do you have central monitoring???

BRANDY LPN · Dec 16, 2003

NOpe small hosp with no central monitoring about 400 del per year. its not that bad as long as theres someone to watch your pit pts while our on break otherwise your stuck.

OBNurseShelley · Dec 16, 2003

Originally posted by elleRN
I recently relocated to the Boston, MA area and I am going on interviews at hospitals within a 40 mile redius of Boston. Today was my first day of interviews, and one of the hospitals north of Boston near the new hampshire border does not use central monitoring. it is a community hospital, and they say the ratio is 1:1. is this the norm, that there be no central monitoring? I come from the new york city and I have never heard of this. even if you are 1:1 what happens when you go to the bathroom and your patient in the meantime is deceling and your co workers at the nurses station don't know because there is no monitor at the desk ringing that something is wrong? The job itself seems great, but I am very uneasy with the monitoring. Give me your input please!!

If you're going on interviews....might I suggest doing travel nursing? It's a great way to get a job and make money without the committment if you like it you can stay. Check out the delphiforums for more info.

I've worked at 5 different hospitals via traveling in various locations as well as interviewed at various hospitals, and have always had central monitoring. Just because it's a small place doesn't mean they don't have it. I dont' think I'd be comfortable working at a place that didn't. That seems a little old-fashioned to me.

Anyway, good luck!

I'm considering another travel assignment in the Boston area, if you find anyplace you'd recommend, let me know.

I would HIGHLY recommend, Emerson hospital in COncord, MA, i've been here for almost 13 weeks on a travel assignment and would stay if they would let me, but they are cutting travelers due to budget. It's an awesome place, WITH central monitoring and 1:1 ratios, they do about 100 del/month, have a level II nursery, 9 OB's. Let me know if you'd like to discuss anything else!

SHelley

SmilingBluEyes · Dec 16, 2003

yes we have central monitoring. would not want to work where it is not present.

BRANDY LPN · Dec 16, 2003

Not having central monitoring is not all that bad except you have to wait for a break when someone is available to watch your pt. as I said in my earlier post I definately want central monitoring and mention it to admin as often as I can but it is not the night mare I thought it would be when I first started, and I figure they cant stay in the dark ages forever. I feel like there is much more pt contact without it because I HAVE to stay at my pts BS if they are being monitored cont. I would not turn down a job based on that alone it can be done and is not as bad as it sounds. I have worked with central monitoring and as I said I definately want us to get it (along with telemetry) but I am happy to go to work and dont feel like its that bad of a deal.

Tweety, BSN, RN · Dec 16, 2003

error. Sorry posted on the wrong thread. I've not business in OB. LOL

fergus51 · Dec 16, 2003

I actually prefer no central monitoring on a regular unit (not super high risk). I find when hospitals have it, nurses spend less time at the bedside and it gives a false sense of security (I want to know what is going on before and during the decel). I would take breaks when someone else was in the room (doc, another nurse, etc) and never had a problem.

imenid37 · Dec 16, 2003

We have had central monitoring for 4 years. When I first worked at my current job, we did not have it. Overall, I think it is better to have it. However, without it you were definitely at the bedside when you were supposed to be documenting fh's rather than hanging out at the desk. Honestly, I don't see that central monitoring has had a sweeping impact on bad outcomes on our unit. After all auscultation is a viable alternative to EFM and you don't have the doptone on the abd. at all times. There could certainly be decels you are not detecting in that case. Pt. could also have a decel while walking or in the jacuzzi. I think until you have worked without it, it is hard to believe that it might not matter as much as you would think. If you were seeing things when you went in that room that bothered you, then you were in there practically all of the time, which was both good and bad in some ways. We do 1:1 care and are pretty well-staffed, so it was usually not hard to do. If I went on an interview and they did not have central monitoring, but they had good staffing and 1:1 care in L/D, I would not just write the facility off. Central monitoring is essential in a very busy unit where the nurses have 2 or more pt's each.(IMHO)

SmilingBluEyes · Dec 16, 2003

spending time at the bedside doing????? exactly what?

so many of our patients get epidurals and want to rest when they are laboring...they don't want us staring over them. Those who elect low-intervention births are not on the monitor anyhow except for "spot" checking, so central monitoring is not even an issue in their case.....hmmmm

when you are at the bedside, or enter the room, do you rush to the monitor first, or to the patient? really think about it-----cause I have seen nurses/doctors pick up the strip first, without even making eye contact, to assess the situation, initially.

It's a double-edge sword, yes, I agree. It does not replace a watchful eye. How I practice, I don't get any false sense of security with central monitoring. I have worked without it....and would not choose to again. What if you have more than one labor patient in your care? The answer is then rushing from room to room, to look at the monitor? Or turning them all up so loud you can hear them when you are in not in the rooms? Ick.

Sorry, I dont think I rendered BETTER care with no central monitoring. I found myself looking at the monitor the minute I stepped into the room, first, then the patient. With central monitironing, I have a clue what is going on already--- so when I check in, I look at the PATIENT and ask HER how she is doing, knowing pretty much what the strip is showing us already.

Having been both places, I say having central monitoring has HUGE distinct advantages, esp if you have more than one labor patient you are caring for. And sometimes, we all do.

fergus51 · Dec 16, 2003

Deb, I certainly don't think no central monitoring equals better care necessarily any more than the opposite is true. Nurses are individuals. The last hospital I worked at had sort of an entry area to the room where we could sit and chart if the mother wanted to rest, but we could still pull the curtain and peek in, as well as hear the monitor, so we knew what was going on. The real benefit of no central monitoring is exactly what you brought up: we never looked after more than one mother in active labor and I think that is ideal. This was in a very large, very well staffed unit, so I know it isn't always possible, but I do believe in 1:1 in L&D. I don't have to tell you how fast things go bad:D

The high risk unit had central monitoring and there were 2 cases in particular with newer nurses that may have been avoided had they not relied so much on the technology. That's where I think central monitoring is really lacking.

SmilingBluEyes · Dec 16, 2003

1:1 is ideal but even AWHONN does not state it is necessary...

we routinely get more than just one labor patient...

sometimes it's one labor and a couplet.....

sometimes it's two labors.

we have to have central monitoring to keep up

not everyone has the luxury of 1:1 total care.

imenid37 · Dec 17, 2003

If we were supposed to check fh's q 15 min (such as pit). We went in the room q15. If the pt. slept, we let her sleep. We can be quiet. Believe me. I work at night and I can tiptoe. If strip looked ok, you went back in 15 min. later. If not, you hung out. When we went in the room a lot, pt's would ask us to help them move, etc. and we did a lot w/ them. I see people charting from the desk a great deal now, not going in the rooms. This is some people, not all. We only have one labour pt. We don't get more than one, except in rare cases. Now of course, if you were to pull up someone else's screen in another person's room, it would probably violate HIPPA. I have done that on occasion when I am in charge to see what's going on w/ other people. (someone can have me flogged for that one, I guess). Several years ago, we did not have as many epidurals as we do now, so our pt's wanted to get ito the rocker and up to the br, etc. I don't think the epidural rate has anything to do w/ central monitoring or not, it is just better accepted by our pt's now. I like the Watchild system we have now, but again, I don't think that no central monitoring would be a deal breaker for me, if other things were very favourable.