I love the heart and the unit I'm on has patients who are receiving open heart surgeries, bypass's and any number of other heart treatments. Telemetry refers to a constant monitoring of the heart. Our patients wear a box with probes and their heart rhythm is transmitted wirelessly to a screen that is monitored 24/7. My new grad program provides us with a tele course and you must pass an exam in order to read the EKG's and strips independently.
My preceptor for this unit, *Sandra, would be precepting for the first time. I was her first student and I think that made the both of us a little nervous. We got along really well however, she found it difficult to let me be as independent as I had been on the last two units. Luckily, there were a few days when she was not my preceptor and the alternate did provide me with the independence I knew I was ready for. At this point I am taking five patients on the med-surg floors and four on the tele/PCU floors. The PCU is structured very differently. The charting took me awhile to learn because it felt like I was going back to the very beginning. It's almost like learning another language when you're learning to chart differently than you're accustomed to. Also on this unit, the nurses check their own vital signs in the morning. This isn't unheard of in other hospitals. However, I'd been spoiled by the CNA's who were taking vitals on my last two units. The reason the nurses do the first set is because these patients are more critical and anything can change quickly and that change can make a difference between life or death.
I found myself going home after working on the cardiac floor and having to do some homework or research on the patients I had cared for that day. There are different medications that are being given and heparin/insulin drips. Also, it helps if you brush up on your pathophysiology. If you don't already know, here is some important information when it comes to medications: DO NOT EVER give a medication if you don't know why your patient is getting it. I know this sounds simple and most of us were taught this in nursing school. However, you might know that allopurinol is given to patients for gout-but what if your patient doesn't have gout? Why is it prescribed? Don't know? Find out!! Ask your fellow nurses or the charge nurse or do some research on your own. Just make sure you DON'T ask the doctor. Unless you know for a fact that the doctor likes to teach-there are some that love to and others who don't. I think a part of this rotation was learning the doctors and which ones like something a certain way and which ones want it done differently.
That being said-don't ever let a doctor scare you. If they do scare you, don't show it. Doctors are like children-they can smell fear a mile away. One of the doctors on this floor likes to test new nurses and will ask you how many times the patient has used their incentive spirometer-yet there isn't one at the bedside. Don't lie to doctors-even the nicest doctor will get upset if you're lying to them. Also, it helps to remember that doctors are human too. They will make mistakes. I always try to remind the doctors I work with that we're a team and we're there to work together. If they make a mistake I will bring it up to them in a professional manner and I expect them to do the same. One way to prevent mistakes from happening in the form of communication is to always use "closed-loop communication." This means that when I am talking to a doctor in person or on the phone I always read back any orders and say "Do I have this information correct?"
One time a doctor accused me of not calling him back after he asked me to with information he'd requested. However, I had made a note of every order he'd given me and I had read that information back to him. I reminded him of this information and he was quiet and went about his business. Always document conversations with physicians when it comes to patient care. *Saundra is the one who taught me that. She said it only takes 1-2 minutes but it can make the difference later when the doctor is mad or frustrated about something.
I would love to work on 5 East after my new grad program. However, I'm still holding out for my last and final rotation. If you recall, my best friend *Darius is on that unit and it would be a dream come true for us to work together. I'm looking forward to starting that rotation next week.
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