The thoughtful and efficient use of technology is essential for improving patient care and reducing healthcare costs. Telemetry is an indispensable aspect of healthcare, and its increasing prevalence demands professionals with particular skills and knowledge.
Explore the Telemetry (Tele) Nursing Specialty
In this ultimate guide, nurses working in telemetry and those aspiring to enter the specialty will find the answers to some of their most pressing questions, from the most basic questions, such as “What is telemetry?” to the more technical ones, such as “What is an idioventricular rhythm?”
Are you already an experienced tele nurse? Discover high-paying, flexible PRN RN jobs in telemetry.
What Is Telemetry Data?
Merriam-Webster defines telemetry as “the science or process of telemetering data.” A telemeter is “an electrical apparatus for measuring a quantity (such as pressure, speed, or temperature) and transmitting the result, especially by radio to a distant station.” Numerous industries use these devices, including software development, meteorology, intelligence, and healthcare.
What Does Telemetry Mean in Medical Terms?
Now that the meaning of telemetry is clear, let’s apply this definition to the healthcare setting. Healthcare professionals can monitor patients’ vital signs, such as blood pressure, oxygen saturation, respiration, and heart rhythms, through telemetry or medical monitoring devices.
To monitor a patient remotely, a healthcare worker places electrodes on the patient’s body. A wire connects each electrode to a device that transmits patient data to a computer. Healthcare professionals see, interpret, and assess the data on the computer. The accuracy of telemetry data requires proper skin preparation, electrode and lead placement, and equipment maintenance. Patients must also understand why they need telemetry monitoring to decrease their anxiety about wearing the devices.
What Is an EKG or ECG?
One of the most common machines used for telemetry is the electrocardiogram, known by the acronym EKG or ECG. An EKG monitors the electrical activity of the heart. Telemetry professionals have extensive knowledge and expertise in monitoring and interpreting the heart’s electrical patterns, recognizing even subtle changes in a patient’s heartbeat.
Wireless monitoring is among the most valuable technological advancements in telemetry because patients no longer have to be confined to their beds. A telemetry pack can often fit in the pockets of patients’ hospital gowns, allowing them to move freely while still being monitored by healthcare professionals. This light exercise usually benefits patients and gives them greater autonomy, such as going to the bathroom unassisted.
Furthermore, healthcare professionals can continue to monitor patients who have returned to their homes. For example, healthcare providers can monitor patients with unexplained heart palpitations or arrhythmias, alerting them to impending cardiac incidents and helping them understand the causes.
Remote telemetry monitoring can assist healthcare professionals in assessing various other conditions, such as sleep apnea, sleep patterns, and weight, in addition to monitoring patients with heart conditions.
What’s a Telemetry Unit Like?
Hospitals have telemetry units for patients who require constant electronic monitoring. These patients are generally considered stable but require continuous monitoring in case their situation changes. Hospitals may move more stable patients to telemetry units to address the shortage of beds in other departments.
Working in a telemetry unit can be challenging since nurses must monitor multiple patients, admit new patients, and prepare others for discharge. Additionally, although some shifts may be uneventful, patients’ conditions may worsen in others, requiring fast action and teamwork.
Despite the potential stress, telemetry work can also be gratifying since this nursing care and monitoring are essential to patient recovery. It also offers valuable experience for nurses interested in working in settings with higher-pressure situations.
What Is a Telemetry Nurse?
Telemetry nurses work in telemetry units, monitoring patients’ vital signs and assessing changes in patients’ conditions. They provide primary oversight over critically ill patients in telemetry units or patients who have been discharged but require constant monitoring. Typically, telemetry nurses monitor and analyze heart rhythms, interpret EKG rhythms, note arrhythmias, and intervene in emergencies.
