By The Nursezone Writing Staff
When an older patient comes in complaining of prolonged and severe chest pain, yet shows no other signs of cardiac arrest, they could be at risk of a serious heart problem. With no immediate diagnosis to offer, the patient may be transferred from the ER to a telemetry unit. Here, the patient will receive 24-hour cardiac monitoring with a telemetry nurse surveilling the patient for any signs of a deteriorating condition or form of heart failure.
This strikes at the heart of telemetry nurse duties (no pun intended). Telemetry nurses are specialized nurses who monitor their patients via remote electronic signals and respond to any changes in cardiac rhythm. Their patients are typically those with preexisting heart conditions, elderly patients, obese patients, diabetics, and transfers from the ICU and ER.
If you’re considering telemetry nursing, know that you will play a vital role in patient care and saving lives. Here are some responsibilities that come along with this.
Telemetry is a mixture of registered nurse duties and technical skills to operate machinery that monitors patient health—the most common being the echocardiogram (EKG). This means that telemetry nurses need the same bedside manner skills as registered nurses as well as the technical know-how to run stress tests and read EKG strips in order to properly care for patients.
This wide breadth of knowledge is often a determining factor in telemetry nurses becoming certified. Certifications for telemetry nurses
(discussed further below) allow for continual education and proficiency in the telemetry field.
Using Electronic Equipment to Monitor Patients
Reading an EKG is one of the primary functions that distinguishes telemetry nurses from RNs. In fact, in many hospitals where nurses are required to rotate between different critical care units, telemetry is one where nurses feel the least comfortable. This is because learning to read a strip of paper full of squiggly lines that are supposed to represent heart function takes a lot of training.
Other equipment that is used in the telemetry unit includes heart monitors and Holter monitors. Each of these plays an important role in determining the overall health of the patient.
Looking for Arrhythmias, Cardiac Baseline Changes, and Abnormalities
On this strip of paper full of squiggly lines (the EKG strip), nurses should be able to determine any arrhythmias, cardiac baseline changes, and abnormalities. Nurses interpret the strip by noting the rate, rhythm, axis, hypertrophy, and ST-segment.
Responding to any Irregularities
Because of the amount of equipment strapped to your cardiac patients, there are many factors determining the health of the patient. Reacting to these irregularities in an urgent manner is needed to protect the patient, and often waiting for a physician to respond takes too long.
Telemetry nurses also have to be ready if the patient’s vital signs trigger any alarms. False alarms are standard in telemetry, and each one has to be treated equally.
Performing Stress Tests
Stress tests, or “exercise” tests, are used to elevate the patient’s heart rhythm, breathing, and blood pressure. By doing so, you’re actively making the heart work harder and pump more blood. Any irregularities or arrhythmias are prone to manifest while the heart is stressed. These are recorded by electrodes strapped to the patient’s chest.
Stress tests are used to diagnose heart rhythm problems, coronary artery disease, and other related heart disorders.
Standard RN Duties
Besides these special duties, they also are required to perform standard nurse duties. These duties include, but are not limited to, the following.
Inpatient and Medical History
When patients enter the hospital, a full medical history is necessary to understand the underlying conditions. Age is a relevant factor in diagnosing Alzheimer’s, ALS, and high blood pressure. Patients suffering from acute abdominal pain will be treated differently if they’ve recently gone abroad to remote regions of the world.
Inpatient documentation is crucial in telemetry units where patients are at risk for severe cardiac problems.
Documenting All Changes in Patient Condition and Behavior
While patients are under your care, monitoring and documenting changes in patient condition and behavior is a crucial aspect of your nursing practice. During rounds, you have a chance to communicate with your patient to see whether their condition is improving or deteriorating. If your patient is feeling relieved and happy, for example, this might signal that their healthy state is returning (although, further tests need to be administered to confirm your suspicions).
Performing Lab Work
When dealing with an acute cardiac patient, physicians must determine whether the causal link to the illness is structural damage to the heart, stress-related, or due to other irregularities. To narrow down options, physicians rely on lab work.
Telemetry nurses perform lab work including blood tests, chest x-rays, CT scans, MRIs, PET scans, and more.
Assisting Physicians in Customized Treatment Plans
Physicians have to manage upwards of twenty patients per shift. Studies published in the Annals of Family Medicine
found that physicians spend, on average, 17.5 minutes of face time with each patient. This isn’t much time when you think of the complexity of human physiology and all the potential diseases one could have.
That’s why nurses are there to assist in documentation and customize treatment plans. Nurses spend a significantly larger amount of time with patients and are able to fill in the gaps for the physician.
Carrying Out Treatment Plans and Administering Medication
Nurses are expected to keep regular tabs on a patient’s medication and treatment plan. Because most of your patients will be stuck to their hospital bed with only some light walking allowed, you are required to fill out all pharmaceutical requests and administer them as needed.
Performing Emergency Treatment
While speaking to nurses might give you the impression that their job mainly consists of documenting, hustling to and from patient rooms, and coordinating medications, know that in the back of their mind, they’re always ready. Ready for the car accident that happens just outside the hospital. Ready for the heart monitor to sound the alarm. Ready for every and all emergency situations where patients’ lives are on the line.
