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

[Kooky Korky, BSN, RN]

5 hours 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.

Every one should get his/her fair share of pts they don't know how to care for? 

This defines Nursing today.  You must be a Manager.

[JadedCPN, BSN, RN]

27 minutes ago, Kooky Korky said:

Every one should get his/her fair share of pts they don't know how to care for? 

This defines Nursing today.  You must be a Manager.

Not at all, I’ve never been management in my 14 years, always bedside.

But I’ve also been that nurse who always has to care for the tele patient, or the spinal fusion patient, or the “harder” patients because other nurses “aren’t comfortable” with them and at the end of the day it’s just not fair. The only way you can get comfortable with something is to learn it. And yes, some coworkers use the “I’m not comfortable” excuse to purposely get out of taking care of certain patients.

ETA there’s a huge difference in not being comfortable, and not being safe. Of course safe care should always be top priority. 

[renatanada]

Many times MDs put patients on tele as a CYA. And it will be a  nurse thrown under the bus if something goes astray. I work in a PCU. We have tele patients but there are no monitors in patient rooms. There is a central tele monitoring staffed by NON-NURSES. Sure, we nurses are trained to read strips and we have ACLS. But this is a ludicrous expectation when there is no monitor in the room, no nurse looking at the monitor in the central tele, AND WE HAVE 5-6 PATIENTS (ahem, ICU nurses). It's a money-saver for hospitals to cross-train nurses in everything. But make no mistake, the nurse will be blamed if anything goes wrong. So start studying strips and cross your fingers (and get out of acute care asap).

[CardiTeleRN, BSN]

Telemetry monitoring is actually a class that is taught and a test is given after the course. You should have been given the material needed to become comfortable with identifying various rhythms etc. You should also be able to ask someone to verify a rhythm you’ve identified if you’re not sure. I can understand why you may not be comfortable if 1) they didn’t provide the course. 2) you weren’t expecting to work with telemetry. It IS actually additional training. 

[CardiTeleRN, BSN]

On 12/1/2020 at 9:20 PM, JadedCPN said:

Not at all, I’ve never been management in my 14 years, always bedside.

But I’ve also been that nurse who always has to care for the tele patient, or the spinal fusion patient, or the “harder” patients because other nurses “aren’t comfortable” with them and at the end of the day it’s just not fair. The only way you can get comfortable with something is to learn it. And yes, some coworkers use the “I’m not comfortable” excuse to purposely get out of taking care of certain patients.

ETA there’s a huge difference in not being comfortable, and not being safe. Of course safe care should always be top priority. 

Is it really an excuse or is it them being honest about their level of knowledge and ability to care for a specific patient? At the end of the day, sometimes it’s not about “fair”, it’s about patient safety. Not forcing the hands of nurses. Instead chastising, maybe use that opportunity to provide education and insight. Show compassion. 

Nursing is becoming a joke. Sigh

[Nurse DeAnne, BSN, RN]

On 11/30/2020 at 2:17 PM, Morning Glory said:

To help you clarify, please review your state's Nurse Practice Act and you will understand Scope of Practice, what it is and what it is not.

 

[Corey Narry, MSN, RN, NP]

5 hours ago, renatanada said:

Many times MDs put patients on tele as a CYA. 

Well, yes and no.  There are specific AHA Practice Standards for which patients with cardiac conditions need telemetry monitoring and as in any other standard, indications are classified into "must have" and "maybe would benefit"

...https://www.ahajournals.org/doi/full/10.1161/01.CIR.0000145144.56673.59. 

Unfortunately, in patients who are admitted as a non-cardiac medical or surgical patient, there is no clear consensus so providers do randomly order telemetry as a way to reassure themselves that the patient is monitored and problems get caught before they get worse. 

Telemetry is overused and part of it may be due to the fact that ordering telemetry is a way to generate revenue for the hospital...it's an additional charge for the hospital stay (which RN's who are tasked with watching yet don't always get directly credited in terms of payment or salary increase).  A study we did at our academic institution for non-cardiac Medicine patients did show how overused telemetry is

...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3851315/.

[Nurse DeAnne, BSN, RN]

Juan de la Cruz, thank you for a fantastic post!  

 

DeAnne

[magellan]

The hospital should separate different levels of care because some areas need specialized of care. Here in California if its Med Surg unit, all the patients will be Med Surg. There will be no TELE, DOU, step down and much more overflow ICU patients. Acoordingly, we have a nurse patient ratio for SAFETY ISSUE. Being safe in our practice will save so much lives. Other States should be doing this already especially this pandemic. It's no brainer.

[Sour Lemon]

On 12/1/2020 at 1:06 PM, 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 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.

