Staffing a telemetry unit

On the floor where I extern, which is a tele floor, the ratio is no more than 4:1, sometimes dropping into 2:1 or 1:1 depending on the severity or disorientation/agitation of the patient. On top of that we usually have 3 techs on the floor, plus a unit secretary and a monitor tech. Unfortunately our techs can't do accuchecks, so it's not unusual to have 4 patients and checks on all 4. This even continues at night. It seems dangerous to me to have more than a 5:1, but I'm still learning.

Cheers,
Tom

I work as an RN on a cardiac step down/telemetry unit in Michigan. We work 12-hour shifts. On days, an RN can have as many as 5-6 patients. An RN-LPN team have have 7-8 patients. But on nights, which I work, an RN can have as many as 7 patients and an RN-LPN team can take as many as 12 patients. Point in fact, last night I had an RN-LPN team with 11 patients which would not have been too bad because I had an awesome LPN with me, but we had 1 patient with a feeding tube, trach, and continuous pulse ox that kept going off every 10-15 minutes. I spent most of my time in her room. Thank God for my LPN who probably saved my butt that night.

Unfortunately, we are losing our night shift RN's left and right, so having more and more patients at night is getting to be the norm. Yes, it is unsafe, and management doesn't care. But I need the job, so I do the best I can.

Anyway, thanks for letting me rant.

Have a wonderful day!!

"Thank God for my LPN who probably saved my butt that night."


I agree that having an LPN on the team is a great asset IF they are allowed/able to function as nurses and not glorified CNAs.

Our LPNs are. They are able to pass most meds (not IV pushes) and do assessments. They only things they cannot do are initial assessements when a patient is admitted, IV push meds, and getting orders from the docs. I'd be lost sometimes without my LPN.

On my tele unit each RN-LPN team has up to ten patients. So the entire unit has 28 patients max, covered by 6 nurses (3 RNs, 3 LPNs) and 3 CNAs. The LPNs can do everything except initial assessments, no IV pushes, no hanging blood or TPNs, and no phone orders. So I usually have 4-5 patients, & then do the above extras on all my LPN's patients.
Christine

I just started working as an RN on a telemetry unit and there are 6 RN's for 6 pts on a good day, on a bad day there are 4 RN's and 8 pts. There are no LPN's on our unit and we have 2 nursing attendants, one for each side of the unit. I hate when the nurses call out because you know your day is going to be hell.

4 patients to 1 nurse is common on days, it can get up to 5 on nights. Four is hard. Almost no patient is "just" a cardiac patient- they have cancer, GI bleeds, renal failure, drug/alcohol withdrawals, diabetes, you name it. I have had 5 patients on only one night so far, and I didn't know my name when I left in the morning. I was just grateful they were all alive.

I want to understand how someone can safely monitor progressive care/tele patients with a ratio of more than 1:4. 4 patients seems to be the max for a group with insulin and pressor gtt's, trachs, feeding tubes, sheaths, open hearts.. etc etc. How is this done safely?

I am starting in a tele/progressive care unit that staffs 1:4 with techs staffed at 1:8.

in philly, we usually had 6-1. sometimes 8 very rarely if we were short...and no drips except bumex or dobutemine. 3-1 if on drips..like a jackass I didn't apprecate it until I left

On this Telemetry floor we try to keep a 1:5 nurse/patient ratio, we consider ourselves lucky if we have 2 CNA's. Sometimes if/when someone calls in the ratio may be as high as 1:6 but never no more than that. Telemetry isn't exactly a place where a nurse will enjoy high ratios that might jeopardize a patient's life, waiting in turn can turn into a CODE situation!! In order to receive adequate care, all states should adopt a policy for ratios so no patient goes without the proper standard of care. Besides, who wants to work where they feel like they may lose a patient or risk losing their license due to being overloaded/overwhelmed? The lower the ratio...the better the care, the better response we get from our patients: physiologically, and psychologically. Just a few ideas....
stutl2ep