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

[NurseSpeedy, ADN, LPN, RN]

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

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. 

Whenever I was floated to units that had patients with some things I would need assistance with it was given to me. I was a Med/surg LPN and was floated all over the hospital-including ICU. I was willing to learn and was given the less severe patients, but was never expected to interpret a wonky ekg or titrate an unfamiliar drip. A qualified coworker would take care of that part and then I would monitor and do remaining care. I later went on for my RN and the same was implemented-speak up if you are uncomfortable and need assistance with a specific area of a patients care, but honestly there are a lot of patients on tele just as a precaution due to pre-existing history or thought that better safe than sorry. The majority of the patients I had on tele with Med surg probably could of done without it.

[Sour Lemon]

On 12/2/2020 at 8:33 PM, magellan said:

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. 

I've worked in Los Angeles and Orange County. I think you may be mistaking your hospital's policies, or even your personal beliefs, with actual laws.

Your reasoning is difficult to follow, to be honest.

[magellan]

52 minutes ago, Sour Lemon said:

I've worked in Los Angeles and Orange County. I think you may be mistaking your hospital's policies, or even your personal beliefs, with actual laws.

Your reasoning is difficult to follow, to be honest.

My explanation is so clear, vivid and substantiated. I even mentioned a hospital that I worked so people will believe my responses. You can verify if I'm just playing around. But I'm happy with my work as an RN and the patients that I served because our nursing practice is not chaotic but very organized.

[NurseSpeedy, ADN, LPN, RN]

On 12/2/2020 at 8:33 PM, magellan said:

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. 

I have never seen a patient in need of progressive care, tele, or Med surge placed in psych unit they are medically cleared and with a psych condition that would be transferred after medically cleared. If they are in L&D....well, then ...there better be a baby about to be born or there is no way they would be on that floor. But hey, I’m in Florida-we do a lot of crazy things but sick patients in psych willl never happen and L&D is strictly labor and delivery. I have worked in ICU units in one hospital that would be step down in another-when it comes to Med/surg, tele, progressive, and even ICU. Different hospitals have different levels of care that vary greatly where the patient is placed. When near capacity, beds are assigned sometimes based on, hey there’s a bed if an appropriate one isn’t available. It stinks but it’s reality.

[magellan]

Yes, if you've seen an overflow unit, all patient populations irregardless of status, you'll gonna get surprisingly shocked. Have you seen an overflow ICU patient placed in Med Surg unit, you'll gonna get drop your face. It happened to us before but because we placed high regards on our profession for patient safety, we fought hard of it. It never happened for so long already. We taught them and educated so they can be open minded and respect our critical thinking for patient safety. It's all about patient safety so they won't end up six feet below the ground.

 

[Nurse Beth, MSN]

In my hospital in California, the nurse patient ratio on the Tele floor is 1:4 and on the MedSurg floor, it's 1:5.

The competencies required of a Tele nurse are above and beyond those of a MedSurg nurse and include passing and maintaining annual basic arrhythmia competency, pacemaker recognition (capturing, sensing, trouble shooting), and current ACLS.

Tele patients are considered a higher level of acuity and different nursing skill sets are needed accordingly.

[RealNurseMom, BSN]

I don’t agree with above posters that state you don’t need additional training and that you should just accept tele assignments. If they are giving you tele patients they need to train you for telemetry. I worked med-surg prior at a previous job and wouldn’t have felt comfortable taking a tele patient. You need to know rhythms well and need to be able to interpret them otherwise you’ll need an EKG each time to translate the rhythm for you as you need to know if the monitor alarms are real or not and what they’re telling you. The hospital should provide you with a tele course prior to you taking a tele assignment.

[Dacatster, ADN]

So here are a few options ask for a day or two of orientation of tele patients. Also I suggest you get ACLS. Just because you are M/S doesn't mean that is necessary. It can make you more comfortable in dealing with emergent rhythms.

[magellan]

So as the PSYCHE, L&D, Acute Rehab, Clinic Nurses, Home Health, or of all RNs so we will be all comfortable handling Tele patients.

[Dacatster, ADN]

I have worked Acute Rehab and clinic, and OB, yes I am... but then again I worked ER too

[magellan]

You are Jack of All Trade, Master of All. What about Hemodialysis or ICU? What I'm saying is if you're comfortable doing things in one or some areas in nursing then the management should respect it. They should listen to us because that's the reason why we became nurses because we know what to do and much more, we know how to use critical thinking. If patients, doctors, management or any ancillary personnel won't listen to us, the next thing you'll know, the clients are already six feet below the ground.

[Dacatster, ADN]

Not a master of all, I know enough to be dangerous ??? yes, I did HD but left after a few weeks on orientation when I found out the company expected you to work 12 hrs, be on call 12 hrs afterwards once a week.... the on call almost guarantee at least half of the 12 hrs if not all. I refuse to work 24hrs and then drive home. Yes, I did work ICU too left that. I had to major surgeries so I can’t do floor nursing anymore