Oncology Nurses are Telemetry Nurses

About a year ago, the medical oncology unit on which I work was told that we were going start taking telemetry patients. Needless to say, this stirred up all sorts of anxieties in the nurses who are very confident in their skill as oncology nurses but fearful of taking on this added, new, and completely different skill. The planning for education was done, which included a four-hour online course followed up by a live class and an exam.

First, the online course. I know I’ve written already about how different education has become with the boom in technology and greater accessibility to experts in all areas of medicine and nursing. This was no different. The amount and type of information we received was overwhelming but very helpful. We were able to learn concepts and practice them on “real” patients and “real” rhythm strips. We were able to discuss case scenarios and what we should do in different circumstances. I think that this was a much more effective and helpful learning tool than if we had done this as a group in a live setting. In the live setting, people would have been more afraid to answer for fear of being wrong. Here we also could work at our own pace, taking as much or as little time as needed to really grasp a concept. And we could go back and review things at any time.

The live class then was focused more on how things would work at our particular institution. Like many hospitals who are adding telemetry beds to non-ICU units, we have a central telemetry room where techs are constantly watching and reviewing all patients who are monitored outside of the ICU setting. On our unit, we have one monitor that shows the rhythms of any of our patients on telemetry, but we never hear a buzz or whistle when there is an abnormal rhythm. Instead, the tech that is responsible for monitoring the patient would call us and then we could check on the patient. The ability to have someone two blocks away in a completely different building to be monitoring a patient on unit is incredible to me. The fear of the nurses dissipated as we began to get our first telemetry patients and realized how much support we had from the telemetry technicians, the ICU support staff, our RRT nurses and our “buddy” unit that had been doing telemetry for several months already.

Learning the technology was another thing that had to be accomplished. How do we set up the monitor, how does the telemetry box the patient wears work, and what happens when the patient wants to take a shower or has to leave the unit for a procedure? The first two were relatively easy tasks. The shower issue was one that we still are not quite comfortable with. We’re told that the leads from the telemetry box are waterproof and that if we simply put the box in a sealed plastic bag, all will be well. But there’s something about placing a patient with wires attached to them into a shower with water running over those wires that still makes us a little nervous. Again, it’s a matter of feeling comfortable and trusting a technology that is so different than what we have been taught in the past. Like any of the new technologies that we’ve dealt with and learned, I have no doubt we will learn this one too.

Another amazing part of this new technology for us is the ability to send the patient off the unit to a procedure and still be able to monitor them. There is a portable monitor that we transfer the patient to and then can still see their strips no matter where they go. I still have to read the directions every time I put someone on or take someone off of the DASH portable monitor. But I’m getting better.

We now have telemetry patients almost every day on our unit. Everyday we get a little less fearful of hearing the telemetry patient is coming. And every day we get more and more comfortable with the new skills we’ve learned. People now see themselves not only as oncology nurses, but telemetry nurses. It’s been a great addition to help bolster the confidence and competence of the nurses. But more importantly, it’s been a great addition for our patients. No longer do we need to send our oncology patients who really do need a specialized kind of care to a unit that does not know the intricacies of caring for oncology patients. It definitely has helped to provide better care to this patient population.

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If you’d like to read more about decentralized telemetry units and telemetry beds outside of the ICU setting, there is a plethora of information out there for you. A few of the more interesting articles I like to pass on can be found at http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid; and http://www.psqh.com/marapr07/caredelivery.html