no monitor tech?

floridaRNtoo · Sep 10, 2006

It is interesting to see the various replies. Our telemetry unit has a bank of monitors inside the nursing station. There is no way I can hear the alarms in the rooms. Most the the alarms are artifact garbage. If I had to respond to everyone of those alarms no patient care would get done! In our ICU there are monitors in the rooms and overhead in all 4 corners of the nurses station as well as near the charge nurses area. On that unit I can see no need for a dedicated person to sit and watch monitors but.... not with the setup we have on our telemetry step-down unit.:uhoh21:

cardiacRN2006, ADN, RN · Sep 10, 2006

I worked in a Cardiac hospital for 9 years that didn't have any monitor techs. We didn't need them. The nurse and the tech were responsible for keeping an eye on the monitors, but they weren't watched constantly. We never had a single bad event as a result of not having any monitors techs. I now work in an ICU, and I am not looking at every single beat-nor is anyone else. I don't go in a watch every single breath the pt takes either.

HappyNurse2005, RN · Sep 11, 2006

A little story about no monitor techs.

someone i know works on a monitored unit. Not a cardiology floor, but a monitored PCU, nonetheless. This person is a CNA. Was at the desk, where the monitor bank is (one set of monitors, in middle of nurses station, perfect view of everyone in teh station). Was the ONLY person in the station, or near it, apparently. Notices an alarm. Shows someone's heart rate is 0. So she goes down to check on him, he's purple, coding, etc.

She did push the code button, go in the hall and get a nurse, pt survived to get to ICU.

vamedic4, EMT-P · Sep 11, 2006

I have another story for you. I'm watching telemetry and talking with one of my nurses when I notice something wierd...my kid with a DDD pacer goes off the monitor. Not unusual, but he comes up a few seconds later...and all I see are pacer spikes. :uhoh21: :uhoh21: :uhoh21: :uhoh21:

No alarms sound, but all you see are pacer spikes. I send the RN I'm talking to in to check the kid...yep, pulseless, apneic, dead. Coded that little one for quite a while, to no avail.

Don't believe everything you read. Monitors do NOT pick up every adverse event. True, they are tons better than they used to be, but they don't have true diagnostic capability...

vamedic4

still making life better for children.

steelydanfan · Sep 11, 2006

The way they rationalize no monitor techs or the charge nurse being at the desk in my hospitals telemetry unit is the pager system.

Great, set for "normal" parameters for ALL pt.s

Constant false alarms, no internal bypass allowed for expected PVS's in a 94 year old.

The nurses spend half theyre time responding to and/or deleting garbage messages.

Inundate someone with enough false messages, and they will become slow to respond to the real thing. This is where technology and real world nursing collide.

I have not seen any technology that can outhink, or out-discriminate a nurse.

And, unfortunately, no-one ever asks US to proof-test the technology; we are simply told of it's adoption.

TachyBrady · Sep 11, 2006

Just some thoughts, observations, and opinions....

In the above 2 stories, the scenario with no monitor tech survived while the patient with the monitor tech did not.

CNAs and monitor tech/s seem to feel the need for monitor techs. Experienced cardiac/telemetry RNs seem ok with no techs.

Even if we had monitor techs, I would still insist on intepreting my own strips. I frequently check my pt's rhythms throughout my shift. I give all of my own meds so I know what my patients are getting and know what effects to look out for (as opposed to having a co-assigned med nurse).

I've worked on a 30 bed telemetry unit for 13 years. We've never had monitor techs. Our monitors are in our busy nurses station. The majority of our patients are stable. If they weren't, they'd be in ICU. Doctors admit to our unit moreso for our closer observation of patients, i.e. 4:1 pt ratio vs 6 or 8 on the medical floors, more frequent VS, telemetry, and RN cardiac experience; not because of high dysrhythmia risk.

On day shift, RNs have 4 patients. We get detailed report on each patient including history. We get frequent monitor strips to supplement our physical assessments and lab work. RNs, as opposed to CNAs and/or monitor techs, have the whole clinical picture of the patient and we know who is at risk for arrhythmias or other complications. The monitor provides just a small part of whole clinical picture. If we deemed a patient serious enough to need continous visualization of their cardiac rhythm, they would not remain on telemetry.

Now, there are times when the unexpected Vtach, pauses, asystole, etc. occur. But as CardiacRN2006 stated above, I've never witnessed a single bad event due to no monitor tech. Despite the fact that we do not have someone constantly staring at our monitors, serious arrythmias ARE spotted and acted on quickly. BTW, those telemetry pagers sound like a nightmare!

