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- by 2monkeys Jun 2, '11I 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...
thanks!Last edit by 2monkeys on Jun 2, '11 : Reason: spelled telemetry wrong
- The ICU nurse not taking a patient would be necessary IF your moniotring system did not alarm. As it has alarms, and as long as the alarms can be heard and responded to in a "timely" manner, it is perfectly fine. YOu don't need to have someone sitting there at all times. Like in an ICU...if all the nurses sre in patients rooms....they aren't watching the monitors but they are immediately available to answer the monitors. Depending on hyour monitors there are usually 3 level of alarms. Emergent: Vtach/fib/asystole, Urgent: PVC's >5 min HR>120 and nonurgent: irregHB,PVC"S <5 ect But, Be sure you have the ICU nurse in house at all times to care for codes or emergencies with a medsurg tele nurse on call. The ICU nurse can take the "stable patients" so that if a code occurs or a critical patient come in to the ED she can easily report off her patients to be available for the critical patient and then call in the tele nurse.
Do you have a supervisor? If you do are they ICU trained? I moonlighted at a critical access as a supervisor. I LOVED that job! I was the IV nurse, extra ED nurse,the Rapid response nurse, the ICU back up nurse. I was not counted in staffing and I worked everywhere but I didn't take an assignment so I could respond to the ED when necessary. If you don't have a supervisor his may also an idea worth investigsating. Without knowing all the logistics and layout....I hope this helps....
- Jun 2, '11 by Flo.I was always under the impression that tele had to monitored by a person 24/7. My hospital has a team of tele techs. It seems dangerous to me that a nurse could have a critical pt and at the same time need to monitor other pts.
- Jun 2, '11 by 2monkeysWhen we have critical patients, they are in the ICU. We also move a med/tele patient there if we think they require closer monitoring than is able to be given on med/tele because our ICU beds also double as med/tele beds if we have the need. In that case, they would be cared for by the ICU nurse, who would be right there by the monitors.
- Quote from Flo.I was always under the impression that tele had to monitored by a person 24/7. My hospital has a team of tele techs. It seems dangerous to me that a nurse could have a critical pt and at the same time need to monitor other pts.
That does not mean that someone needs to sit there at all times with eyes peeled to the display. It does however mean someone qualified at all times to respond and treat the monitors and be responsible for them. Depending on the monitor analysis system dertemines whether or not a teletech is necessary. It would seem sad to me that the nurse with the critical patient doesn't have co-workers to assist her in her time of need.
In this case there is a very limited patient population with very limited resources with a total census of 6 monitors at one time. and total patient population of 20 to 25......a team of tele techs is probably not the most prudent use of resources in this case.