patient acuity

[sistasoul]

Hi all,

I currently work on a telemetry floor as an LNA. I was told by my clinical instructor to start out on a med surge floor to get my skills up to par. I really liked my medsurge rotation and am planning to apply to the hospital I work at when I graduate in May '08'. Are the patients on a medsurge floor less acutely sick than on a telemetry floor? I am curious because sometimes our patients end up having to go to the ICU. I would not feel comfortable working on the telemetry unit as a new grad becuse every little pain is looked at as a potential MI and don't feel I have the basics under me yet to deal with such patients. The nurses seem stressed out on this floor also.

What is an "average" acuity level of patients on med-surge? Having a clinical on the floor does not really give you a picture of what a floor is actually like. Thank you in advance for any info.

[Daytonite, BSN, RN]

Thank god for the advice of your clinical instructor. I worked on a telemetry (stepdown) unit for 5 years. These units are very busy and not for newcomers to nursing. The pace can be very fast. Patients are either coming or going from or into the ICU. The patients are often unstable which is why they are on a telemetry unit. They are being watched and can go bad at any time. We had frequent Code Blues or situations that were very close to Code Blues.

You instructor was correct. You want to start out on a medical or surgical unit and build up your skills. Assessment and organizational skills are especially crucial. I never approved of any new grad working on a stepdown unit and the head nurse of our telemetry unit NEVER took on a new grad EVER. The First Year in Nursing Forum is full of threads of people who started as new grads on Stepdown and Telemetry units and have had horrible experiences with it.

[RN1989]

The patients on a medsurg floor may be just as ill and needing a lot of care even though they are not on tele. Tele is obviously going to have a cardiac slant to it though and you may have lots of gtts, vents, etc. depending on your hospital's definition of a tele unit. That being said, I would recommend medsurg first over tele so that you get good and comfortable with a large variety of diagnoses and treatments. When a pt is on tele, obviously you are looking at the cardiac component but if you aren't well versed in everything else you can miss things and have to play catch up with your pt's condition because you were so focused on the heart that you didn't think about all the other comorbidities.