Med Surg nurse being given Tele Patients

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by Morning Glory Morning Glory (New) New

I am a med-surg nurse working per diem in addition to my full time job.  When I took the job, I clarified with them that I would only be used on med/surg floors and specifically clarified that I would not be floated to tele.  They agreed to this

I've been with this job for a year and they immediately started periodically floating me to tele.  Now, with COVID, this is now becoming a constant issue.  The hospital that requires the most help has a MED/SURG and TELE mix floor and I'm finding myself ending up with tele patients.  I do my best to get med surg patients and refuse those who are clearly out of my scope but I still end up with tele patients. What makes matters worse is that the employer/staffing agency has sent emails out saying if we refuse to go to tele floors, we will be terminated. Seems they have no right to do that. 

In addition to this, these hospitals have very little staff and are poorly run, which increases the risk.  No transport, no house keeping, high patient ratios... just not safe. 

I'm debating quitting this job on the grounds that I've hired in as a med surg nurse but, in actuality, they require a med surg nurse WITH tele experience. I seriously need the extra money but this is clearly not a safe situation. This stinks because I do like the job for what it is and I need the money, but they've made it clear that they don't take scope or practice seriously.

Here is my clear question.  My understanding is that if I accept a tele patient and, god forbid, something happens I am at fault with the Arizona Board of Nurses because I accepted the patient and therefore I hold all the responsibility. 

I've considered reaching out a a lawyer who specializes in nursing practice cases but given the high fee for something I feel I already know the answer to, I've decided to read the nursing practice act in my state but I so far can't find anything specific on levels of care (I'm still reading though)

Is this the point that I should quit this job?  In some ways it's a good job; good pay, a per diem gig that only requires two shifts per month, but I don't want to have to keep explaining why I shouldn't be taking tele patients.

Is it against the nursing practice act for a med surg patient to accept care of a tele patient?  These patients we are talking about are not on cardiac drips (I would flat out refuse that) and they aren't post CABG, they are just basic tele patients. 

I hope this question made sense and thanks for any help

LovingLife123

LovingLife123

1,575 Posts

Why on earth would it be out of your scope of practice?  A RN is a RN with licensing.  I’m not licensed as a specific specialty of nurse.  I have certain certifications in addition to my license, but you are not licensed as a Med/Surg nurse.

I don’t understand you being upset at being floated to a tele floor.  A med surg nurse should have a basic understanding of an ekg and different heart rates.  
 
Am I missing something?  I’m in ICU where all of my patients are on monitors and monitored by me, but I’ve floated to cardiac floors where pt are on tele and there’s a separate area where patients are monitored and the tele room calls you if they see something.  Then you go and look at your monitor and determine if a physician needs to be called.

I understand it might be out of your comfort zone, but every RN in my facility completes an ekg interpretation course every year.  You should know the basics.

sevensonnets

sevensonnets

975 Posts

I'm having difficulty understanding why you are so averse to taking care of a patient with a heart monitor. Could you clarify?

Yes. Absolutely. The issue isn’t the tele monitor just the tele admission status itself. I’m under the impression that having a patient with a progressive care/tele status places them outside of my scope. I’m probably overthinking this. A better way to define is is that I’m being given progressive care patient as a med Surg nurse with zero experience with progressive care patients. I’m wondering if that is again at nursing practice. I will eventually find the answer but I just thought it reaching out for other outlooks. 

43 minutes ago, LovingLife123 said:

Why on earth would it be out of your scope of practice?  A RN is a RN with licensing.  I’m not licensed as a specific specialty of nurse.  I have certain certifications in addition to my license, but you are not licensed as a Med/Surg nurse.

I don’t understand you being upset at being floated to a tele floor.  A med surg nurse should have a basic understanding of an ekg and different heart rates.  
 
Am I missing something?  I’m in ICU where all of my patients are on monitors and monitored by me, but I’ve floated to cardiac floors where pt are on tele and there’s a separate area where patients are monitored and the tele room calls you if they see something.  Then you go and look at your monitor and determine if a physician needs to be called.

I understand it might be out of your comfort zone, but every RN in my facility completes an ekg interpretation course every year.  You should know the basics.

