Increasing our workload once again!

  1. Hi all, I work on a busy 42 bed ortho/neuro/trauma unit that includes a 6-bed close observation step-down unit. Most patients in step-down are post-op craniotomies with ventrics, multi-traumas with head injuries, several with trachs, etc. Most patients are Q2 hour VS and neuro checks. It's usually staffed with 2 RNs, or RN and LPN, (occasionally RN and CNA). The Chief of Trauma has decided to add telemetry monitorsto this unit for trauma patients that need cardiac monitoring. He says it won't be diagnostic, we may only get these patients occasionally, and he wants to implement this in 8 weeks (there are 70 nurses that will need to be trained for tele). I don't like tele, which is a reason I chose to work on this unit.
    Does it sound like they are doing this half-a$$ed (only 8 weeks to implement) and will this be safe for those on tele if we only get patients like this occasionally? They don't plan to increase staffing at all. Most nurses are pretty upset about the whole thing...
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  2. 13 Comments

  3. by   bellehill
    I am currently working a 42 bed neuro/neurosurgery unit which has already implemented telemetry. It seems like it goes in waves...everyone is on tele then no one is. Personally it doesn't bother me, this hospital has a very good telemetry certification class I went to and if I have a question there are always other nurses to ask. When we had a step-down unit on this floor (it has since been taken away) everyone of those patients was on telemetry, I am actually surprised you don't have monitors on everyone. We are all human and don't like change but give it a chance, I have caught many problems that I wouldn't have know about if the patient weren't tele.
  4. by   Sadie04
    Thanks Bellehill, how intensive was the cert class? Do you often have patients on your unit that are inappropriate and sent there because there are no other tele beds in the house? Do you read strips and include them in the nursing notes Qshift? I don't think it will be so bad once I'm used to it, I just hope I get thorough training as it's been a long time since I've worked with telemetry. Thanks for sharing your experience
  5. by   Katnip
    I don't doubt everyone can learn this, but 8 weeks to certify 70 nurses seems like an awfully short time to me.
  6. by   New CCU RN
    Quote from Sadie04
    Hi all, I work on a busy 42 bed ortho/neuro/trauma unit that includes a 6-bed close observation step-down unit. Most patients in step-down are post-op craniotomies with ventrics, multi-traumas with head injuries, several with trachs, etc. Most patients are Q2 hour VS and neuro checks. It's usually staffed with 2 RNs, or RN and LPN, (occasionally RN and CNA). The Chief of Trauma has decided to add telemetry monitorsto this unit for trauma patients that need cardiac monitoring. He says it won't be diagnostic, we may only get these patients occasionally, and he wants to implement this in 8 weeks (there are 70 nurses that will need to be trained for tele). I don't like tele, which is a reason I chose to work on this unit.
    Does it sound like they are doing this half-a$$ed (only 8 weeks to implement) and will this be safe for those on tele if we only get patients like this occasionally? They don't plan to increase staffing at all. Most nurses are pretty upset about the whole thing...

    From how sick your patients sound... I would think the tele would sort of be a benefit. You will be able to know immediately if one of your patients gets into trouble. Honestly, shouldn't all step-down patients be monitored??

    I guess this is also coming from a cardiac standpoint where...your walky talky r/o mi can be talking to you one minute and in v-fib the next. I also have never worked step-down but I am positive that all step-down patients in my facility are monitored by tele.
  7. by   CseMgr1
    So, what else is new? Every time I turn around, something else has been added to our workload, too. I think it's Corporate's way of separating the strongest from the weakest, to see just how far they can push us, before someone else cracks and leaves...leaving us even more shorthanded. Even my partner at work who rarely complains, told me today that she told our supervisor that she is not happy..and is looking elsewhere.

    Every one's got their limit. Right now I am so damned exhausted, I can't see straight. :zzzzz
  8. by   tiliimnrn
    Hi,
    I used to work on a step-down unit, then they decided to add vent patients to the group...so I left tele and went to a medical floor....there they decided to add oncology...I hated that so I left there....I went to a post-partum, gyn floor and now all-of-a-sudden they've decided that no bed can be empty, so whatever comes in the door comes up to our floor (if the other floors are full) and they have been lately. They always have to screw around with whatever you do, not to make it better..........no, to make you have to do more I feel like we're the blind leading the blind half the time. Why can't they just quit messing with us:angryfire
    Last edit by tiliimnrn on Mar 8, '04
  9. by   Tweety
    Hard to imagine a step-down unit without telemetry. What about trauma patients with cardiac contusions, or patients with pre-existing cardiac issues.

