Float nurses doing cardiac assessment on DOU/Tele

KulRN · Dec 4, 2007

I work on a busy Med-Surg floor and we also get floated to Telemetry once in a while. For me I get really nervous when I float because I am not exposed to reading strips or the tele monitor, I only have the basic knowledge but I know how to do cardiac assessment, the only problem is not quite sure what to do if I detect something wrong...But I do ask questions and help from the regular nurses and Charge Nurse on the unit...As a med-surg nurse I have transferred quite a few patients to either PCU or Tele because of my thorough assesment. Given the proper orientation, I am 100% sure that I can become a good PCU/Telemtry Nurse. I'd love to know more about cardiac drips. Just my two cents.....Oh, and one more thing, I really think that if a floater is assigned to a tele or PCU, the charge nurse needs to take into consideration what this floaters are capable of (competencies) and check acuity of the patients assigned to them (us).

CaLLaCoDe, BSN, RN · Dec 4, 2007

I work on a busy Med-Surg floor and we also get floated to Telemetry once in a while. For me I get really nervous when I float because I am not exposed to reading strips or the tele monitor, I only have the basic knowledge but I know how to do cardiac assessment, the only problem is not quite sure what to do if I detect something wrong...But I do ask questions and help from the regular nurses and Charge Nurse on the unit...As a med-surg nurse I have transferred quite a few patients to either PCU or Tele because of my thorough assesment. Given the proper orientation, I am 100% sure that I can become a good PCU/Telemtry Nurse. I'd love to know more about cardiac drips. Just my two cents.....Oh, and one more thing, I really think that if a floater is assigned to a tele or PCU, the charge nurse needs to take into consideration what this floaters are capable of (competencies) and check acuity of the patients assigned to them (us).

Sounds like you know your telemetry nursing well! Good for you! I am flustered when we get folks..travelers, medsurge, float nurses who don't check the important labs, k+, mag, phos or are and are not covering low ones and aren't dealing with blood pressure issues. To me, these things are basic to nursing regardless and do not exclude other areas of the hospital.

Virgo_RN, BSN, RN · Dec 4, 2007

What's a DOU?

We frequently get floats from other floors to our PCU. Most of the time they will be assigned to the medical overflow and the CHF patients if possible, but it's not always possible. A basic cardiac assessment at our facility involves listening to heart and lungs, checking peripheral pulses and capillary refill, and checking for peripheral edema. That is not out of the realm of the med/surg or general medical nurse. Reading the rhythm strips, on the other hand, might be, since for a lot of nurses, the only exposure to EKGs they get might be in nursing school, and all they learn is how to recognize a normal sinus rhythm. Consequently, it might behoove the nurses in the telemetry unit to offer to help read the rhythm strips for the floats. Personally, I love to teach, and would be happy to do this. But I am so busy that the float needs to approach me and ask for help. If they don't ask for help, how am I supposed to know they need it?

Does your unit have a written assessment standard? If so, you could print out a copy for the float nurse to use as a guideline for what they need to be assessing. If not, maybe someone could talk to the clinical educator about putting one together.

Lastly, a good charge nurse is aware of which patients are most likely to go into lethal arrhythmias (often the signs are there long before it happens), and which patients are on which drips, etc. I know that for myself, if a patient isn't looking so good, I will notify the charge nurse, even if it's just a feeling I have. This way, they have a heads up that something might happen. The CN should be aware of the skill level of the nurse assigned to such a patient, and be checking in, even if inconspicuously looking at the tele monitor or checking the charting. Recently we had a patient go into sustained SVT, and his/her assigned nurse was a float from another floor. When the patient converted to SVT, I was expecting the nurse's phone to ring, as the monitor tech is supposed to call the nurse in these circumstances, in case the nurse is in another room or busy with another task and isn't looking at the monitor. The phone didn't ring and the phone didn't ring, and I was starting to think the monitor tech was shirking, but then the charge nurse came down and I understood why the monitor tech hadn't called. The charge nurse was aware of the situation and was handling it, because she knew the assigned nurse was not trained to do so (the assigned nurse did the right thing and went in to assess the patient when she saw the arrhythmia, and was in the room with the patient when the charge nurse came).

KulRN · Dec 5, 2007

DOU? DOU is a Direct Observational Unit....the same thing as PCU (some hospital calls ICU step down either PCU or DOU. ) Like where I work, we call it PCU (progressive care unit).Can someone tell me where I can get a reading material about algoryhtms ( the ones that we have in our unit is soooooo confusing, I want something easier to read and understand).Thanks!

Virgo_RN, BSN, RN · Dec 5, 2007

What kind of algorythms?

Daytonite, BSN, RN · Dec 5, 2007

nursemel374. . .I worked on a stepdown unit for a number of years and was also a hospital supervisor. I know that you probably see things differently since you worked ICU. You have to understand that many med/surg nurses are keenly afraid of ICU and stepdowns. When I was a supervisor we often floated nurses from med/surg areas to stepdown and the stepdown nurses to the ICU. There was no way we could get med/surg nurses to go into the ICU, even if we promised that they were going to get really, really easy patients (i.e. observation patients). Even getting them to go to stepdown was hard and I had worked there and knew what the unit was like. We would inevitably get a call from the nurse who was supposed to float there and listened calmly to their panic over the situation. They do not feel competent to go to these areas. All they can think about is the advanced procedures, telemetry and drugs that they are not familiar with. Now, what I always did was remind the nurses on stepdown that they were getting a nurse from med/surg to help them out and to give them the lightest assignment they could and then I followed up on that several times throughout the shift to make sure the float person was doing OK and hadn't been put in a situation that was over her head. If need be we put the float nurse on meds and IVs for the unit patients only or basically put them in the position of a CNA. If the stepdown staff abused this I nipped it in the bud quickly. I also would tell the nurse who had to float that all we expected them to do was basic nursing care; that they were the extra pair of hands that was needed. We did not expect them to be reading telemetry or know the arrhythmia protocols. If one of their assigned patients happened to have a cardiac problem during their shift I expected one of the regular staff nurses to take over and handle the problem, no questions asked, and I expected to be notified immediately of what was going on. Because I was aware of how upsetting being floated was for everyone, I made it my business to follow up and make sure that every person who was floated was having as good an experience as possible. Those units who didn't treat float people well didn't get a whole lot of sympathy from us supervisors and we had a few little nasty table turning tricks we could pull on them. And, believe me, when it was their turn to float, their deeds with people floated to their unit did not go unforgotten. We supervisors had sole discretion as to who got floated and to where.

:lol2: I have to tell you that I also saw some ICU nurses go into a real panic when they got floated to a med/surg unit. Their biggest complaint? "I can't handle more than 2 patients at a time." You have to imagine that this caused some interesting discussion among the supervision staff.

anonymurse · Dec 5, 2007

I have to tell you that I also saw some ICU nurses go into a real panic when they got floated to a med/surg unit. Their biggest complaint? "I can't handle more than 2 patients at a time." You have to imagine that this caused some interesting discussion among the supervision staff.

Yep I got replaced by a floater from ICU the other night. A lot of things were out of her comfort zone, like not being able to see all her pts at the same time (our ICU is set up so the nurse can watch both her pts through glass), very terse written report (I gave her detailed verbal report on the two she was getting from me to try to get her comfortable), and taking 4 pts. I also think she wasn't comfortable having much less data with much less currency at her fingertips. Basically her superbly thorough ICU habits were getting in her way, not only in data needs but in being frustrated at not being able to lavish time on her pts. I think it would be harder to float from ICU to tele than the other way 'round because it's easier to get technical help when a pt is going down than it is to get help prioritizing your work all night.