A Day in the Life of a Telemetry RN

A telemetry RN specializes in caring for patients that need increased cardiac monitoring. Although there is a focus on cardiac and respiratory conditions, telemetry floors see a wide variety of patient diagnoses with many comorbidities. The most common are congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) exacerbations, chest pain/acute coronary syndrome, myocardial infarction, sepsis, acute cardiac rhythm changes, and strokes, as well as pre and post-cardiac procedure care. Due to the higher acuity of patients, most facilities require telemetry RNs to be proficient in advanced cardiac life support (ACLS) and electrocardiogram (EKG) interpretation and often recommend prior experience in a general med-surg environment. Another critical skill in the telemetry RN toolbox is the ability to perform and solve problems under the intense pressure of emergency management situations. 

Like most hospital units, the telemetry floor is fast-paced and involves many scheduled and unscheduled tasks. Organization, time management, prioritization, and critical thinking are essential competencies for a prospective telemetry RN to develop. A good understanding of physiology and pharmacology is also important. In addition, the role requires knowledge of how cardiac, respiratory, renal, and other major bodily systems work together on a daily basis. Various types of equipment are utilized on telemetry units and each has alarms that will indicate a change in the patient’s status. Responding quickly to these alerts helps the RN identify subtle shifts in the condition and intervene appropriately. This is crucial for saving patients’ lives.

A significant difference between a medical floor and telemetry unit is the use of critical IV medications, which require frequent assessment and dose/rate titration based on patient presentation and vital signs. Some common medications are diltiazem, amiodarone, adenosine, atropine, metoprolol, digoxin, carvedilol and nitroglycerin. Many times, vital signs will need to be evaluated as often as every 15 minutes. Because of the potential for patients' conditions to change rapidly, assessments are performed more often. A full head-to-toe assessment is completed at least once per shift, followed by focused assessments at least every four hours and repeated as needed. Again, recognizing subtle changes in a patient’s condition and stepping in quickly is vital. 

Scheduled tasks throughout the day:

Typically, the following tasks are expected to be completed during a certain time each day or at specific intervals. 

• Multiple medication passes

• Assessment - Full head-to-toe assessment and follow-up assessment every 4 hours

• Vital signs - usually at least every 4 hours

• Blood sugar monitoring and insulin administration 

• Interpreting telemetry strips and EKG results

Additional tasks:

These responsibilities can be performed at any time during the day. Some can even be carried over into the next shift.  

• Dressing changes and wound care - CHF patients are often edematous, which can cause weeping and drainage from skin in the swollen extremities  

• I/Os - Accurate intake and output is critical for cardiac patients to help prevent fluid volume overload

• Providing patient and family education

• Updating charts and care plans

• Monitoring lab results and effectively relating abnormal labs to a physiological source

• Managing and programming multiple medical devices such as vitals and cardiac monitors, EKG machines, and IV medication pumps

Essential skills of the Telemetry RN

• Ability to solve problems quickly and perform well under pressure

• Proficiency in ACLS protocols

• Time management, prioritization, and critical thinking

• Good understanding of physiology and the interaction between the major bodily systems

Working as a critical care telemetry RN is a challenging and rewarding experience. Your skills will be put to the test and further developed on a daily basis. In addition to offering an exciting and fast-paced work space, the dynamic environment is especially appealing to those who seek diversity in their routine. Due to the trust and teamwork involved in managing emergency scenarios and caring for the critically ill, nurses who work on a telemetry unit are likely to develop a strong bond with their peers. Telemetry units can also be called the Intermediate Care Unit (IMCU), Step-down Unit, Progressive Care Unit (PCU), or Advanced Care Unit (ACU), but all typically include increased monitoring, higher acuity patients, lower patient ratios, and more ancillary and support staff. There is no specific program or specialty required to become a telemetry RN, most training is received on the job. However, there are additional certifications available through the American Association of Critical Care Nurses 

If you are looking for a change and feel that the challenge of telemetry nursing might be right for you, schedule your EARN evaluation with a peer RN today. The process only takes about 15 minutes and you will be guided through every step. Plus, it is 100% free!

References:

Telemetry nurse practitioner at a glance. Discover Nursing. (n.d.). Retrieved November 12, 2021, from https://nursing.jnj.com/specialty/telemetry-nurse. 

Staff, I. H. (2021, November 12). An overview of telemetry nursing. Incredible Health. Retrieved November 14, 2021, from https://www.incrediblehealth.com/blog/telemetry-nursing/.