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

[la_chica_suerte85, BSN, RN]

Often the tele techs, who monitor the monitors, will notice a change, notify the RN who notifies the doc. If they need some sort of intervention, they get transferred to a higher level of care.

Working as an aide, we are normally alerted first to the change to go do the cursory check on the patient to make sure leads are in place and not being messed with. Often the RN is already in the room doing a procedure and has taken the leads off or is moving the patient and causing things to look funny. At my last job, I believe it was possible to be a monitor tech through certification but they weren't the ones reading the ones at the nurses' stations. They would work in a more intensive central monitoring station. The unit secretaries were the ones who would monitor the ones at the nurses' stations. No special training necessary as I understood it.

[RescueNinjaKy]

Working as an aide, we are normally alerted first to the change to go do the cursory check on the patient to make sure leads are in place and not being messed with. Often the RN is already in the room doing a procedure and has taken the leads off or is moving the patient and causing things to look funny. At my last job, I believe it was possible to be a monitor tech through certification but they weren't the ones reading the ones at the nurses' stations. They would work in a more intensive central monitoring station. The unit secretaries were the ones who would monitor the ones at the nurses' stations. No special training necessary as I understood it.

That strikes me as a tad unsafe. If there are issues with changes in rhythm, the techs notify me or another nurse. Sure there can be some artifact or leads coming off and those are fine to delegate to an aide to change the leads, but a change in rhythm is pretty different from just the leads looking crappy.

Also anyone who is trained as a tele tech is required to attend ekg interpretation classes and be oriented by a tele tech before they are allowed to work by themselves. I cannot imagine a unit secretary just hopping on and monitoring it without any training.

[txgal34]

My med-surg has LVN's and RN's. We have tele on both floors. While the acuity is higher on a tele pt, both RN's and LVN's get tele pt's and it doesn't change the amount of pt's we get. All nurses have PALS and ACLS. We also have a tele tech on the one floor to watch both floors. On our med-surg floor, only and ICU nurse can IV push cardiac (cardizem, etc) med and if they need a drip, they are sent to the unit.

[RescueNinjaKy]

My med-surg has LVN's and RN's. We have tele on both floors. While the acuity is higher on a tele pt, both RN's and LVN's get tele pt's and it doesn't change the amount of pt's we get. All nurses have PALS and ACLS. We also have a tele tech on the one floor to watch both floors. On our med-surg floor, only and ICU nurse can IV push cardiac (cardizem, etc) med and if they need a drip, they are sent to the unit.

That sounds excessive that only an icu nurse can push cardiac drugs on a telemetry floor. Your hospital doesn't have a step down or progressive floor? We push cardizem, lopressor, dig, all the time. We have amio drips, cardizem drips, and heparin drips too. We just can't have pressor drips. To get an icu nurse to push basic cardiac drugs seems like a lot of extra work and to send someone to the unit to have a drip seems like the unit is gonna be packed quickly.

[txgal34]

That sounds excessive that only an icu nurse can push cardiac drugs on a telemetry floor. Your hospital doesn't have a step down or progressive floor? We push cardizem, lopressor, dig, all the time. We have amio drips, cardizem drips, and heparin drips too. We just can't have pressor drips. To get an icu nurse to push basic cardiac drugs seems like a lot of extra work and to send someone to the unit to have a drip seems like the unit is gonna be packed quickly.

First, it is not a "tele only floor." They lump two floors... one is medical, one is surgical and if tele is ordered, tele box is on. On one floor our tele tech sits and watches the monitors which are for both floors. While this in not a rural hospital, it is on the outskirts of the city. We can do IV lopressor just not true cardiac IV meds like cardizem. actually IV cardizem and IV dig are the only two i have heard of that we call an ICU nurse to give....it is hospital policy. all drips (except heparin) go to the unit. no, we don't have a step down, they got rid of that a few years ago. when IV cardizem is pushed it has to be an ICU nurse and a crash cart there too. i can honestly say in the nearly 3 years i have been here i have had icu have to come up twice. IMHO, if they are sick enough to have a cardiac drip they have no business being on a true med-surg floor where you are taking 5-7 pt's.

[RescueNinjaKy]

First, it is not a "tele only floor." They lump two floors... one is medical, one is surgical and if tele is ordered, tele box is on. On one floor our tele tech sits and watches the monitors which are for both floors. While this in not a rural hospital, it is on the outskirts of the city. We can do IV lopressor just not true cardiac IV meds like cardizem. actually IV cardizem and IV dig are the only two i have heard of that we call an ICU nurse to give....it is hospital policy. all drips (except heparin) go to the unit. no, we don't have a step down, they got rid of that a few years ago. when IV cardizem is pushed it has to be an ICU nurse and a crash cart there too. i can honestly say in the nearly 3 years i have been here i have had icu have to come up twice. IMHO, if they are sick enough to have a cardiac drip they have no business being on a true med-surg floor where you are taking 5-7 pt's.

But it sounds awfully inefficient in patient flow to transfer a patient to icu just to have a cardizem or amiodarone drip, which is why I ask about the step down. I've had patients convert to afib rvr and they don't feel it at all. Just start them on amio gtt and some sort of anticoagulant and they're fine. They're still quite stable. I guess it's cuz I work cardiac but if everyone is going to icu for it, Wouldn't your icu be full all the time?

[txgal34]

But it sounds awfully inefficient in patient flow to transfer a patient to icu just to have a cardizem or amiodarone drip, which is why I ask about the step down. I've had patients convert to afib rvr and they don't feel it at all. Just start them on amio gtt and some sort of anticoagulant and they're fine. They're still quite stable. I guess it's cuz I work cardiac but if everyone is going to icu for it, Wouldn't your icu be full all the time?

this is my first hospital job...so this place is all i have to go on. we are med surg nurses, obviously trained, but not cardiac nurses....possibly why it is the way it is. i know larger hospitals that have a true "tele" only floor, we don't. we have icu and ccu. yes, acutally all floors here seem to stay quite full. if someone goes into NEW afib with RVR they are 90% of the time transferred to the unit. if it's not new onset, then usually not. as you probably would think...we do have a fair amount of transfers from med-surg to unit, then back again! not sure why policy is that way...but it is.