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

[EllaBella1, BSN]

Honestly, I didn't read through all of these responses. I did however, read bits and pieces, and while I agree that it isn't a scope of practice issue, I do think it's an issue. You need to be trained or receive orientation on tele patients. As a med-surg nurse, would you know to check QTc before giving Tikosyn, for example? My guess is probably not. You will have someone else watching your tele monitors who will be able to alert you to changes in rhythm or potential problems, but you would still need to have the clinical insight to know when to check your tele. That said, I don't think it would take much training or orientation to get you up to speed, and I think it says something that your floor feels comfortable and confident in floating you to a higher level of care. 

[Katie82, RN]

I agree that under normal conditions, this would not be considered beyond your scope of practice. As a RN, you should be able to handle telemetry. I did. The last hospital where I worked Med/Surg pulled me to Telemetry all the time. The big deal with telemetry is that it is a step-down from the ICU, but still considered a "specialty" floor, so it is usually a big money-maker for the hospital. I hated Telemetry, there were always so many patients who did not need to be there, they were just generating revenue. The staff always felt sorry for me, and gave me the easiest patients. I never told them that the reason I hated floating was because I thought it was incredibly boring, had nothing to do with feeling out of my level of expertise. 

But your problem is compounded by the fact that you are working at so many different hospitals. Don't think I would feel comfortable either. 

[KalipsoRed21, BSN, RN]

Scope of practice describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency.

Let’s be clear here. Any nurse taking telemetry patients regardless of this stupid excuse of “My hospital makes me take tele patients all the time. If I can do it so can you.” is in fact practicing out side of their scope of practice if they have not received formal education on how to read EKGs. If the nurse has taken and passed an EKG course, then they are not practicing outside their scope of practice. There is no gray line here. Doesn’t sound like the OP has received EKG education, thus taking tele patients is outside the scope of her practice. If any other responder is floating from a med Surg unit to tele and being asked to monitor “stable” EKG patients, and they accept this assignment, they are practicing outside the scope of their practice. If you are Med Surg nurse and you need to float to tele “to take the easy patients” then I would suggest you tell your employer you are happy to go to the tele unit to watch Med Surg patients than cannot be moved to your floor due to space issues. And you are only willing to do it if they get an order for those patients to be taken off of tele first.  The only other acceptable way to take them is to under go a basic EKG course. Basically if you are not ACLS certified, you are not qualified to take care of tele patients.