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

[magellan]

On 12/3/2020 at 11:55 PM, Dacatster said:

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 

How come you become dangerous in the practice when you are Jack of All Trade meaning you know everything?

[anewsns]

I would just take a basic rhythm interpretation class. The cardiac monitor really isn’t that big of a deal 

[Dacatster, ADN]

3 hours ago, magellan said:

How come you become dangerous in the practice when you are Jack of All Trade meaning you know everything?

I know what “Jack of all Trades “ means. I was being funny, hence the emoji..... btw not sure if you are, but I never claimed to “ Know everything”

[magellan]

You're not funny but you're so serious.

[Dacatster, ADN]

1 hour ago, magellan said:

You're not funny but you're so serious.

???

[Animal House R.N., ADN, CNA, LVN]

I understand your worry. I have the same issue and worry. I have worked many non monitored pods to a monitor pod. Good luck with everything. 

[KalipsoRed21, BSN, RN]

On 11/30/2020 at 12:35 PM, 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.

Okay I’m about to get real snarky here. The whole argument that ‘an RN is an RN is an RN’ makes me feel like you and anyone who follows that sentiment is either super new, has no experience outside their one facility and floor, or just down right sticking their head in the sand.  Actually I would have to say this line of thought is just down right idiotic and unsafe. 
 

Of course an ICU nurse is going to feel comfortable with floating to a floor with lesser acuity. And it’s great your facility requires ecg refreshers.  But, sweetheart, not all floors/hospitals require med surg nurses to have tele training. You have to know how to interpret an EKG well before you can monitor an EKG for concerns. Furthermore, this silly line of thought that an RN is an RN regardless experience is how people get killed. 
 

That line of thought is how I got a job working in a pediatric ER (I had only had adult cardiac experience and no pediatric training even in orientation) and ended up with a near miss on a 4 year old who didn’t look like he was struggling to breath to me and a sat of 93% on an adult isn’t terrible if they have congestion so I stuck that little babe back in the waiting room long enough that he had to be intubated. RN is an RN is ***. Training for specialties is necessary and should be provided by the employer. Needless to say I quit that job and went to an ER where I got adequately trained. 

Different scenario. Was working home health and had a work buddy (who’s main experience was pediatrics) who called and told me how she had a man rushed to the hospital because his heart beat was irregular (she had never had a patient with A-fib.) So there was a wasted ER trip and treatment then hospitalization because the EMS bolused him with fluids for low BP 90s/50s and thus sent him in to fluid overload. He lived in the 90s/50s and anyone with adult cardiac experience would have been able to put that together....but not a peds nurse who never had a patient in A-fib and on beta blockers before. 
  Yes, nurses with higher acuity training (ER/ICU) will find it easier to go to a decreased acuity unit and not feel like they might miss something important. It doesn’t go in reverse though, and it does not cross over to pediatric or adults depending on which age range you normally do ER/ICU for. 

To the OP. You will either need to decide to learn tele or quit it sounds like. There is a great game on the internet called ‘ Free ECG simulator’ by skillstat. And the best book out there is Rapid EKG Interpretation by D. Dubin. But if you don’t care to expand your skill set, the you should probably not put yourself at risk. Either way do what is best for your sanity and I wholly support you in just wanting to stick with your specialty if that is what you decide. Good Luck!

 

[KalipsoRed21, BSN, RN]

On 11/30/2020 at 1:28 PM, 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.

Wrong, wrong, wrong. Your one facility, child, is not every facility. The OP is asking the right questions. If a nurse accepts a tele patient they have to be able to interpret concerning EKGs. Some med/Surg units have tele, some don’t take any tele. Even with a tele tech reading the ECG for you it is still the RNs responsibility to be able to anticipate the course of action for changes in telemetry. You, LovingLife123, are just down right scary. Of course you are uncomfortable going from your specialty to another specialty, but you are going from high acuity to a lower acuity. It is a whole different can of beans when someone’s main experience is a lesser acuity floor and they are asked to go up in acuity. 
Furthermore, one does not need certification to be in a specialty. Basically a years worth of experience on any floor will make that floor your work ‘specialty’. If you leave that kind of floor for more than a year you would be considered familiar with that speciality but your current experience would be what you specialize in. 
For this reason, most agencies do not send nurses to assignments on floors that they haven’t worked in over a year. So even though I have ER, Med/Surg, and Tele experience, since I’ve only done home health for the last 3 years they would only send me to home health jobs.

