I have been working with a Nurse who has made it clear that Tele’s are not wanted on the ICU. I feel, at times, because this Nurse is not comfortable with the change in our Hospital from two Nurse’s in the Ick-U to one Nurse and one Tele, that I am purposefully not taught the full depth of Tele interpretation that I should know to do a good job. So, I have looked to other resources to keep expanding and building my knowledge. I do this because Tele’s that are assigned to other Nurse’s have gained a greater ability in their interpretation skills, and are thus, making correct interpretations 100% of the time, while I, paired with this Nurse am only making correct interpretations 50% of the time. Another Nurse I work with just simply refuses to answer my questions. This Nurse states it is because “it is not my job to police my fellow techs.” I get a bit resentful about not getting the additional training I feel I need; and, I try to be very careful at how I ask a question because I by no means am “policing” or “judging” what my peers do. I admire their skill and ability and am merely trying to understand their rationale so I may emulate them and become as talented at interpretation as they are.
Well, because another Tele seems to be interpreting anything difficult or not understoond as “Sinus Arrhythmia” I wanted some clarification. Again, it is my hope to understand the rationale behind what another has interpreted NOT to police….so I asked someone with more proficiency than I about when to appropriately distinguish something as a “Sinus Arrhythmia.” I was told: “that anything that is not an obvious dissrhythmia that is regularly irregular can be coined with that specification.” This still didn’t seem quite right to me as I had learned that a Sinus Arrhythmia was always in conjunction with the respiratory cycle and that the R-R intervals should be measured to accurately convey whether inspiration/expiration is affecting the pattern of the rhythm.
Sooo, I asked my Nurse about this and the response was to explain that “Sinus” meant that the origination of the rhythm was from the Sino-atrial node. My thought was “DUH! That is not what I am asking.” Anyway, before I could get totally frustrated by the response to my question I was saved because another Nurse who is willing to mentor and teach came in. It seemed that Nurse 1 was not understanding my question. I therefore, conceded to myself that I was not being clear or articulating the question clearly. I pulled out one of my resource books; and, I asked my question again…”Does Sinus Arrhythmia always coincide with the respiratory cycle?” Additionally, I showed Nurse 2 a picture to demonstrate what I was asking. At this point I was given a response that made sense..it was explained that my measurement of the R-R intervals was a correct means of identifying this rhythm. Nurse 2 further explained that the way in which I was taught was correct, but the cyclical nuance I was confirming as a Sinus Arrhythmia was an extreme and that most arrhythmic patterns were not that obvious. Nurse 2 also gave a great anatomical and physiological explanation of why this was so, so that I could completely understand how this rhythm works with the conduction of the heart.
Because I got an explanation I feel a bit better about identifying this basic rhythm, but I am still frustrated. I am at a point that I feel I must master Telemetry on my own. Because I realize I am not adept at rhythm interpretation, I have read 4 books and am currently working on Pure Practice for ECG’s…but there is so much to conduction morphology and ratio’s that I am sure I am missing I wish there was someone willing to teach me this sometimes subjective skill so that I can interpret correctly at a higher percentage rate. (Sigh).
I DO feel better about acknowledging that there is a block on my quest towards mastery. Venting indeed can bring about positive reflection. Since I can recognize that there is a block towards progression in this realm of my life, I feel confident that I will over come it and MASTER the domain of telemetry. I can sometimes be a little slow to catch on, but when I do I am on FIRE!
