I work on a small 25 bed unit in a Critical Access Hospital. Out of 25 beds, 3 are ICU beds. Our Units are attached, with the ICU basically within the med/tele unit. Our census is generally 5 or 6 patient on med/tele, and about 1 in the ICU. With all of the worries about cost savings, we are trying to utilize our staff appropriately, and I need some suggestions and experiences from other nurses who may have the same thing going on.
Normally the ICU nurse monitors the tele right at the ICU nursing station. This is the only place the rhythms are visible, and this monitorcan be seen from the med/tele nursing station also. Lately, if the census is low on the med/tele and there is no ICU patient, we will put a med/tele nurse "on call" and keep the ICU nurse (for monitoring tele) and one med/tele nurse. (we normally staff with 2 med/tele, one aid/unit clerk, and one ICU nurse). The ICU nurse has been taking an assignment of patients on med/tele, which brings her away from moniroting the telemerty patients for periods of time. We do have beepers available, but these are not to be used as a first line alert for rhythm alarms, (their intention was to alert the nurse caring for the tele patient about an alarm, althought the ICU nurse actually sees the rhythm).
I hope that was clear...so here is my concern: I feel that the ICU nurse is putting patient and her license at risk by not directly monitoring the telemetry in the ICU, this prevents her from leaving the ICU unless she finds a qualified replacement to monitor for her break, etc. As an ICU nurse, it can also be a very long 12 hours if you don't get and ICU admission. Our rule of thumb is you can leave for the amount of time it takes you to take a potty break, and we are able to hear the alarms from the bathroom (yes, we are that small). But there are several ICU nurses who disagree, and want to take an assignment of med/tele patients (althought the census is low and it is not necessary) because they feel that they are not doing their share of the work.
There are some potential solution such as a monitor in one hallway allowing nurses to see and respond to alarms, but that still leaves an opening for missing an alarm due to a small staff (everyone could be in a patient's room).
Any ideas or experiences? I am looking for a solution to this that would allow for appropriate staffing for the census and safe patient care, of course...