What Constitutes a Telemetry Unit

  1. Are there any guidelines for what constitutes a telemetry unit? I work on a 35 bed unit, 24 beds which are tele beds. Our nurse to patient ratio is up to 6:1 days, 9:1 eves, 10:1 nights. We feel this is too much. The accepted standard for telemetry is a 4:1 ratio. When my NM presented these guidelines to management, she was told that we are not a telemetry unit, we are a med-surg unit and our patient ratios are acceptable. We are the only floor, aside from the ICU that does tele. All the nurse are required to be basic coronary certified and ACLS certified. We are capable of pushing emergency meds and have standing orders in place for these. When patients on other floors are having problems, they end up on our floor. When patients come out of the unit, most likely they are transferred to our floor. So what is it that actually constitutes a telemetry floor. We do not have a monitor tech, the charge nurse watches the monitors ( but does not take patients). I'd like to find some type of guidelines that we can work with. I should also mention that we are also the oncology unit in our hospital and the nurses are also required to be chemo competent as we do run chemo.
  2. 13 Comments

  3. by   VORB
    Your nurse to patient ratios are way out of whack.

    We've got tele monitoring in every dept in our hospital. But we're surely not expected to have the knowledge base you obviously are, nor have the pt acuity that you seem to. And we're typically no more than 1:6 days or nights, 24 hours a day.

    It sounds like an accident waiting to happen.
  4. by   Be_Moore
    Your patient ratios are very much not in line with accepted standards. I'd be looking for a new job, honestly...it's YOUR license that is at stake if something goes wrong...and with that many patients, something could easily go wrong.
  5. by   wooh
    And when the charge nurse is doing charge nurse duties, who watches the monitors? I doubt things will change until someone with a family smart enough to sue dies. And even then, unless they lose more in the settlement than it would cost to give decent staffing, probably still won't change.
  6. by   RNKPCE
    If it is grey, has a trunk, and weighs a ton it is an elephant even if you call it a dog.

    I work tele and we have 4:1 ratio 24/hrs a day
  7. by   nerdtonurse?
    This is a case of the administration calling you what they need to to keep from increasing nurse/pt ratios. If there were suddenly funding available for telemetry floors, you'd suddenly be a tele floor.

    Your ratios need to come down, and you absolutely need a telemetry tech. We have a dedicated tele tech, and when she does so much as go pee, one of us watches the monitors. Is it possible you could -- anonymously, of course -- bring your concerns up to your risk management organization? Forget pt care, nobody but us cares most of the time; get a set of settlement payouts from where people died after their tele wasn't watched, and send it to your legal/risk mgmt departments. They don't care about us or patients, but you talk about costing them money, and things might change. You might also slip a line to JC, especially if you haven't had a visit from them in a while.
  8. by   creativemom
    We don't have someone that watches the monitors either. Each RN is responsible for monitoring their pt's for tele. What I find outrageous is how can you monitor the other 5 when you're in with another pt? Many times the main desk is empty. Those of us who are PCNA's who "float" to this floor are not trained and have no idea what the "Beeps" "grunts" and "buzzes" mean from the tele monitors. Even though I've asked a dozen times to learn... completely frustrating. Now I have to wait until I learn it in school!
  9. by   youknowho
    That sounds downright scary. We have 4:1 as mandated by California law and I still feel that some days its too much depending on the acuity of the patients. if you have a union I think you should make sure they know what is going on. If not, then perhaps you might be safer in another facility. 10 patients!!!??? What are they thinking? Even for a med/surg floor, this is too high to provide safe nursing care.
  10. by   susiern06
    We are a 43 bed Telemetry Unit in NY. Our nurse to patient ratio is 1:6. We have worked as 1:7 and even 1:8 if there are sick calls or if one of us floats, but always with a protest of assignment. We always have a tech on monitors. They watch our floor plus a few more monitored beds elsewhere in the hospital. We have 2 techs at the monitors the majority of the time, and can do with one if staffing is an issue.
    The thing in my hospital is they don't classify us a critical care unit. Something happened during a strike a long time ago and the classification changed from critical to med-surg and it was never changed back. Yet we all maintain BLS, ACLS, and our mandated Stroke CE's to be able to work our floor. And we are floated to CCU and ER if need be.
    Our CCU/ICU watches their own monitors, but their ratio is only 1:2/1:3 max!
  11. by   stelon
    I work as a CNA on a tele floor and they don't even give US 10 patients unless it's a bad day--and this is rare. The nurses on my unit are 1:4 and the aids are 1:8.
  12. by   flightnurse2b
    our ratios are alot like yours.. we are required to have ACLS, NIH stroke certification and also 12 hours of inhospital trauma training per year because we are a trauma center. we get some seriously sick patients.

    but we have two monitors techs every shift. that is all they do. they do not leave the monitor room unless on of them is relieved by us. with ratios like that, we cannot be expected to be responsible for monitoring our own tele.... our unit is just way too big. the telemetry/PCU beds alone are i think 78 beds, and thats just one part of the floor.

    we had a staff meeting a while back where we told our manager that our ratios were just too high and the acuity was too high and we couldn't deal with it. she said if we clocked out on time and stopped having so much incremental overtime, they could pay two more nurses.... but, we said, how the heck can we get out on time with 7-8 patients on tele/progressive care???
  13. by   wooh
    Quote from flightnurse2b
    she said if we clocked out on time and stopped having so much incremental overtime, they could pay two more nurses.... but, we said, how the heck can we get out on time with 7-8 patients on tele/progressive care???
    That's hilarious! If you were getting out on time, then they'd have the proof they need that you weren't overworked and didn't need the extra two nurses!
    (Reminds me of trying to get a PICC line on a weekend. Our interventional radiologist refuses to come in and put in a PICC unless the patient has an IV for sedation, but if they have an IV for sedation, they refuse to come in on the weekend because the patient already has access and can obviously wait until Monday.)
    Nursing is 100% only about keeping from getting ourselves and our patients smooshed between rocks and hard places.
  14. by   mama_d
    nursing is 100% only about keeping from getting ourselves and our patients smooshed between rocks and hard places.

    amen to that!

    your ratios are freaking ridiculous. i work tele/oncology and the absolute highest we'll go is 6:1 with one tech for 25 patients on nights. ideal staffing for nights is 5:1 with two techs. we do watch our own monitors.

    even our medical floors don't do 10:1 except in extremely rare circumstances...and those are the nights when codes get called repeatedly at shift change as nurses do their hand-off rounds.

    is there any way that you and some of your cohorts can do some research into evidence-based practice, mortality rates, fall rates, med error rates, etc. as it applies to staffing with the acuity of patients that you get, and compile it all into a nice package and forward it on to upper management?

    additionally, much as i'm reluctant to say this, it may be time to start ramping up the incident reports. we have been having issues with staffing recently where i'm at, and the number of errors have obviously increased...each incident report that i write i notate as a contributing cause that "staffing was at critical level". bury risk management in paperwork, create a paper trail of evidence that high ratios are directly contributing to less than optimum patient outcomes, and things may eventually change.