Med Surg nurse being given Tele Patients

[Morning Glory]

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

[OyWithThePoodles, RN]

I will also add, there were many times I was sent to the PCU or ICU to take patients. BUT. They didn't have drips or vents, usually walkie talkies that were simply waiting on a transfer to a lower level care floor. They didn't have anything going on that was actually out of my knowledge base (I wasn't trained on drips or vents). We were told that we could certainly take the patients as long as there wasn't anything that needed to be done that we hadn't been checked off on or trained to do.

[OUxPhys, BSN, RN]

Tele pt's are med/surg pt's unless they require a nurse who is ACLS certified. Then that usually requires a PCU/Stepdown or ICU nurse. I know the two places I have worked where there were MS tele floors the RNs were not ACLS certified. 

[magellan]

Its not all about EKG or reading the strip that separate the med surg nurse with that of a tele nurse. It comes with alot of highly specialized skills when taking care of tele patients like how to manage cardiac infusion drips (nitrol, Cardizem, levophed etc), external pacers, post heart cath, discontinuing cardiac sheath etc which she still have no knowledge about it.

[OUxPhys, BSN, RN]

1 hour ago, magellan said:

Its not all about EKG or reading the strip that separate the med surg nurse with that of a tele nurse. It comes with alot of highly specialized skills when taking care of tele patients like how to manage cardiac infusion drips (nitrol, Cardizem, levophed etc), external pacers, post heart cath, discontinuing cardiac sheath etc which she still have no knowledge about it.

This is true but pt's like this are on a step-down or PCU, not a MS floor. There are MS nurses who have tele pt's. Tele does not always indicate a need for PCU or step-down. 

[magellan]

11 minutes ago, OUxPhys said:

This is true but pt's like this are on a step-down or PCU, not a MS floor. There are MS nurses who have tele pt's. Tele does not always indicate a need for PCU or step-down. 

It should be a case to case basis then. If the nurse says that she's comfortable working with tele patients then let her/him handle them. If not, then let the other nurses take the tele cases so at the end of the day, they'll be effective in giving nursing care to our patients.

[Newishnurse1995]

There’s a difference between a progressive care patient and a tele patient. Not all tele patients are critical. May have A-fib, A-flutter, heart block etc. Like always, if something happens just call the doctor or call a rapid response if the patients condition deteriorates. If you need a refresher in rhythms, take an online class or watch Youtube. I read my old nursing books at times to refresh my memory if I’m unsure about something. You got it!

[JadedCPN, BSN, RN]

4 hours ago, magellan said:

It should be a case to case basis then. If the nurse says that she's comfortable working with tele patients then let her/him handle them. If not, then let the other nurses take the tele cases so at the end of the day, they'll be effective in giving nursing care to our patients.

That's not how it should work though, not just with tele patients. That's not how other nurses learn and grown their knowledge base either, but not taking care of specific patients. Plus what do you do on the day where none of the nurses there are comfortable taking care of tele? Everyone should get their fair share.

[magellan]

22 minutes ago, JadedCPN said:

That's not how it should work though, not just with tele patients. That's not how other nurses learn and grown their knowledge base either, but not taking care of specific patients. Plus what do you do on the day where none of the nurses there are comfortable taking care of tele? Everyone should get their fair share.

It's even illegal to mix med surg patients to that of tele, progressive, DOU, acute rehab and some times ICU patients in the first place. Here in CALIFORNIA, it's a NO NO to mix patients in one unit with different areas of care. It's just NO WAY JOSE. That's why we have a Manager or Supervisor to be on top of the Staffing and to make sure that even staffing issues has to be filled up or else, it's a safety issue I.e. patient's will be crashing, fall to the floor, develop decubitus,  cross contaminated etc. I'm practicing here in California and we don't have staffing issues anymore since the implementation of the nurse to patient ratio so we better take care of our patients effectively. I just feel sorry of other States when there is no law that exist which limits the number of nurses to take care of patients. It's just so SAD every time you sign in for work but there's so much to take care of patient that is beyond your comprehension and physical limits. However, I heard that before California implemented the nurse patient ratio law, it took about 15 years of fighting before it was legalized. It was more time to finalize the law for the healthcare than legalizing the recreational Marijuana.

[JadedCPN, BSN, RN]

3 minutes ago, magellan said:

It's even illegal to mix med surg patients to that of tele, progressive, DOU, acute rehab and some times ICU patients in the first place. Here in CALIFORNIA, it's a NO NO to mix patients in one unit with different areas of care. It's just NO WAY JOSE. That's why we have a Manager or Supervisor to be on top of the Staffing and to make sure that even staffing issues has to be filled up or else, it's a safety issue I.e. patient's will be crashing, fall to the floor, develop decubitus,  cross contaminated etc. I'm practicing here in California and we don't have staffing issues anymore since the implementation of the nurse to patient ratio so we better take care of our patients effectively.

I haven't worked in California so I can't speak on the legality of anything.

However, it is very possible that a patient can be on telemetry and still be med surg. That was the type of scenario I was referring to.

[magellan]

1 minute ago, JadedCPN said:

I haven't worked in California so I can't speak on the legality of anything.

However, it is very possible that a patient can be on telemetry and still be med surg. That was the type of scenario I was referring to.

It's no way Jose to mix patients with different levels of care. Before, it was allowed but it is not safe to mix ICU patients to that MED SURG UNIT as overflow, it's not happening that anymore. We almost do away of overflow units because, it's a mix up of different levels of care.  I love practicing nursing here in California because with nurse patient ratio, half of our issue in nursing practice is already solved. Nurse patient ratio is a guaranteed that 90% in our care, the patient will live.

[JadedCPN, BSN, RN]

26 minutes ago, magellan said:

It's no way Jose to mix patients with different levels of care. Before, it was allowed but it is not safe to mix ICU patients to that MED SURG UNIT as overflow, it's not happening that anymore. We almost do away of overflow units because, it's a mix up of different levels of care.  I love practicing nursing here in California because with nurse patient ratio, half of our issue in nursing practice is already solved. Nurse patient ratio is a guaranteed that 90% in our care, the patient will live.

I understand what you're saying. Again in the scenario OP is referring to and that I was referencing, it isn't a mixture of levels of care; its a med surg patient on telemetry.

I hear California is wonderful for adult world. Thankfully I've lived in pediatric world my whole life so have never had to worry about unsafe staffing ratios or 99%  of the issues related to adult nursing. 

[magellan]

8 minutes ago, JadedCPN said:

I understand what you're saying. Again in the scenario OP is referring to and that I was referencing, it isn't a mixture of levels of care; its a med surg patient on telemetry.

I hear California is wonderful for adult world. Thankfully I've lived in pediatric world my whole life so have never had to worry about unsafe staffing ratios or 99%  of the issues related to adult nursing. 

Thankfully too that at least you're just an effective nurse in your practice because our lives are really important. We only have one shot in our life and afterwards, it's a journey to an unknown.  As what I have said to my friends, I want to live forever because life is just so much fun. It can have bumps here and there but in general, life is still bountiful and beautiful for all of us.