Being cross trained wthout a choice.

icuRNmaggie, BSN, RN · Oct 20, 2015

How many beds are in this facility?

How many ICUs?

What are the criteria for admission or transfer to the step down unit?

What are the nurse patient ratios for telemetry and stepdown?

Do you have a secretary, cna and monitor tech?

Do you have a union contract?

sky1263 · Oct 20, 2015

Well the stepdown unit has 8 beds and the ratio is 1:4. On our end on the telemetry unit we do have a tech monitoring and I think last weekend on the stepdown unit they did have a pct helping them. Unfortunately there is no union here. I am from NY where we had super strong unions but I have just been in this state for one year and I was shocked to know there is no union. The secretary is over on our telemetry side of the floor. We used to be one floor below and the med-surg unit was where we are now but they decided a month ago to have us switch floors so we were closer to the ICU. Now they are right down the hall from us so that's a good thing.

I think there is 6 or 8 beds in the ICU as well. Honestly, when they don't have enough staff or the ER gets backed up, they suddenly move patients out of ICU to our unit sometimes to make room in the ICU. They did that big transfer of patients the other night due to no staff, it was crazy. It's not a very large hospital overall but I am concerned about what type of things I would be responsible for that I may not be familiar with and will just get 2 days training to learn. The only drips we do on our unit is heparin, any other ones such as nitro, insulin etc goes to the stepdown or ICU. I am concerned though in general. The ICU is down the hall but there is just one charge nurse covering both the step-down and telemetry unit and just 2 nurses with 8 patients. I don't know, it just seems a bit risky to me.

SquishyRN, BSN, RN · Oct 20, 2015

I don't see any text from the OP other than "Hi all." ðŸ˜³ Is this maybe because I'm using the app?

JustBeachyNurse, LPN · Oct 20, 2015

I don't see any text from the OP other than "Hi all." ðŸ˜³ Is this maybe because I'm using the app?

Yes. Click on the post it's because they've bolded text

Anna Flaxis, BSN, RN · Oct 20, 2015

Do you think this is a risk to our licenses?

No.

As a tele nurse, you ought to be able to handle step-down patients. A ratio of 1:4 doesn't sound bad at all, especially if you have a CNA to assist with routine VS, I&Os, and ADLs.

What is more important than ratio, IMO, is acuity mix. And by acuity, I don't necessarily mean how sick they are, but rather, how time consuming. For instance, a walkie-talkie otherwise healthy 55yo on a diltiazem drip is going to be less time consuming than your average train-wreck complex medical patient who has diabetes and C-Diff diarrhea, who is immobile and takes 20 pills at bed time that all have to be individually crushed in a bite of apple sauce and spoon fed one at a time.

In a lot of facilities, the former qualifies to be in the ICU or on Step-Down simply because they are on the dilt gtt, while the latter qualifies as a general medical. But you tell me which one is more work...

I say give it a chance, don't let yourself be intimidated that these are "Step-Down" patients- you might find this is completely do-able. Embrace the challenge!

sky1263 · Oct 20, 2015

Yes, I am sure you are right. I don't have a choice anyway but to accept it. Thanks!

iluvivt, BSN, RN · Oct 22, 2015

Unless you have a union and in the contract it specifically states that they cannot do this without first bargaining it then you do not have a choice! You do,however have a choice in how you choose to look at and how you choose to make it work for you and your group!

I would look at as an opportunity to learn and grow professionally even though it is not your choice. This will happen MANY times in your career,whether it be change of IV pumps and other equipment,change in recommendations for tracking competencies,change in law allowing nurses take on new skills,and all the new drugs that come on to the market that you now must administer and know how to safely administer and tons more!

This does not necessarily put your license at risk,YOU however are responsible for providing a level of care that meets the current standards of care! You will NEVER be able to state in a court of law that the hospital moved these patients over to our unit with little training and therefore I did not know XY and Z and that is the cause of said event or occurrence. So it is imperative that you take the given training and then add to it if needed,learn all the new medications you will be using,review and learn the new diagnoses you will be working with and assessing,read and or review all the policies that you will be using. Foe example, will you get patients on Dopamine drips?.if so you need to know this can cause severe tissue necrosis if it extravasates and there is an agent you can administer to reverse the potential for tissue damage.

So you can do it and it will be exciting and easier if you stay positive and view it as a challenge. The best antidote for uncertainty and fear is to gain the knowledge and couple that with the experience.

allnurses Guide · Oct 22, 2015

This is America - so yes you have a choice unless your position is protected by a Union Contract and employer can ask you to do any thing that does not discriminate against race, creed, ethnicity or sexual orientation. We don't have slavery in this country so yes you have a choice - You can quit and go to work else ware.

Hppy

BuckyBadgerRN, ASN, RN · Oct 23, 2015

Why would your license be at risk? (SO biting my tongue) Are you a nurse or not? Just because you're being trained to a different area does not mean the big bad BON is going to come gunning for your license.

Hi All,
I work on a telemetry unit but was told today that they are going to cross train us to work on the step down unit. They had to transfer all the step-down patients last week to our unit because they didnt have enough staff to keep the unit open over night. So they put 3 patients on the med-surg unit and the others came to us. They said they will give us two days training and then rotate us over there. This seems like a huge liability to us-the nurses. Plus I feel it should be a choice if we want to be trained to work there rather than having no choice. Do you think this is a risk to our licenses?

brandy1017, ASN, RN · Oct 23, 2015

I would choose to look at it as a chance to grow, learn and expand my nursing skills. I started off on a medical-surgery floor that continuously adapted over the years to step down tele, many cardiac drips, post cardiac, pulmonary, and neuro procedure patients as well as general med surg. Drips are not that hard, people are afraid for no reason. My biggest concern is a working IV and ideally to have a central line when dealing with drugs like dopamine that are vesicants that can destroy the skin if the IV infiltrates! These experiences will increase your confidence and add to your skills for your next job in the future. Hopefully you will be ACLS trained as many of the drugs used in ACLS are commonly used on a tele step down floor and it will all make sense! Look at it as your next great adventure in nursing and a chance to tiptoe into ICU territory if that interests you down the line as you will be one step closer to ICU. Personally I prefer the step down unit and like knowing if a patient is going bad they will be transferred to ICU, but others enjoy the challenge of ICU. Good luck to you and your coworkers!

Elle23 · Oct 26, 2015

I've ever worked a unit where I did not have to be cross-trained and/or floated to other units for staffing purposes.