Hey, be cool. I’m just asking a question. You floating from ICU to progressive care is not the same thing as med Surg floating up to progressive care. I have no experience with progressive care patients. I’m simply asking if this is against practice which I think it is. It’s okay to ask questions. 

We don’t have yearly ekg learning although I wish we did. In our med Surg, we also get called from the monitor tech and we reach out to the doctor but we don’t analyze them. Again, I’m probably just overthinking this but it doesn’t seem right caring for progressive care patients with no experience. If I have the impression that this is just that I’m not comfortable with handling a patient on remote tele, I screwed up in explaining this. This is an issue of a med Surg nurse being give. Progressive care patients 

LovingLife123

LovingLife123

1,575 Posts

1 minute ago, Morning Glory said:

Hey, be cool. I’m just asking a question. You floating from ICU to progressive care is not the same thing as med Surg floating up to progressive care. I have no experience with progressive care patients. I’m simply asking if this is against practice which I think it is. It’s okay to ask questions. 

You are confused though.  It’s not out of your scope of practice.  You may be trained as a medsurg nurse, but you are not licensed as a medsurg nurse.  It’s not a scope of practice thing.  A lawyer can’t do anything for you.

At my facility a pt can go on tele to a med surg unit.  You should have a basic understanding of it like I said.  I also understand it may be out of your comfort zone, but we are all doing that now.  Do you think it’s comfortable for me to go from ICU to the floor?  I assure you it’s not.  But it’s something we are all doing.  If you don’t want to, then perhaps another facility is a better place to be.  But it’s not anything you get a lawyer involved in.

Gotcha. Yeah, I’m just over thinking this. I see what you’re saying. It just kind of is what it is right now with Covid too, where med Surg floors are getting blended with progressive care patients. I know where the line of safety and I won’t cross it.  I was just over thinking this. 

And yes, the basic knowledge is there even if I’m not an expert in tele, I know the basics to the point where it truly isn’t unreasonable to care for these patients. 

19 minutes ago, LovingLife123 said:

You are confused though.  It’s not out of your scope of practice.  You may be trained as a medsurg nurse, but you are not licensed as a medsurg nurse.  It’s not a scope of practice thing.  A lawyer can’t do anything for you.

At my facility a pt can go on tele to a med surg unit.  You should have a basic understanding of it like I said.  I also understand it may be out of your comfort zone, but we are all doing that now.  Do you think it’s comfortable for me to go from ICU to the floor?  I assure you it’s not.  But it’s something we are all doing.  If you don’t want to, then perhaps another facility is a better place to be.  But it’s not anything you get a lawyer involved in.

Yeah, the more I think about this the more I realize I was being a little ridiculous. These patients aren’t that much different than what I see on med Surg so there isn’t a truly unsafe issue. It’s not like I’m blindly titrations cardizem bags with zero experience. Thanks for this input, it really helped me to see this more objectively. 

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 30 years experience. 9 Articles; 4,338 Posts

Where I work, there is a difference between Progressive Care Unit patients and Med-Surg patients with remote telemetry.  The PCU patients have the telemetry monitors in the unit and there is a person on staff designated to watch the monitor and alarms. Every nurse in the unit is trained to respond to the alarms accordingly as part of their annual skills training. 

In some of the Med-Surg units that are not considered PCU, the telemetry monitors are watched remotely in a central telemetry monitoring area off site.  Nurses don't have annual training in heart rhythms and is paged by the central telemetry monitor staff for any of the alarms.  Nurses then page providers or the Rapid Response RN for guidance on next step.

OP, is your question more along the lines of not having the appropriate training for rhythm interpretation and being asked to respond to in-unit telemetry monitor alarms?  Institutional policy should dictate whether nurses who aren't trained in specific skillsets should be assigned to patients that require those skills.    But yes, it is not a scope of practice issue.

Been there,done that, ASN, RN

Has 33 years experience. 6,898 Posts

Think I have been there, done that.  I held a position during my second year of nursing on a unit that had both med surg - patients and monitored post -open heart patients. I worked 6 months with a mixture of both...before I received telemetry training. I  learned who to go to when my patient's monitor alarmed.

 My question to you is.. can you interpret telemetry? If you know your basic dysrhythmias and the treatment, you and your patients should be safe. If you want to stay at that position, obtain your ACLS.

Best wishes.

 

Edited by Been there,done that