Although telemetry nurses traditionally care for cardiac patients, these nurses now care for patients with more diverse conditions, including gastrointestinal diseases, diabetes, coronary disease, and other conditions requiring acute care. The following are conditions telemetry nurses typically see:
- Chronic obstructive pulmonary disease (COPD)
- Congestive heart failure
- Chest pain
- Diabetes
- Gastrointestinal complications
- Pneumonia
- Surgical needs
- Wounds
RN-to-patient staffing ratios vary by state. However, to have a general idea, telemetry RNs in California care for up to four patients at a time. Telemetry nurses care for more patients at a time than ICU nurses but less than medical-surgical nurses. This role can sometimes be intense, requiring telemetry nurses to make quick decisions.
Depending on the setting, tele nurses may work with specific populations, such as pediatric telemetry. Telemetry nurses may also work remotely to monitor patients.
Which Patients Need Telemetry?
As telemetry becomes more prevalent, there are concerns that it is not being used efficiently. High false positive rates in telemetry monitoring and the resulting alarm fatigue are concerning. Unnecessary monitoring also causes other problems: limited patient mobility, excessive attention on monitors generating worry for patients and family members, and high hospital costs incurred when patients take monitoring equipment home.
Cardiac monitoring, in particular, is indicated for patients at high risk for life-threatening arrhythmias. An article published in Johns Hopkins’ Medicine Matters, warns about telemetry overuse, summarizing the following outcomes of a retrospective analysis of 562 patients and 1,932 monitoring days:
- Telemetry indicated group: In this group, 34 percent of patients had a total of 336 arrhythmic events.
- Telemetry not indicated group: Of the group that received telemetry when guidelines did not warrant its use, only 11 percent had a total of 53 events, and none of these patients had a clinically significant arrhythmia.
Another study mentioned in the Johns Hopkins article found the following outcomes of telemetry use in a group of 2,240 patients over a seven-month period:
- Telemetry led to direct changes in healthcare management in 7 percent of patients (156 patients).
- Telemetry was considered beneficial but did not alter management for 5.7 percent of patients (127 patients).
- During these seven months, there were 20 deaths in the telemetry unit (0.9 percent of patients). Four of these deaths (20 percent) occurred while patients were being monitored.
The results of this study suggest that the role of telemetry may be overestimated, especially considering the elevated costs of monitoring patients around the clock, estimated to be $1,400 per patient per 24 hours. The author concludes that using telemetry with patients who don’t require constant monitoring is not an effective use of resources.
Telemetry is clearly useful in patients at high risk of arrhythmia. However, it is often overused with little to no benefit.
The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend cardiac monitoring for QT interval, ischemia, Class I, and some Class II patients. These organizations do recommend telemetry for Class III patients:
- Class I: Individuals at risk of an immediate, life-threatening arrhythmia, such as patients in the first 48 hours of acute coronary syndrome (ACS) or with high-grade lesions awaiting intervention, acute heart failure, second- and third-degree atrioventricular (AV) block, temporary pacing, long QT syndrome, Wolff-Parkinson-White (WPW) with rapid anterograde conduction, intra-aortic balloon pump (IABP), post-cardiac arrest, post pacemaker placement with pacemaker dependence, post cardiac surgery, conscious sedation, and post percutaneous coronary intervention (PCI) or ablation with complication
- Class II: Individuals presenting with known arrhythmia with active arrhythmia medication titration, chest pain syndromes, post-pacemaker placement without complications, syncope, heart failure, post-PCI, and post-ablation
- Class III: Post-surgical patients and individuals with rate-controlled atrial fibrillation (AF), chronic premature ventricular contraction (PVCs), and End-Stage Renal Disease (ESRD) on hemodialysis
What Do Telemetry Nurses Do?
Although policies regarding the duties of a telemetry nurse may vary across state lines and from one hospital to the next, the following are typical responsibilities of a telemetry nurse:
- Interpret and treat cardiac rhythms.
- Provide basic and advanced life support.
- Calculate drug dosages.
- Initiate IVs.
- Administer IV medication.
