acls needed for "med/surg" floor in tenet hospital

lady_jezebel · May 15, 2005

tele is med-surg in my hospital, and yes, many are acls certified.

caroladybelle, BSN, RN · May 15, 2005

Many Med/surg floors require ACLS. However, it invariably backfires on the facility in that when they start requiring all MS nurses to read tele, EKGs and do ACLS, many figure that it is much easier to go the full mile and transfer to ICU for the lower patient load, thereby leaving MS floors understaffed.

The other issue is after they teach you all of this, management then starts admitting "stable(??????)" critical care patients to the floor when ICU is full, saying that you are properly trained to care for them.....lousy MS staffing levels be darned. This presents a seriously unsafe situation for the MS nurse carrying the standard 5-10 patients, instead of ICUs 2-4 patients, and yet being expected to handle ICU level drips and monitoring "just this once (yeah, RIIIGHT)".

As soon as the nursing staff gets treated to some of this, they quit/transfer and the hospital gripes that they "cannot find decent staff". It is quite typical for Tenet.

Why not just go the full mile and go to the ICU where they are required to staff you better?

UM Review RN, ASN, RN · May 15, 2005

I work in a "Progressive Care Unit." That is, we take tele, stroke and med-surg patients. We aren't required to have ACLS, but we are required to have EKG skills and be "Tele-Certified" per our hospital's standard.

We CAN do many things that we're not usually required to do. For instance, we can take a patient on an insulin gtt, but the q1h accuchecks make it impractical to keep that protocol up for very long, as we really don't have the resources to handle such a work-intensive patient. So we lobby the doc to get that patient moved to ICU. We also do have plenty of types of drips, but we don't titrate. Again, we don't have the resources to do that type of care. If the doc will set parameters (say, "HR

That said, they NEVER float us to another specialty area that we have not been oriented to and are not qualified to work. They asked me to float to ICU one night for "tele" patients, and I was well within my rights to refuse. ICU is ICU. If a patient is in ICU, that patient is NOT a med-surg patient, they're an ICU patient. If they're a Med-Surg patient, the patient should be on a Med-Surg floor or someone's insurance company is getting ripped off.

To my simple mind, it means that at any time, that patient might require procedures and interventions that as a non-ICU nurse, I have not been trained to interpret/assess/administer, so I'll fight tooth and nail to avoid it.

Hope I gave you some ammunition, because that sounds like inappropriate floating to me.

tntrn, ASN, RN · May 15, 2005

Our "owners" United Health Services" had declared that all L & D and Mother-Baby nurses get ACLS certified. I'm kicking and screaming all the way to the class, for exactly the same reason that carobellelady mentioned before. Once we are "qualified" we'll be expected to handle that kind of patient on a routine basis (qyn AND all of that). Now if we only have one incident a year or so, just how qualified will we really be? I don't like it, personally. I have decided that I am not going to study on my own time, before the class, like everybody says you must do. It's their requirement, let them pay me for my time. (We'll see how that goes.)

Our current staffing ratios are already biting them in the butt. Our unit used to have the best patient survey numbers because we had great response time to call lights, etc., etc. Now on our floor, a nurse can have up to 8 bodies: that could be 2 couplets and 4 fresh gynies. Response time has suffered as you can imagine, but apparently management can't, so now the survey numbers are not as good any more.

I can see this happening when all of a sudden we are expected to take the 90 year old gynies who have pace-makers and all kinds of other things onto our "family birth center" unit.

Antikigirl, ASN, RN · May 15, 2005

I was so shocked when I found that when I took on a job as a neurovascular nurse that I was one of two that had their ACLS! We had many codes, and believe me...every time it was like a darn circus!

I was the youngest and the newest so sheesh, let me lead the code? Nope, they would try to do these codes in the most interesting of ways (I have some hillarious stories...so much that I want to write a book on it!)...and here they were with a 'ER wannabe nurse' doing ride alongs with paramedics and ACLS certified and eager to help! Oh brother...oh well...sometimes being the lowest on the totem pole ya know..LOL!

Now I am working at an assisted living facility and still keep my ACLS up. No, I don't have any equipment (not even an AED!), but I sure as heck can help paramedics and get patients ready and positioned so they can get straight to work and help by doing CPR.

What scares me though is now the facility will not certify their CNA/caregivers in CPR anymore...so many have chosen not to bother...GREAT...they are the first on scene, and I need them to start CPR if needed (depending on code status)! Last code, I taught the CNA as we did it! (she was AWESOME and had CPR training years ago, but never done it...I just calmly talked her through...she hugged me afterwards and thanked me so much for helping and being sooooooo calm!).

NurseSue · May 15, 2005

What tenet hospital are you working for? I just accepted a job at Graduate and am to begin there this summer on the telemetry floor?

NurseSue · May 15, 2005

i'm so mad and frustrated from the constant bs from tenet- california's evil hospital corporation.
2 years ago i was hired for a dou/telemetry floor- ekg and acls training and certification required. not long after, when all the talk about safe staffing ratios from title 22 came buzzing around, they (administration) started to say "well, its more of a med/surg floor" but yet we are still required to keep up our acls and about 30%+ on average are on tele.
yet again, one of our regular night nurse got floated tonight to a stepdown unit while other "med/surg" rns on a different floor aren't allowed on step down yet they routinely remind us we are "med/surg". and the med/surg nurses that get floated to our unit get all the lightest load and we end up with the heaviest.
everytime i ask- why do we need acls if we are "only" med/surg- i never get a definite answer.
so let me ask all the nurses here, b/c i am a fairly new nurse, and so maybe i'm blowing this all out of proportion, but does your med/surg floors require acls??? what the heck does DOU/tele stand for? thanks for letting me vent.
and yes, i'm looking for another hospital... sad, b/c my co-workers are the best. otherwise i'd of left long ago.

Which tenent hospital do you work in? I just accepted a job with Graduate Hospital and am to begin this summer as a new nurse.

redwinggirlie · May 15, 2005

your situation sounds strange, yet having ACLS is a bonus wherever you go. Sound like you will go.....

bonjovigirl · May 17, 2005

NurseSue,

I don't know if this helps, but I have done clinical work at Graduate for school, and all the employees there seem very happy. It is one of the (dare I say) happiest staff we have come across as students.