So what's next? Techs telling us to call the docs?

hypocaffeinemia, BSN, RN · Jul 2, 2009

I was a monitor tech for many years before becoming an RN and I have a plethora of horror stories involving me informing nurses of dysrrhythmias where I can hear their deer in headlight glaze over the phone.

I think the canned response is silly, but new policies aren't just created out of the blue so you should be taking a look at what instigated this change.

The very last week I was a monitor tech before my internship started I had a nurse tell me that the torsades his patient just went into I was urgently calling about was "just artifact", so I had to call the code overhead myself.

BrnEyedGirl, BSN, MSN, RN, APRN · Jul 2, 2009

We don't have monitor techs any more, thank goodness,...but that was always a huge argument with some techs,...they would call to tell us room 440-2 was in v tach when in fact he was brushing his teeth, or standing at the nurses station laughing with staff,......Rule #1 in nursing,.treat the pt not the monitor!

Tait, MSN, RN · Jul 2, 2009

I think the canned response is silly, but new policies aren't just created out of the blue so you should be taking a look at what instigated this change.

The CMU night manager stated that it was one MD who required the policy because he wasn't informed of situation.

jnrsmommy · Jul 2, 2009

We don't have monitor techs any more, thank goodness,...but that was always a huge argument with some techs,...they would call to tell us room 440-2 was in v tach when in fact he was brushing his teeth, or standing at the nurses station laughing with staff,......Rule #1 in nursing,.treat the pt not the monitor!

Yes, treat the pt, not the monitor... but you have to be able to see the pt first. The only thing the tech has to go by is what is on the screen. It is still our job to assess the pt when we are told by any other staff member that something is wrong.

Lucky0220 · Jul 2, 2009

As busy as we are on the floor with ratios of 1:8 sometimes, it never hurts to have an extra pair of eyes looking at that monitor. Better safe, than sorry. On my unit, we think that the monitor techs (located in a central monitoring room) don't call often enough!

ChristyRN2009 · Jul 2, 2009

I agree with the previous poster, I like having the extra set of eyes. And technically any rhythm change needs assessment and a call to the physician. But I have the nursing judgement to say "I don't think MD is going to care about the patients brady of 54 when they are in a deep sleep." I still have to document that I got the call from the techs and that no further action necessary based on clinical condition of patient.

Tait, MSN, RN · Jul 2, 2009

It's not the point of having the techs call. That I am fine with, it is having a tech have a script to tell me how to do my job that is irritating.

We all have RN after our name for a reason, because we have the power, knowledge and ability to assess based on presented information. I don't appreciate having untrained personnel in a room across the street call and dictate my course of action.

I guess I should be glad I have never had the pleasure of hearing said script at all.

Tait

Virgo_RN, BSN, RN · Jul 2, 2009

The very last week I was a monitor tech before my internship started I had a nurse tell me that the torsades his patient just went into I was urgently calling about was "just artifact", so I had to call the code overhead myself.

We recently had a pt. that was in and out of torsades for several hours, and was tolerating it just fine. Whenever I'd peek in on her, there she'd be, sitting on the couch chatting with her husband as if nothing was out of the ordinary at all. I'm glad the MT didn't call a code, especially since the MD was well aware of the arrhythmia and we were treating it.

There is often a lot the MTs do not know about the patient situation, though I do try to keep them informed. Reperfusion arrhythmias are one of those that I won't call the doctor about, because they are an expected finding. I'll tell the MT not to keep calling me for every 8 beat run, unless they become longer and/or more frequent.

I love my MTs and am glad they're there, but their job is to report rhythm changes to the nurse, not tell the nurse whether a call to the MD is warranted. If an MT feels that the nurse is not listening, or is not taking appropriate action, then the MT should say something to the charge nurse; use the chain of command.

casper1 · Jul 2, 2009

I've never worked at a hospital that utilized telemetry techs. Nurses who work on units which utilize telemetry are sent to classes where they learn the various rhytyms. We are taught which arythmias are life threatening and which ones require closer monitoring. Our nurse to patient ratio is 1 to 6 on nights

Tait, MSN, RN · Jul 3, 2009

I've never worked at a hospital that utilized telemetry techs. Nurses who work on units which utilize telemetry are sent to classes where they learn the various rhytyms. We are taught which arythmias are life threatening and which ones require closer monitoring. Our nurse to patient ratio is 1 to 6 on nights

Yeah, the first hospital I worked at a nurse would have to rotate and watch tele for some of their shifts. However there we were lucky if we had five people on telemetry.

Currently we have almost 12 floors with tele and our floor often has 12-24 telemetry patients on a given day. When I first started we had our secretaries cross trained so they would do the desk and listen for alarms/pull strips. Well then a few people died around the hospital due to inattention, so then we had a tech and a secretary to watch the monitors. Same thing happened, someone died, and it was too expensive to have two people on so they created the Central Monitoring Unit.

Since then it has been classic chaos. Some days are better than others, but still we fight over when to change batteries (apparently now they send us tele boxes with near dead batteries in them, and then call an hour later to tell us to change them. I guess this is because they don't want to buy new ones, but need enough battery in the box to track it if it gets lost in the tube system on the way to the floor). They also tend to tell anyone who answers the phone the rhythm issue, so of course one night I didn't find out my patient had had a 12 beat run of VT at 2000 until I saw the strip at 0400 because they told the secretary instead of me, and she forgot.

Tait

mama_d, BSN, RN · Jul 3, 2009

My facility got rid of monitor techs before I started working there. Each floor with tele monitoring has central monitors at the front and the back, and we're responsible for monitoring ourselves. They've been talking off and on about bring the monitor techs back...personally, I'm resistant to the idea. I know what's going on with my patients, what's usual for them, what each doc's idea of when to be called is. I suspect that if I had someone telling me when I needed to call the doc (aside from fellow nurses whose opinion I trust) it would annoy me greatly.