   Finally, if you actually read the OP’s question, you would realize that she does not have tele experience and took a job where she was told she would not have to work outside of her experience. So by asking her to take higher acuity patients than she is familiar with, without offering to properly train her, they are taking a risk with her license. Her head would be the one on the poker for accepting patients outside of her scope of practice. She certainly can increase her scope of practice by taking the appropriate education, but what the facility is asking her to do is unacceptable and she should probably report them to JACHO or something.

[KalipsoRed21, BSN, RN]

On 12/2/2020 at 8:35 AM, CardiTeleRN said:

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

Not to mention that JadeRN is choosing to take the risk with her license by taking patients she is unfamiliar with how to care for and “just doing it”.  It’s not that there isn’t some truth to the point that experience with things one is uncomfortable with is needed to get comfortable with it....but education PRIOR to taking those patients and a good ON SITE resource is needed for a nurse to do that. If those two things aren’t met then the nurse SHOULD say no. Facilities aren’t out to protect you...you have to put your foot down yourself.

[LovingLife123]

7 hours ago, KalipsoRed21 said:

Wrong, wrong, wrong. Your one facility, child, is not every facility. The OP is asking the right questions. If a nurse accepts a tele patient they have to be able to interpret concerning EKGs. Some med/Surg units have tele, some don’t take any tele. Even with a tele tech reading the ECG for you it is still the RNs responsibility to be able to anticipate the course of action for changes in telemetry. You, LovingLife123, are just down right scary. Of course you are uncomfortable going from your specialty to another specialty, but you are going from high acuity to a lower acuity. It is a whole different can of beans when someone’s main experience is a lesser acuity floor and they are asked to go up in acuity. 
Furthermore, one does not need certification to be in a specialty. Basically a years worth of experience on any floor will make that floor your work ‘specialty’. If you leave that kind of floor for more than a year you would be considered familiar with that speciality but your current experience would be what you specialize in. 
For this reason, most agencies do not send nurses to assignments on floors that they haven’t worked in over a year. So even though I have ER, Med/Surg, and Tele experience, since I’ve only done home health for the last 3 years they would only send me to home health jobs.

   Finally, if you actually read the OP’s question, you would realize that she does not have tele experience and took a job where she was told she would not have to work outside of her experience. So by asking her to take higher acuity patients than she is familiar with, without offering to properly train her, they are taking a risk with her license. Her head would be the one on the poker for accepting patients outside of her scope of practice. She certainly can increase her scope of practice by taking the appropriate education, but what the facility is asking her to do is unacceptable and she should probably report them to JACHO or something.

No, you are absolutely wrong here.  I think you are misunderstanding what the Op asked.  Many people did.  She asked about her license.  Her license.  Floating to another unit, while uncomfortable, and can be dangerous depending on the situation, is not out of scope of practice.  It’s not.  Nor is it illegal.  
 

As I stated, certain specialties require certain certifications.  But, if a nurse floated to our unit, then can care for the patient without the certification.  It’s not out of the scope of practice.  My hospital would get cited by JAHCO.  But again JAHCO, is a credentialing agency, not law.  
 

Scope of practice is set by the BON of each state.  You should familiarize yourself with scopes of practice for your state.

The OP stated a page in that she understood and that she felt she had overreacted.  I simply explained answered her question.  

[JadedCPN, BSN, RN]

8 hours ago, KalipsoRed21 said:

Not to mention that JadeRN is choosing to take the risk with her license by taking patients she is unfamiliar with how to care for and “just doing it”.  It’s not that there isn’t some truth to the point that experience with things one is uncomfortable with is needed to get comfortable with it....but education PRIOR to taking those patients and a good ON SITE resource is needed for a nurse to do that. If those two things aren’t met then the nurse SHOULD say no. Facilities aren’t out to protect you...you have to put your foot down yourself.

I'm not jeopardizing my license, nor am I advocating for anyone else to either. My point is that there is a different between not being comfortable with a type of patient, and not being safe. A huge difference. 

Of course you shouldn't provide unsafe care. And if you aren't comfortable with a particular type of patient, absolutely advocate for yourself by asking questions, getting training, and finding resources. But just because you have never taken care of, for instance, a post op cholecystectomy, doesn't mean it is not safe to take care of them; and it would be extremely unrealistic to have nurses take care of diagnoses that they've only ever experienced previously or came across in orientation. That is my point.

[magellan]

Then, all nurses irregardless of specialty areas like Psyche, L and D, Home Health, infusion Nurse, Easthetic Nurse etc should know how to take care TELE patients. That's why we have different areas of specialty so that not all different populations of patient will be mixed up and hard to do the planning and the course of actions.