Staffing a telemetry unit

I work on a telemetry floor and we have 19 tele beds. We are fully staffed with 4 RNs 1 LPN and a NA. They usually have 1 RN in the charge nurse role but lately we are lucky to be working with 3 RNs and a LPN and they always float or call off are NA and they like to float are 4th RN so that leaves us with 1 RN to 6 or 7 patients (usually only primary to 4 or 5 and cover the LPN) and the LPN takes 5 or 6 but she does her own assessments and passes meds with RN doing doctor calls and IV meds. What makes it difficult for us is when you have 3 or 4 patients getting blood on the floor, patients on drips you have no nurses aide and your RN and LPN are having to do VS, glucoscans,etc (what we rely on our aides to help us with) and watching these patients and the monitors. There have been times when we have had a patient go bad and if you have 3 RNs and 2 are with the critical patient that leaves 1 RN and 1 LPN for the other 18. The nurses are getting burnt out and we don't feel like we are able to give the care/time are patients deserve.

On our telemetry floor it's 6:1 on nights with a tech for every eight patients. This is pretty good but still it can be horrible at times! Mostly because we have a high med/surg population.

I worked on a Tele floor which was considered to be our "step down unit" cardiac ICU. We had 30 monitored patients with 4 RN's. The RN in charge had to take 2 patients plus charge duties. We didn't have a monitor tech, so the charge RN had to do that too. There were patients not even a day out of their CABG along with all the cath's, angio's, stents, MI's, etc. We didn't have aides to help us either. I worked the 3-11 shift which never ended until after 1 am with all the paperwork as you all know. We always felt patient's were at risk with this nurse/patient ratio, but no one would listen to us. There were so many "cut-backs" they kept telling us, so it was their way or the highway! So as many of you know, where would an older nurse go to get the same rate of pay to start with as you had with where you were, you know that story....years of experience/rate of pay/benefits vs. starting all over again at the bottom of the ladder!

Needless to say, things were pretty terrible for us. The thing that most amazed me was the way patient's family treated us....like it was my fault that I didn't have the ability to have "bilocation" and answer 3 call bells at once! We constantly got yelled at by patients and families all the time. It was so deflating personally, not to mention professionally......it seemed we were not nurses but maids, cooks, housekeepers, dishwasher, etc....we didn't really have time to do our actual nursing duties and provide the actual nursing care we were suppose to give....no matter how we tried! I left work feeling really bad most of the time because there were things I could have done and should have done but were unable to do because there wasn't enough timme to do it!

We were constantly getting called into the "office" because families complained about us in one way or the other, our supervisors knew the situation, but were unable to take our sides of course, they knew the situation, but weren't able to stick up for us. It was a very sad situation in out hospital, and it sounds like it is the same way everywhere really. its all a business, not a caring profession anymore! When are people going to wake up and realize that its not the nurses fault, its the money-making business owners that make the rules!

We would have new grads come to our floor, we'd do the buddy system with them for a month, and then after about 2 months with us they would tell us they're not putting up with this crap working here and they would leave. So it would put such a strain on us training them and having to do all our work, but they were the smart ones really, they were young and wouldn't put up with it and look for a better place to work! so they thought!

Oh well, next time I'll tell you of my work injury that ended my nursing career as a cardiac nurse! Watch your backs!

Have I got this right? 6 RNs for 6 pts?? 4 RNs for 8 pts???? That is heaven! Where in NY do you work.........I wanna sign up

At my hospital it's usually 4-6 pts per RN, usually covering a SrLPN for 1 or 2 folks....on days. Lucky when we have 3 techs for VS, BGs, baths, foleys.....usually we have 2. Eves the ratio is 7-8 pts to RN, nights the same.
Good luck to us all! :hatparty:

I thought our staffing was bad. When I was first hired as a new grad. I was the only RN on the floor 23 beds and generally had 2 LPN's. I had 7 pt's and they had 8. Now there are usually 2 TCU RN's and 1 TCu LPN. Kentucky has become lienient on LPN job descriptions. They are able to perform IV therapy, no new cardiac gtts for the first 24 hrs, they can monitor blood but cannot spike, and can perform IVP on certain drugs. Our floor has telemetry, we are required to be NIH stroke certified (no TPA) and perform peritoneal dialysis on the floor. At times this is a heavy load. Have you seen the NIH stroke scale assessment?!! This is nights. Days are primary care. The NA passes trays and I&O and accu check. Generally day has HUC, MW, nurse ratio of 4:1 and charge RN. Night we do have a Monitor Watcher, NA. It can be bad at times. I've been on the floor on a night when we had 3 codes 23 patients and 3 nurses. We have a rapid response team and a House MD 24x7. Do other TCU's have moitor watchers?

ark-two, can you explain about the stroke scale assessment for stroke-certified hospitals? Our hospital is looking to become certified and the floor I work on is a candidate the "stroke" floor....:/

Check your state regs. In NJ you cannot have more than 6 telemtry patients. Hi acuity hospitals should have less as you ARE supposed to staff by acuity in NJ

The NIH stroke scale isn't hard, but just time consuming. We follow ACLS in ER. If the pt has began symptoms of stroke within 3 hr or less we attempt to put them on TPA. They need to have a CT that is read in 1 hr or less from the time they hit the door to evaluate for a bleed. The NIH start with a swallow eval that our ER has been pretty good about performing. If they fail they are held NPO until dietary can perform a swallow eval.
NIH
1a LOC 0 for alert 1-arousable 2- strong stimualtion for response 3-flaccid or reflex motor movements
1b LOC What mo is it? How old are you? 0-answers both correctly. 1-answers one correctly 2- answers neither correctly Anyway it goes on and on. There are a total of 11 steps with substeps for a total of 17 complete steps. It usually take 1/2 hr for a cooperative patient. In order to become certified you can go to www.NINDS.NIH.gov. The assessment in shown on the website and how to score each step and determine the total number for the scale. Then you take the test and if you pass you print off a form for your certification. The test is not hard, but some of the assessments performed are confusing. Ex: hard to hear response due to background noise or hard to see what exactly the patient is doing due to the view is far away.

The tele/step-down unit I am on has 32 monitored beds. On days, the try to keep the ratio at 1:4 for a primary and 2:8 for an RN/LPN team. On nights, it goes up a bit to 1:5 and 2:9. There are 2 PCTs on days and 1 on nights when we are lucky- they do fingersticks, some baths, and stocking for us. All in all it is pretty decent.

I work on a 39 bed telemetry floor. One bed is non-monitored, the rest are montiored. At night, normally a nurse has as many as 9 patients, most of which are on critical drips such as nitro, heparin, argantroban, integrillin, dopamine, dobutamine ect.

Our floor setup is kinda complicated (which is why it's gonna be redone in like 2 years). There are 3 hallways (3 nurses stations), a normal night is
First hallway: 9 beds - 1 nurse (normally the charge nurse) has all 9 patients and she has a CNA .. or .. there is the charge nurse and an lpn (but normally its the first scenario)
Second hallway: 13 beds - 2 nurses (or 1 rn and an lpn) assignment split evenly. If an lpn, the nurse backs her up doing IV pushes and new assessments on pt's and stuff like that.
Third hallway: 17 beds - Normally just two nurses (or an RN and LPN).

Now if we're lucky, the third hallway gets the CNA at night (as long as the charge nurse doesn't get her on the first hallway), but if for some miracle there end up being 3 nurses on the third hallway, the CNA goes to the second hallway.

So that's how our unit is staffed during the night. On day shift they normally have 2 nurses on the first hallway, 2 or 3 on the second, and 3 on the third, and all hall's have a CNA on them.
Very stressful at night (but that's another thread lol).