Educating Patients on Diagnoses and Tests
Patients in your care are going to have questions. But the ICU and telemetry unit can often be places where nurses are rushing to and from patients. Remember that having complications with your heart is a terrifying condition. Telemetry nurses have to practice patience and bedside manner in order to educate patients on their health properly.
Speaking to the Family
The patient isn’t the only person you need to be communicating with. As a telemetry nurse, you’ll be speaking with the family of the patient and informing them of any critical shifts in health or diagnosis. If the patient is a minor, all tests must be confirmed with the parents to ensure there are no legal complications. Otherwise, only the necessary information should be relayed.
Providing a Hygienic Environment
Nurses are trained to keep rooms hygienic and sanitary. This includes proper sterilization techniques on all equipment and instruments and preparing patient’s rooms after the previous occupant left.
Maintaining Physical Exercise and Proper Diet of Patient
While the patient is under your supervision, you are responsible for ensuring they know when to exercise and when to stay in bed. A short walk up and down the hospital hallways will help get the blood flowing and boost their mood. However, if their heart is in critical condition, this quick walk could also spell disaster. Maintaining physical exercise and offering your patient a proper diet are two necessary elements for a speedy recovery.
Alarm Fatigue: What is it?
As a telemetry nurse, you may have upwards of five patients under your supervision at one time. This means five different patients with five heart monitors all working in conjunction. Any malfunction or slipped off leads from patients doing something as simple as rolling over in their sleep will trigger the alarm and send nurses rushing in. Because of the twenty-four-hour care that’s necessary for telemetry unit patients, these alarms can go off at any time.
The repeated false alarm is known as alarm fatigue
, and it poses a serious threat to nurses and patients. ECG machines are among the highest contributors to false alarms. Because patients transferred out of ERs and ICUs into telemetry units are often hooked up to ECGs by default, the rise of alarm fatigue is inevitable.
How to Become a Telemetry Nurse
If the above duties sound like the type of work that would interest you, there is a straightforward path to becoming a telemetry nurse.
For aspiring nurses, the first step on the path is to go through an accredited nursing program and achieve either a Bachelor of Science in Nursing (BSN) or an Associate Degree in Nursing (ADN). These are four-year programs and two-year programs respectively, and each covers the basics needed to pass the National Council Licensure Examination
(or the NCLEX).
Passing the NCLEX
The NCLEX is what decides whether or not you can be a registered nurse. Hospitals require RNs to have received this minimum certification before being considered. To ensure you pass the NCLEX and become a certified nurse, there are few things to keep in mind.
Plan Your Studying
Many nursing students will be preparing for the NCLEX at the same time as final exams and other work. Cramming at the last minute will only increase your stress levels on test day and reduce the amount of sleep you receive the day before. These factors can significantly inhibit you from performing optimally on the exam.
Instead, plan your studying months in advance.
Take Practice Tests
Use practice tests as a way to determine which areas you need to focus your studying on. Treat the practice exam like the real one to prepare yourself for how the actual test will feel. If you perform well on the practice exam, don’t be overconfident and continue your study routine all the way to the finish line.
Applying for the Exam
Once you’re ready, you’ll need to receive an ATT (Authorization to Test). This can be done by applying through NCSBN’s website and becoming a member. Once you’ve received your ATT, all you need to do is set up the test date.
Building the Perfect Nurse Resume
Once you’ve passed the big test and become an RN, try to find a hospital with telemetry nursing positions available. In order to get the interview and land the job, you need to build the perfect nurse resume. When in doubt, look online for a nurse resume sample to follow. Your resume should include a professional summary, core qualifications, work experience, achievements, and education. New nurses won’t have much in terms of work experience, but you can still emphasize your educational achievements and any part-time work or volunteer hours you’ve completed.
Transitioning to Telemetry
Often, new nurses will go through rotations at a hospital where they will experience different units in critical care from the emergency room to the intensive care unit to telemetry. After your rotation through telemetry, speak with your supervisor about receiving training in this specialty.
To increase your job responsibilities as a telemetry nurse, you can become certified. There is not one central organization that deals with telemetry certifications and different hospitals recognize different certifications. The two most common credentialing programs include the Academy of Medical-Surgical Nurses (AMSN) and the American Association of Critical-Care Nurses (AACN).
Along with increased responsibilities, certified nurses also enjoy a bump in their telemetry nurse salary
and are hired more easily by hospitals.
The average heart beats more than 100,000 times per day
. This incredibly complex muscle gives us energy day in and day out, and when something goes wrong, it can feel like the floor was removed beneath our feet.
Telemetry nursing involves acute care for patients who are experiencing cardiac problems. These patients are typically transferred from critical-care units, or they are at high risk of heart disease. Nurses monitor a patient’s heart and vital signs remotely using EKGs and other medical equipment to ensure that their condition does not worsen while a diagnosis is reached. Nurses will assist physicians in running lab tests, stress tests, and individualized health plans to fit the needs of each patient.
Along with these specialized duties, telemetry nurses are also registered nurses and must fulfill the responsibilities of an RN. The dual nature of telemetry nurses—both practical and technical knowledge—is what often encourages them to become certified. This certification process helps to ensure proficiency in all areas of expertise.
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