- Observe patients for the effects of medication.
- Monitor patients before, during, and after surgery and other procedures.
- Recognize the signs of cardiopulmonary and respiratory emergencies.
- Begin standard interventions.
Besides monitoring patients remotely, telemetry nurses also work at the bedside, administering drugs, performing EKGs, and educating patients and their family members.
What Do Telemetry Technicians Do?
Telemetry has many false alarms, which can lead to alarm fatigue. Alarm fatigue, in turn, can lead to missed or delayed responses to alarms. In response to this situation, the role of telemetry technicians has grown significantly. They monitor the data and contact bedside nurses to stop false alerts. According to the National Telemetry Association, the number of telemetry technicians grew by 29 percent from 2010 to 2020. Training programs to become telemetry technicians last approximately 120 hours.
Telemetry technicians or monitoring technicians are trained to perform the following tasks:
- Perform stress testing.
- Apply EKG leads to patients.
- Monitor Holters.
- Monitor cardiac-related vitals, such as heart rhythms.
- Analyze data for critically ill patients.
What Do CNAs Do in Telemetry?
Certified nursing assistants typically assist patients with activities of daily living regardless of their work setting. In telemetry units, these duties may include the following:
- Bathing patients and assisting with hygiene, including mouth care, shaving, combing hair, and washing patients’ hair
- Changing bed linens
- Changing incontinent patients promptly and providing appropriate skincare
- Emptying bedpans, urinals, and commodes and assisting patients to the bathroom
- Assisting patients with meals and feeding patients if needed
- Distributing nourishments as scheduled
- Providing fresh water at the bedside as appropriate
- Measuring and recording intake and output
- Positioning patients correctly, aligning and supporting torso and limbs to contribute to patient comfort
- Transporting patients via wheelchair or stretcher using safety measures appropriate for patient and vehicle
In addition to this assistance with activities of daily living, CNAs in telemetry units may also have the following responsibilities:
- Making hourly rounds for patient safety and customer service
- Responding to patient call lights promptly
- Obtaining vital signs, weights, and other records
- Applying chest leads for patients on remote telemetry monitoring and performing basic troubleshooting, such as replacing loose or missing electrodes
- Collecting and labeling urine, stool, and sputum specimens as directed
- Keeping inventories of patient belongings at admission, transfer, and discharge
- Providing one-on-one patient supervision for patient safety and suicide precautions
- Documenting patient care in an accurate, professional, and timely manner
- Performing assigned duties such as unit errands, stocking supplies, returning equipment, and answering unit phone
- Attending staff meetings regularly
- Keeping patient care area and work environment neat and organized
What Is a Telemetry Report in Nursing?
According to the American Heart Association, hospitals typically expect telemetry nurses to monitor and document the following:
- Rhythm
- Rate
- Pulse rate interval
- QRS duration
- QT
Telemetry nurses must also document whether these measurements are within established parameters. Some hospitals may also require QTc documentation for all patients. Furthermore, telemetry nurses typically must document a patient’s waveform strip on admission, upon transfer to a monitored unit, and every four hours.
Any significant change in the patient’s rhythm or hemodynamic status, including before and after cardioversion, also requires documentation of a waveform strip. All healthcare providers should have access to waveform strips.
For example, in the case of a significant arrhythmia, telemetry nurses must document events before and during the arrhythmia (defibrillation, insertion of subclavian central line, etc.), possible related signs and symptoms, vital signs, and interventions with patient response. This report must be promptly available to all healthcare providers, allowing a consulting cardiologist, for example, to access the electrocardiographic waveform to guide the patient’s care.
How to Become a Telemetry Nurse
The first step to working as a telemetry nurse is to become a registered nurse (RN). The most common pathways to obtaining RN licensure are a Bachelor of Science in Nursing (BSN) or an Associate Degree in Nursing (ADN). After completing their respective RN programs, graduates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and meet state-specific requirements. Telemetry nursing positions are often available for new graduates. However, some positions may require a minimum of one year of acute care experience and may prefer nurses to have at least two years of experience.
