Do you have to go with patient's to procedures????

[CareBayer]

Recently, doctors at our hospital have started to require a patient's nurse to go with them to a procedure (if they are on a heart monitor.) This is called "nurse and monitor." I work on a step-down tele floor and have six patients to care for. When I leave the floor with one patient, that means that my five other patients do not have a nurse to care for them. It's too much of a burden for the other nurses to be responsible for my patients as they have six of their own to care for. The hospital has tried to remedy this situation by hiring nurses to accompany monitored patients to these procedures, but as you can imagine, there are not enough of them!

Do you have a similar situation at your hospital? I understand that a doctor would want to cover his (or her) own a$$ by having a nurse accompany a patient (most of whom are STABLE by the way) but then I am putting my other patients at risk by leaving the floor for up to an hour or more at a time!!!

[nrsang97, BSN, RN]

I have to go but I am in the ICU. I cannot see why a stable stepdown patient cannot leave unit without a nurse. If possible can the test be done portable ( echo, us, xray,tcd)?

If the pt is on remote tele does a nurse need to go? In our facility where they use remote tele on stepdown (6 pt each) a nurse does not need to accompany pt to routine testing.

If they are requiring you to leave with your patient then you need to have a lower pt load maybe 4 each. There is no way you can travel with 6 each for testing.

We do have TACT ( transport assist code team) that will take and monitor ICU patients to CT,nuc med, MRI,angio, etc. But they aren't always available and are pulled into staffing to fill a hole somewhere.

What about a float person to cover while someone is off the floor with their pt or take the pt for them?

[snowfreeze, BSN, RN]

Document, document, document. Those docs might be actually doing you a favor, they want the nurse patient ratio to be 1 nurse to 4 patients on a stepdown telemetry unit or less depending on the acuity. Make the best of it, change the standard.

[nrsjo]

Yep, been there. It's a policy where I work that any monitored patient on a cardiac drip needs a nurse to travel with. It's really was bad when they need a stress test- you can be gone for hours. The policy is due to change to every monitored patient. Remote tele only reaches to the end of our unit, and transporters are not trained to read monitors. No one wants a patient with a cardiac history to die in transport or in the CT/MRI machine. I understand the the rationale, but at the same time, trying to get a flex-up in staffing to justify it hasn't worked.

[jmgrn65, RN]

Only in the ICU's however during the week there usually is a nurse in the dept.

[suanna]

Where I work the doctor must write a specific order for a tele patient to leave the floor without a nurse. If you weren't there who would be responsible for evaluating the heart rhythm? If the patient dosn't need monitoring and evaluation- why are they on tele in the first place?

[Virgo_RN, BSN, RN]

If they are on a vasoactive drip, they need a nurse escort. But I call the House Float, cause I can't leave my other patients.

[Chaya, ASN, RN]

On our med/surg tele unit they have just started requiring an Md order for the pt to be allowed to travel without tele. Otherwise a nurse needs to go with and a portable Zoll unit needs to be used for monitoring during transport. We have a rapid response team that can usually provide both the nurse and the Zoll unit, but not always. Our unit only has one Zoll unit which is dedicated and remains on the Code Cart. We very seldom have enought personnel on the unit that an RN can be spared to leave the floor for 45" at a time maybe 2-3 times in a shift. I can see the rationale for this but we haven't worked out all the bugs yet.