I floated to telemetry last night from critical care.
There are basically two acuity levels staffed at 1:5 and 1:3 RN assignment. There is an LVN and a CNA on the unit too. Last night I had three patients, two on vents. One on renal dopamine. The LVN, whose been my froend for years worked with two RNs while the CNA worked with the other two.
She told me they have been getting floats from med-surg and even post partum who don't know basic rhythms.
Our regulations require competency validation and orientation before a nurse can be assigned responsibility for patients on a unit.
OK, I know basic arrythmia and ACLS are needed.
What else is necessary for a nurse to know before being assigned patients on a telemetry unit?
Mar 25, '06
Please know what the labs mean and how they're ordered, especially troponins. Please familiarize yourself with cardiac meds, especially the drips and the IVP meds.
ACLS would sure be a help.
We had a patient who came to the floor with chest pain but the LPN who was assigned to him was a med-surg float, and though she medicated him X1 with NTG SL for his continuing chest pain, she didn't know what to do next, so the follow-through for the patient was delayed a bit.
If she'd had a little orientation, she would know that we have a standing CP protocol to use. I think that would've helped.
Above all, if you're not familiar with Cardiac stuff, I would appreciate a brief report of each patient as the shift goes on, so I can help you to help the patient.
Mar 26, '06
I'm on a committee that makes recommendations to management.
We have a chest pain protocol and an anticoagulent protocol. Those should be required. We need to get the tele staff and manager to write this.
My LVN friend is concerned she may have to chose between going outside her scope and say defibrillating a patient because the float RN doesn't know what to do.
Of course we want to prevent this. The unit staff is so happy with their staffing it may take some motivating to get them active again. I think I'll have to volunteer to float when it's not my turn just to find out more and recruit someone to attend a meeting on a day off.