Med Surg or Tele? How is it decided

[venousr3tuRN]

Hello AN! It's been a long while since I've been on here. Anyways, I finally was able to make the switch to my first acute position in a Med Surg/Tele unit after working in LTC for the past 2 years. I only got 3 days of orientation but I hit the ground running and absolutely love it. It's a new challenge everyday, but the support I have is incredible. Besides that point, I was wondering when they give out assignments, how is it chosen who gets Medical patients and who gets Tele that day? Some weeks I've been Medical and others I've been Tele. I notice that if we have LVNs on the floor, they'll automatically be Medical. I asked my charge nurse once but we were so busy there was no time to talk. It seems like it's chosen randomly at my place. How is it done at yours? Just wondering

[THELIVINGWORST, ASN, RN]

At my hospital there are no LPNs and there is virtually no difference in the assignment of medical vs tele pts

[venousr3tuRN]

I see. At my place they have standard ratios depending on Medical and Tele patients. So if you have all medical patients, you can have up to 5 patients. But if you have at least one Tele patient, you can only have 4. My unit always has at least 2 nurses take all medical.

[Nurse Leigh]

I'm still stuck on the part where you said you only got three (3!!) days of orientation. That just doesn't sound right.

I'm sure working in LTC gave you some great time mgmt and prioritizing skills but LTC and Med Surg are such totally different beasts (although I know LTCs are getting more acutely ill residents).

Is yours the only floor that takes tele patients?

[venousr3tuRN]

I thought it was too short as well, but my hospital is a very small community hospital and doesn't even have a new grad program to offer.

There's a second floor Med Surg that also takes Tele. They mostly have all the post-surgical and bariatrics patients.

[nursej22, MSN, RN]

I think some hospitalists think patients are more closely observed when they are on Tele, which is not necessarily true, especially if the patient won't leave the tele on, or there is so much artifact that they can't be read.

My last facility had an all RN staff; they ended up firing the few remaining LPNs who didn't leave through attrition. The medical tele and medical floor had the same ratios. The cardiac tele did as well, with few aides. Only OHS and CIWA got a lower ratio.

[CrazierThanYou]

At my last hospital, everyone was on tele. We made jokes about it regularly.

[AnthonyD]

I think some hospitalists think patients are more closely observed when they are on Tele, which is not necessarily true, especially if the patient won't leave the tele on, or there is so much artifact that they can't be read.

So true. In fact, sometimes they are observed less closely, due to the "I can see what they're doing on the monitor" mentality.

[Bob Loblaw]

Don't you have to be telemetry qualified/certified there along with ACLS, PALS, EKG experience to interpret the tele? I think we decide telemetry by:

1. Something real bad could happen real fast to this pt- tele yes

2. Patient is sick and I have no doubts that he will live through the day/night with standard care- tele no

[nursej22, MSN, RN]

Our med tele floor did not treat an arrhythmia; if that was needed, then they transferred to cardiac tele. So, the former manager decided that ACLS was not required. If they had an npo patient who required scheduled IV metoprolol, they had to be transferred to cardiac tele.

I have seen tele ordered because the patient was feverish and tachycardic, in atrial fibrillation and had been for years, CIWA (impossible to keep monitors on them), COPDers who needed continuous pulse oximetry that we couldn't do, and dying patients so we would know when they passed.

There were never enough beds on cardiac tele, so a good part of my shift was triaging people and convincing docs why a new admit needed a monitor more than someone waiting for a lap chole.

[Bob Loblaw]

I just have to ask, who interprets and acts on the cardiac information provided by telemetry? I didn't know telemetry RN's didn't need ACLS and EKG interpretation qualification, I would think that would be a key concept in the entire telemetry process. We remove our dying pt's from monitorring to allow a more quite and peaceful passing for the individual and family without all the alarms.

[RNdynamic]

3 days of orientation is terrible. I would not want to be taken care in a hospital by a nurse who was oriented only 3 days of acute care!!