Many hospitals prefer having RNs with BSNs work in telemetry. Some positions require nurses to complete BSNs within a given period, so RNs with ADNs may consider completing RN-to-BSN bridge programs to increase their competitiveness. Furthermore, telemetry nurses need technical and data analysis skills, so taking courses in information technology can be helpful.
How to Become a Telemetry CNA
Becoming a CNA is a great way to enter the nursing field. Even if you are already in nursing school, becoming a CNA can allow you to begin working in healthcare before you obtain your nursing license. If you have no prior nursing education, you will have to complete a CNA training program, which may take as little as four weeks. If you are already a nursing student, you may be able to skip this step.
In addition to a CNA certification, nursing assistants must obtain a Basic Life Support (BLS) credential. Some healthcare facilities may hire new CNAs without this certification but with a stipulation that they must obtain it within a specific timeframe. The American Heart Association offers a BLS course for healthcare professionals and other personnel who need to be able to perform cardiopulmonary resuscitation (CPR) and other basic forms of cardiovascular life support in various settings. The course trains participants to recognize life-threatening emergencies, deliver appropriate ventilations, give high-quality chest compressions, and provide early use of an AED.
It covers the following knowledge and skills:
- CPR for all ages
- The BLS components of the AHA Chain of Survival
- Importance of early use of an AED
- Giving effective ventilations using a barrier device
- The importance of teams and teamwork in multi-rescuer resuscitation
- Removing foreign-body airway obstructions (choking) for adults and infants
In addition to the previous requirements, telemetry units typically require CNAs to hold high school diplomas—or the equivalent—and prefer CNAs to have at least one year in acute care settings. Any healthcare experience and secretarial skills are also valued.
What Are Important Skills for Telemetry Nurses?
The following are essential nursing skills for nurses in telemetry units:
- Monitoring EKGs
- Monitoring echocardiograms
- Interpreting cardiac rhythm strips
- Detecting vital signs
- Dressing wounds
- Administering medications
Since telemetry nurses typically care for patients with cardiac conditions, they need extensive knowledge of cardiovascular health to understand and interpret the data received from the telemetry devices.
In addition, according to the National Telemetry Association, telemetry nurses should strive to develop the following soft skills:
- Effective communication
- Ability to think quickly and solve problems under pressure
- Organization and attention to detail
- Ability to remain calm in stressful situations
Telemetry nurses must be prepared to deliver critical care to patients with diverse healthcare needs. The following are additional soft skills that many positions require:
- Excellent customer service skills
- Ability to multi-task in a fast-paced environment under minimal supervision
- Working well as part of a team
- Being self-driven
- Willingness to learn and grow professionally
- Being punctual
- Ability to adapt to an innovative environment
What Are Important Skills and Abilities for Telemetry CNAs?
