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
You should take an EKG class and work on learning basic rhythm interpretation. Make sure you are BLS proficient and what your role is in any cardiac emergency. Not all rhythm changes are an emergency. If the monitor tech notifies you of something that has the potential to go south, there are no doubt many people around you who are ACLS trained to intervene while you do what you DO know is in your scope of practice as an RN: vitals, assessment, call a code or RR, and calling the doctor.
The med/surg positions I've held all required floating to tele. To be honest, tele rhythms were never my strong point, and I always dreaded being floated there.
You have my sympathy, but I think you'll find more of the same if you leave this job for another. And they can certainly fire you, just as easily as you can quit.
What you are describing sounds more like medical telemetry than progressive care telemetry. Don't get too caught up on them being on telemetry, that's not necessarily what defines their nursing acuity.
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.
Maybe there is no "Tele Room" where a monitor tech watches the monitors at all times, which frees the nurse to go see the patient and verify VS, heart rate and rhythm via auscultation and checking pulses and any actual distress.
Not every Tele situation has a monitor tech on duty. I worked on a floor that had Tele and the nurses had to take turns watching the monitor. First, we had no specific EKG interpretation classes when we first started having monitored patients. Next, who has time to sit in front of a monitor for more than a very brief interlude?
Some nurses love Tele and are knowledgeable about numerous rhythms/arrhythmias, others not. If OP is only working 2 shifts per month and she is not learning EKG's, I understand her dis-ease at being assigned to Tele. Especially because she told them from the start that she was not comfortable with cardiac monitoring.
Knowing the basics is a lot different different than knowing the more complicated and unusual rhythms.
You should take an EKG class and work on learning basic rhythm interpretation. Make sure you are BLS proficient and what your role is in any cardiac emergency. Not all rhythm changes are an emergency. If the monitor tech notifies you of something that has the potential to go south, there are no doubt many people around you who are ACLS trained to intervene while you do what you DO know is in your scope of practice as an RN: vitals, assessment, call a code or RR, and calling the doctor.
no doubt, huh? You must work at Dreams Fulfilled Medical Center, LOL.
I think OP is perfectly justified in feeling she has been badly used, by both the job and by her employer.
OP, get the ACLS education so you will feel confident. Also, learn EKG backwards and forwards. Best wishes to you. You won't get any sympathy here on the Board or even any real comprehension of your work environment because lovinglife123 works in a different type setting and can't understand what you are trying to explain.
Actually, Kooky Korky, I've been working in CVICU for 42 years, working for the last 26 of those years in the same hospital. I'm not of the 'things don't go my way so I'll cut and run' mentality. If a nurse knows they are going to be exposed to an experience they know little about, it's up to them to dig in and learn about whatever it is they fear, and gain some confidence. A telemetry monitor is not a thing to fear.
I work for Banner in AZ. In all the hospitals I've worked at, med-surg nurses have always been assigned patients on remote telemetry. Never progressive care patients, but med-surg status with remote tele orders.
Thanks everyone. Just to clarify, I'm not talking about me having an issue with accepting patients who are on remote tele, that's pretty basic in med/surg. I'm saying, as a med surg nurse, I've been given PROGRESSIVE CARE patients but we've always used term "tele" and "progressive care" interchangeably.
This stemmed form me being informed that this was against the nursing practice act and you can get in a lot of trouble to caring for a progressive care patient as a med surg RN. In actuality, these patients aren't really that much different than what I'm used to.
I had a patient who was on a cardiac drip that I refused after report and they changed the nurse and they tried to give me a post op CABG patient and that was also stopped. So I was over reacting a little bit but I still think it was worth it to ask to get a conversation going.
For me, my question is answered. It's impossible to harm someone from asking a question, but it's possible if you don't . You should always feel safe and confident asking questions and if you're ever in a working environment where they look down on that, leave that place immediately.
Yeah I’ve always been under the impression that med surg nurses weren’t supposed to take a tele assignment. That’s why we just spent weeks and weeks upskilling med surg nurses to PCU, and PCU nurses to the ICU. I’m sorry. I would find that very frustrating especially when the answer isn’t readily available.
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
You could take some CEU classes of EKG interpretation yourself, to be more comfortable with the tele strips. We all learn new things, why not improve your understanding of heart rhythms?
I do not think floating medsurg to tele (progressive) unit is a big deal or out of scope of practice.
I worked on a med-surg floor for 9 years and the majority of our patients were tele. Most unnecessary, but the hospitalist would order it on EVERYONE. Drove me crazy. But it certainly wasn't out of my scope. Granted, our tele patients were monitored by a monitor tech who watched their rhythms and contacted us if something was wonky.
If you are worried, you could take a refresher on rhythms (I have always sucked at rhythms) to boost your confidence.
sevensonnets
975 Posts
You should take an EKG class and work on learning basic rhythm interpretation. Make sure you are BLS proficient and what your role is in any cardiac emergency. Not all rhythm changes are an emergency. If the monitor tech notifies you of something that has the potential to go south, there are no doubt many people around you who are ACLS trained to intervene while you do what you DO know is in your scope of practice as an RN: vitals, assessment, call a code or RR, and calling the doctor.