It's hard to tell, but are you saying that patients on a single unit can't be mixed tele with non-tele? Or are you speaking of a "higher" level of tele?

Where I work now, our tele and med surg were combined for a while due to covid-related low census. The hospital I worked at prior also combined patients on telemetry monitoring with non-monitored patients. My understanding is that tele ratios must be followed if a nurse has any tele patients ...but not that a nurse can't care for med/surg and tele patients simultaneously.

I am also in California.

 

[magellan]

On 12/2/2020 at 7:53 PM, Sour Lemon said:

It's hard to tell, but are you saying that patients on a single unit can't be mixed tele with non-tele? Or are you speaking of a "higher" level of tele?

Where I work now, our tele and med surg were combined for a while due to covid-related low census. The hospital I worked at prior also combined patients on telemetry monitoring with non-monitored patients. My understanding is that tele ratios must be followed if a nurse has any tele patients ...but not that a nurse can't care for med/surg and tele patients simultaneously.

I am also in California.

No way Jose that areas of specialty will be mixed with different areas. Have you been to overflow units before where everything is mixed up from Med Surg, Tele, Psyche, DOU, L and D or ICU patients and RNs wouldn't want to work there because of it's unorganized way of dealing with nursing care. Like if you have an ICU patients that needs a Levophed drip,  you have to run to the main ICU floor to grab the stocked drip that is suppose to be given to the patient. The next thing you know, the patient is already six feet below the ground when you get back to him.  When they are in their particular units, all the stock pile needed will be there too. It's not just about the learning curve of the nurses or the nurse's compliance mode is the real big concern, it's all about safety. We want always to be safe so that these patients will have a great shot of being treated and be discharged back to their home base, not to the Mortuary or funeral parlor. It had happened several times before.  

[magellan]

On 12/2/2020 at 7:53 PM, Sour Lemon said:

It's hard to tell, but are you saying that patients on a single unit can't be mixed tele with non-tele? Or are you speaking of a "higher" level of tele?

Where I work now, our tele and med surg were combined for a while due to covid-related low census. The hospital I worked at prior also combined patients on telemetry monitoring with non-monitored patients. My understanding is that tele ratios must be followed if a nurse has any tele patients ...but not that a nurse can't care for med/surg and tele patients simultaneously.

I am also in California.

Have you been to Gardena Memorial Hospital in Los Angeles, California to work. This hospital is just an example but all of these hospitals here in LA have followed to what is appropriate. If the patients are downgraded from tele to Med Surg, within an hour the patient will be transferred to a Med Surg unit no matter what condition they are in. The doctors will gonna get mad if their orders are not met.  I'm a registry nurse here in Los Angeles area and I would say that transferring and placing patient to their correct areas of specialized care are met to all Hospitals here with the nurse patient ratio. So how could I complain more. But I'm just putting in information so you'll get the base line.

From the word itself, when it is Med Surg it should be Med Surg patient, if it's Progressive Unit, patient should be considered Progressive with their condition, not to be placed on a Psyche or L and D units etc. Do I make any sense at all? Or did you answer the priority question in NCLEX questions about placing a Med Surg patient to a particular room or unit.  Maybe you could have answered placing a Med Surg patient to a Psyche unit. It's really a big time concern if this situations are mixed up and what's more if it still happening today. They should listen to us as an RN because that's the reason why we become RNs, it is we know what to do or else, the next thing you'll know if they don't listen to us, the patient is six feet below the ground already. 

Have you been to Gardena Memorial Hospital in Los Angeles, California to work. This hospital is just an example but all of these hospitals here in LA have followed to what is appropriate. If the patients are downgraded from tele to Med Surg, within an hour the patient will be transferred to a Med Surg unit no matter what condition they are in. The doctors will gonna get mad if their orders are not met.  I'm a registry nurse here in Los Angeles area and I would say that transferring and placing patient to their correct areas of specialized care are met to all Hospitals here with the nurse patient ratio. So how could I complain more. But I'm just putting in information so you'll get the base line.

From the word itself, when it is Med Surg it should be Med Surg patient, if it's Progressive Unit, patient should be considered Progressive with their condition, not to be placed on a Psyche or L and D units etc. Do I make any sense at all? Or did you answer the priority question in NCLEX questions about placing a Med Surg patient to a particular room or unit.  Maybe you could have answered placing a Med Surg patient to a Psyche unit. It's really a big time concern if this situations are mixed up and what's more if it still happening today. They should listen to us as an RN because that's the reason why we become RNs, it is we know what to do or else, the next thing you'll know if they don't listen to us, the patient is six feet below the ground already.