CNAs working in telemetry are not expected to have the knowledge of cardiovascular health or the specialized nursing skills that RNs in this setting must have. However, their role is also essential. To fulfill this role to the highest degree, CNAs must develop the following skills:
- Be courteous, caring, and understanding toward patients, families, and other members of the healthcare team
- Be well-organized, flexible, and able to function effectively and independently
- Work in a fast-paced environment
- Have creative problem-solving skills
- Have excellent communication skills
- Have basic computer, clerical, phone etiquette, and customer service skills
In addition to these skills, CNAs should generally have the following physical abilities to perform their tasks:
- Handle patient weight up to 35 lbs. without the use of assistive equipment and/or devices
- Have fine motor skills to be able to grasp and control medical equipment and perform precise procedures
- Be able to push and pull up to 45 lbs. force (i.e., medical carts)
- Perform hands-on CPR for at least 20 minutes using 100-125 lbs. of force
- Be able to bend, stoop, squat, reach, and kneel frequently
- Lift up to 20 lbs. occasionally and 5 lbs. frequently
- Have vision and hearing abilities within normal limits (glasses, contacts, and hearing aids permitted)
- Be able to communicate and exchange accurate information
Telemetry Nurse Certifications
Most nursing positions require Basic Life Support certification. Therefore, this certification is virtually a given. However, certain nursing positions, including telemetry, require nurses to have more advanced life support skills. With this in mind, nurses interested in telemetry should also obtain an Advanced Cardiovascular Life Support (ACLS) certification. This course is meant for healthcare professionals who direct or participate in managing cardiopulmonary arrest or other cardiovascular emergencies and for emergency response clinicians. It covers all of the following:
- Basic life support skills, including effective chest compressions, use of an AED, and use of a bag-mask device
- Recognition and effective early management of cardiac and respiratory arrest
- Recognition and effective early management of peri-arrest conditions, including symptomatic bradycardia
- Airway management
- Related pharmacology
- Management of ACS and stroke
- Effective communication as a resuscitation team member or leader
The American Heart Association also offers an ACLS certification for experienced providers. This course is designed for healthcare providers proficient in BLS and ACLS skills, reading and interpreting EKGs, and understanding ACLS pharmacology and for providers who regularly lead or participate in the emergency assessment and treatment of pre-arrest, arrest, or post-arrest patients. This course teaches the following skills:
- Demonstrate proficiency in providing BLS care, such as integrating AEDs and prioritizing chest compressions.
- Recognize and manage respiratory arrest.
- Recognize and manage cardiac arrest until transfer of care or termination of resuscitation, including post-cardiac arrest care.
Additionally, the National Telemetry Association offers nurses a Telemetry Certification. The exam lasts 180 minutes and requires a minimum passing score of 80 percent. The National Telemetry Association provides candidates with preparation materials and offers test-takers two attempts. Upon passing, nurses receive the distinction of Telemetry Nurse Specialist certification with a sew-on patch, hard copies of the certification, and letters of completion.
What’s the Average Telemetry Nurse Salary?
According to the U.S. Bureau of Labor Statistics (BLS), registered nurses make, on average, $94,480 per year or $45.42 hourly in the United States. Registered nurses working in general medical and surgical hospitals, such as telemetry nurses, make a little more than average, $96,830 per year or $46.55 hourly. Telemetry nurses may also work in specialty hospitals, such as cardiac facilities or children’s hospitals, and make even higher average wages ($98,220 annually or $47.22 hourly).
Based on BLS data, certified nursing assistants make an average of $39,610 annually or $19.04 hourly in the United States. CNAs working in general medical and surgical hospitals, such as telemetry CNAs, also make slightly more than average, $40,840 annually or $19.64 hourly. As with RNs, CNAs working in specialty hospitals can earn higher wages, $42,180 annually or $20.28 hourly.
Telemetry FAQs
If you are applying to your first tele nursing position or haven’t worked in telemetry for a while, a training tip is to brush up on your cardiac telemetry terminology to help you recognize different heart rhythms. Read up on some cardiac rhythms that tele nurses need to know.
What Is Normal Sinus Rhythm (NSR)?
As its name indicates, a normal sinus rhythm is a regular heart rhythm at 60–100 beats per minute (bpm), or the age-appropriate rate in children.
The following are variations of the sinus rhythm:
- Sinus tachycardia: A sinus rhythm with a resting heart rate above 100 bpm in adults or above the expected range in children (by age)
- Sinus bradycardia: A sinus rhythm with a resting heart rate below 60 bpm in adults or below the normal range in children (by age)
- Sinus arrhythmia: A sinus rhythm with an irregular ventricular rate
What Is Junctional Rhythm?
A junctional rhythm is a type of irregular heartbeat or arrhythmia. In people with junctional rhythms, their sinoatrial (SA) nodes—the hearts’ natural pacemakers—aren’t working correctly.