Management has told us that we can have monitor techs but they would have to decrease our RN or CNA or Secretary staff in order to stay within our budget. I said 'no thanks', we'll keep what we have.... "If it ain't broke, don't fix it".

vamedic4, EMT-P · Sep 13, 2006

Bernaboop: It is good to hear that you've never seen an adverse event as a result of not having a monitor tech:wink2:

It's just a little different here in peds. Our kids have issues, and I mean ISSUES. Heart surgeries on DOL 1, multiple cardiac defects, respiratory issues, et cetera. Not to have monitor techs on our floor would spell disaster for our particular patient population. Even though we are (usually) adequately staffed 3/4:1, the possibility for more patients is sometimes there..and it can be very dangerous given the high acuity of our kids. In ICU there is no monitor tech, as the patients are all 2:1, and the RN has access to whatever she needs to see in the room or at the desk.

TachyBrady · Sep 13, 2006

vamedic,

To tell you the truth, I don't know a whole lot about peciatric telemetry or PICUs. I do know how our telemetry unit is run and I feel confident in the safety of our system. My response above was directed toward those of you who made comments that having no monitor tech is unacceptable and dangerous. I disagree with that generalization because we have no monitor tech and it works well for us. To personnel who are not nurses and/or monitor trained, in theory, it may not make sense to have monitors with no one continuously watching them. In reality, that may not be the case.

mamason · Sep 14, 2006

I worked on a telemetry/step-down unit last year. (Had a baby) We had no monitor tech to watch our monitors. We, the RN's, were responsible for all monitoring. We were generally assigned 8 pts each. We carried "beepers" that were set up with the tele monitors. Any type of alarm would sound off the RN's beeper and show him/her what type of arrythmia was going on with the pt. It also gave a particular buzz/beep for certain life threatening readings. A lot of false alarms because this system was not fool proof. A lot of time and aggravation with pacemaker pts. Some how the system would read a pacer beat as asytole. RN's spent a lot of time trying to reset false alarms. This took much needed time away from pt care that was needed. Some RN's got to the point of ignoring the alarms assuming that it was a false reading. Very bad and unsafe floor to work on. I think that a monitor tech, RN, etc. would have been benefici:nurse: al to this unit to help weed out interference and such on these cardiac monitors. But, the facility wasn't willing to spend the money for that. The RN's were constantly overwhelmed and still are. I have a friend that still works there and she states that it's crazy.

dawngloves, BSN, RN · Sep 18, 2006

I have to say, having worked both with a tech and without, I'd much rather have a tech. One place had a beeper system, which was a huge PITA. Imagine trying to start a difficult IV and your beeper goes off for V tach and you run off to find your pt scratching himself or you are with a scared pre CABG pt,talking to them, and you have to run off for a V fib that is actually someone brushing their teeth.You want to throw the damn thing out the window.

Another scary place had monitors at the stations, that were at the ends of hallways.If it is 9am and everyone is in a room checking vitals and passing meds, no one can hear it.I've come out a room many a time to hear an alarm for V tach, and it's now SR and you look in the history and it was artifact, but heaven forbid.

Having a tech gave me much more uninterupted time with my pt so I would not have to run off during a bath for artifact.They would also call the code team while we initiated a code giving the coding pt that much more time.

vamedic4, EMT-P · Sep 20, 2006

Dawngloves and mamason illustrate some things that I said earlier. It can be inherently dangerous NOT to have a tech. And with patient ratios increasing for nurses everywhere, are you willing to put your license on the line? That's what's happening when something is missed, and someone's head is going to roll. I can guarantee you it won't be an administrator either. They can weasle their way out of just about anything.

vamedic4

Monitor tech, medic, HUC,

all around do it all guy

SillyLilly · Sep 23, 2006

Last week I saw the importance of needing a monitor tech, and when it makes sense to not have one.

I interviewed at 2 tele units. 1 was very busy and had 'lots of sick pts'--the nurse manager claimed they just got monitor techs and it has taken some of the stress off.

Other hospital did not have "really sick" patients like the other hospital claimed, was smaller, and seemed quiter. They used the pager system. To me, both make sense.

I guess it is good to take the load of the nurses if the load is too much. Why not?? Nurses will still assess the strips, just not have to respond to all the beeping and booping.

We have nurse assistants to help us with our duties of ADLs and etc. It makes sense to have monitor techs if it is needed on the unit.