a team is what makes an enjoyable working environment.

everything things take time. enjoy orientation, ask billions of questions ( my favorite question was "is there a protocol for that" and usually there was ) and fall back on to your preceptor when you need help.

Good luck! Tele is awesome!

iloveny68 · Jan 19, 2011

I AM the new grad on a med surg/tele floor that you are talking about! Can't say I'm in tears, although I did cry one night as I drove home. Most of the time it is just treading water to stay afloat. I'm not complaining - I LOVE my unit, my co-workers, and med surg/tele. I am in my third week off of orientation, and the schedules/organization that everyone posted are pretty much what I try to do, but like another poster mentioned, monkey wrenches are everywhere, and my pager never seems to stop going off. I tried to review alot of cardiac, repiratory, and renal, as they seem to be the biggies that we see (we get a LOT of renal overflow). We also have a great deal of pts that are clock watchers for their pain meds. Good luck! I think it is a great opportunity - I learn so much every day.

nyrn5125 · Jan 19, 2011

good thing to orient on days because there is a good appreciation for time management, getting things done quickly, and many tasks to complete. you shouldn't let the other nurses crying scare you. yes you'll have your share of those days.just go in the bathroom and cry til you feel better. try to get as much knowledge as you can from your preceptor. ex.. what should i know about afib? when they come from cath lab with stents what do I watch for?

there is no stupid question

OldNurseEducator · Jan 19, 2011

Good luck. I'm jealous. I envy your youth and what you are about to experience. Remember, as nurses, we were all in your position once. Be good to yourself and be patient. I am at the end of a long, interesting, educational, and wonderful nursing career. I envy you. You will pass NCLEX. Have confidence. And never lose your love for patients and for nursing! :)

Up2nogood RN, RN · Jan 19, 2011

As I was a CNA too before an RN, I too thought it sounded easy enough. While you will have a great advantage in being comfortable with pt care never assume it will be easy.

I would love to go back in time some days and be a CNA again!

I would assume that you will have a tele class to clue you in on unit specifics and protocols.

On my unit now we can have surgical pts on tele but also get medical overflow on tele. I must say that it's been great experience having a variety of pts and I'd rather have my pts on tele than not.

Good luck it sounds like you'll do just fine.

smily nurse, BSN, RN · Jan 19, 2011

I graduated in 1972 (old lady) and went right to ICU; my program had lots and lots of clinical experience so I was very comfortable