Typically, the SA node sends electrical signals that control the heartbeat. However, the SA nodes send slow or weak signals in people with junctional rhythms or may stop working altogether. In these cases, the heart responds using backup pacemakers, which keep the heart beating but may make the heartbeat slower or faster.
The following are the heart’s three pacemakers that normally work together, sending electrical impulses through the heart.
- SA node: This group of cells is in the heart’s upper right chamber (right atrium) and usually serves as the first-line pacemaker.
- AV node: These cells are in the junction, or center, of the heart, between the atria and ventricles. They typically take over when the SA node isn’t working correctly. Therefore, most junctional rhythms occur in the AV node.
- His-Purkinje system: This group of thin fibers is also near the center of the heart and includes the bundle of His and Purkinje cells. This group of fibers conducts electricity in the heart and serves as a backup pacemaker.
A junctional rhythm can be further classified into the following types according to its rate:
- Junctional bradycardia: A rate below 40 bpm
- Junctional escape rhythm: A rate of 40 to 60 bpm
- Accelerated junctional rhythm: A rate of 60 to 100 bpm
- Junctional tachycardia: A rate above 100 bpm
What Is Idioventricular Rhythm?
An idioventricular rhythm is a heart rhythm in which the lower heart chambers beat more slowly than usual. The heart’s lower chambers or ventricles may start the heartbeat if the natural pacemaker in the upper chambers cannot. An idioventricular rhythm is less than 50 bpm; an accelerated idioventricular rhythm is 50 to 110 bpm.
Idioventricular rhythms can typically occur in people who have or have had the following health conditions:
- Advanced or complete heart block
- Sinus arrest or sinoatrial nodal block
- Heart attack
- Congenital heart problems
Certain medications and illegal drugs may also cause an idioventricular rhythm.
What Is a PVC Heart Rhythm?
Premature ventricular contractions—also called premature ventricular complexes, ventricular premature beats, or ventricular extrasystoles—are common types of arrhythmia. PVCs are extra heartbeats that begin in one of the heart’s two ventricles, disrupting the regular heart rhythm. A person with PVCs may report a feeling of fluttering or a skipped beat in the chest.
Not all PVCs require treatment. Occasional PVCs in people without heart disease are generally not cause for concern. On the other hand, people with frequent or bothersome PVCs or with underlying heart conditions may require treatment.
What Is an SVT Rhythm?
Supraventricular tachycardia (SVT), also called paroxysmal supraventricular tachycardia, is another type of arrhythmia. It is an irregularly fast or erratic heartbeat that affects the heart’s upper chambers. A typical heart beats 60 to 100 times per minute. During an episode of SVT, the heart beats about 150 to 220 times per minute. Not all cases of SVT require treatment; however, some people may need lifestyle changes, medication, and even heart procedures to control or eliminate the rapid heartbeats and related symptoms.
What Are Shockable Rhythms?
EKGs can help determine whether a cardiac arrest is shockable or non-shockable. Two shockable rhythms are ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Non-shockable rhythms include sinus rhythm (SR), supraventricular tachycardia, premature ventricular contraction, and atrial fibrillation.
Healthcare providers may reverse cardiac arrest with shockable rhythms through cardiopulmonary resuscitation or by using a defibrillator to shock the heart and restore a normal heart rhythm within minutes.
Final Thoughts on Telemetry Nursing
There is no question whether telemetry nursing is necessary and valuable; it is also generally well-compensated and a relatively easy field to enter. However, the ideal nursing specialty ultimately depends on personal factors, including interests, personality traits, aptitudes, and time constraints, among many others.
If telemetry has caught your attention but you’re still unsure whether it’s the perfect fit, learn more about cardiac nursing careers.
Finally, whether you are looking for full-time work or just a way to earn extra money on the side, browse Nursa’s PRN shifts for nursing professionals.
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