    I think it's a great skill to have. Sounds like to me your unit needs it. Good luck!
  10. by   nekhismom
    I think you will probably benefit from it in the long run, but are ALL of you expected to be trained/certified in 8 weeks? YIKES!!

    As with any change, it can be difficult. Let's hope it doesn't increase your workload by much.
  11. by   kimmicoobug
    I think it would be a benefit, personally. We have tele on our med-surg floor for some of our pts, and it is just lovely to know what is exactly going on with our patients.
  12. by   bellehill
    Quote from Sadie04
    Thanks Bellehill, how intensive was the cert class? Do you often have patients on your unit that are inappropriate and sent there because there are no other tele beds in the house? Do you read strips and include them in the nursing notes Qshift? I don't think it will be so bad once I'm used to it, I just hope I get thorough training as it's been a long time since I've worked with telemetry. Thanks for sharing your experience
    The class was 16 hours with a test after...awarded me 19 CE hours. It was a very helpful class. The opposite is happening with us, we get these patients who have no business being on telemetry and no histpry of cardiac problems. We run strips qshift and document alarm settings in the nursing notes...takes 2 minutes.
  13. by   Owney
    I hope that if you will be responsible for telemetry patients, you will have protocols in place not only to recognize dysrhyrthmias but what to do about them. I have been certified in ACLS for 20 years and I would recommend that your hospital train all RNs who are responsible for tele patients to be trained to at least that level.

    I would also insist that the hospital equip your crash carts with AED's (most units are doing this, since airliners now have them) and train everyone on the unit to apply them.

    Adminstrators need to understand that monitoring means more than just hooking up a patient to a machine. I once saw an OB physician order an ER nurse to take a patient OFF of a fetal monitor. When the doctor explained that the monitor may show fetal distress, and there was no one to interpret it, we were simply creating a legal record of negligence. We did train nurses in fetal monitoring and established a telemetry monitoring system to L&D.

    Excuse an ignorant ER nurse's naivete, but to me the words "step-down" and "telemety" are almost interchangable.
  14. by   ItalianRN
    I work on a Tele unit that has just added Neuro. No additional training or staffing has been offered & most of the Neuro patients are completes. Our PCT's are killing themselves & still can't keep up either. The other day I had a patient trying to kick me in the head. It got so bad that we had to call security to help. He was a big guy. It wasn't his fault, it was due to the injury but I still don't want a trip to the ER for myself. As a Tele unit we usually had 5 & sometimes 6 patients. That hasn't changed. Many nurses & PCT's, who have worked on this unit for years, are looking to transfer. It already had the reputation of being the busiest unit in the hospital, & the added Neuro patients makes it 1000x worse. I never wanted to work Neuro. I absolutely hate it.

    These patients aren't getting the complete care that Neuro patients should be getting. We are not doing Neuro checks other than checking pupils & hand grasps when possible. We note speech & gait, if there is any & that's about it. We mostly send them for tests & give meds. A lot of them need to be restrained because they are so out of it that all they do is try to pull everything out & get out of bed. They're either calm & non-responsive, or they are very aggitated & want to fight you on everything. Neuro is not my thing. I knew that from my first day in Neuro clinicals when I was in school.

    I am only on this floor temporarily because my Tele Stepdown unit is temporarily closed due to construction. My unit will reopen in 2 more months. We get post open heart surgery patients mostly. I already asked my Manager if our Stepdown unit will include Neuro too & she said "no way". If she said yes, I'd already be looking to transfer to the OR or someplace that they couldn't add on like this. As it is, we are all overworked & overwhelmed with our responsibilities. I do not want to risk a patient's care or my license due to administrative decisions. They really need to decrease the ratio if they are going to keep this unit as a Tele/Neuro floor. They also need to offer Neuro training & perhaps include some Neuro nurses in our staffing.

    I love the people I work with in this unit, but I'm looking forward to going back to my Tele Stepdown Unit.

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