"Universal Beds" Concept

[RN-PA, RN]

Administration at my hospital is planning to make us a "Universal Beds" hospital in a year or so. I work part-time on a med-surg unit, and the plans are to make more beds in the hospital telemetry-capable. On our 30-bed med-surg unit which has an oncology emphasis, we will have the capacity for 8 telemetry beds while our "sister" general med-surg unit will have an 18 bed capacity (out of 32 beds). We are all going to have to be cardiac monitor trained and ACLS certified as well as BLS certified. (On another note, I am also being sent to a mandatory 3-day course to learn chemotherapy administration the end of this year.)

Administration believes that the Universal Bed concept is much better for the patients and they've found that when a patient is transferred to another unit like telemetry, at least one day is added to their length of stay, so this should save the hospital money and be less of a disturbance for the patient and family to keep them in the same bed during their hospitalization. The staff has been told that their nurse to patient ratio will be reduced from 1:6 to 1:5. But my concern is that we have a LOT of part-time nurses and I'm wondering how we can be competent let alone proficient in reading monitors (and also administering chemotherapy on our unit) when we may possibly be assigned these patients infrequently? (If you don't use it, you lose it.)

I'd love to get feedback from anyone whose hospital has implemented this system or if they haven't, what you think about this concept. I would like to feel positive about all the changes, knowing that it sounds like they'll be better for the patients. But I'm feeling leary about all of this since, as a med-surg nurse, I often sort of feel like I'm a "Jack of all trades, master of none", and this is really threatening to make that feeling more pronounced. Also, I never was interested in telemetry; I just wanted to do med-surg, but it looks like those days will soon be in the past. (We're not even called med-surg anymore; we're now "Acute Care".)

[SmilingBluEyes]

Hmmmm I don't like the sound of that at all. Esp on the chemo part.....

Not just "anyone" should be doing chemo and other such tasks. But hey it's only my opinion.

and I would not hold my breath on that promise to reduce the nurse-patient-ratio. It's probably a way to keep the masses calm.

[stidget99]

My hospital is doing the same thing. We are a 29-bed med-surg unit with the emphasis on orthotics. What we have been told is this: an RN in the ICU will be responsible for reading the rhythm strips and that our only "responsibility" will be to follow through if one of our patients is having some type of an irregular rhythm. So, because of our "limited responsibility", our pt:nurse ration will be unchanged. However, I have a gut feeling that in due time, we will be responsible for all of it: cardiac drips, monitoring and reading the rhythm strips while still being responsible for 7-8 pts. Sounds awfully dangerous to me. Right now the pt:nurse ratio on the tele unit is 1:5 max. I wouldn't feel so nervous but our administration has told "untruths" in the past. Time to find another job.

[mdfog10]

You should go to your state's BRN to check out your state regs. I would be highly suspicious of "limited liablility" statements.

[lsyorke, RN]

Our hospital has telemetry on almost all floors. We have a central monitoring system that is staffed with 3 monitor techs at all times. It's really not a big deal for us. A "true" cardiac is put on the telemetry floor, but a stable cardiac can go anywhere in the hospital(ie. long term afib). The bottom line is that we really rely on the monitor techs(who are great!) for interpretation. Lets face it, if you don't interpret strips all the time, it's not something you retain. We have ALOT of patients that don't need telemetry, but are on it anyway.I would rather have an ortho patient on the ortho floor with telemetry than on the telemetry floor where the ortho experience is limited(as long as their cardiac stable)

We do an annual strip review, but are not required to be ACLS.

[RN-PA, RN]

Hmmmm I don't like the sound of that at all. Esp on the chemo part.....

Not just "anyone" should be doing chemo and other such tasks. But hey it's only my opinion.

and I would not hold my breath on that promise to reduce the nurse-patient-ratio. It's probably a way to keep the masses calm.

We're taking a 3-day course at a university hospital and then taking an exam to be able to administer chemo, so it should be safe; the problem is that we don't get a lot of inpatient chemotherapy patients-- Most are going to our outpatient infusion department. We generally care for patients with the after-effects of chemo: dehydration, neutropenia, anemia, etc. in addition to our med-surg patients. My concern is as I said before: If you don't use it, you lose it. If as a part-timer you get a chemotherapy or telemetry patient very infrequently, it's not easy to remember all you've been taught unless you practice it regularly.

As far as the nurse to patient ratio, management has already reduced the sister med-surg unit to a 5:1 ratio with one more aide than we have because they have a lot of isolation rooms and sometimes more of the higher acuity patients. (Trachs, occassional peritoneal dialysis, etc.) The problem lies in the staffing at the beginning of a shift. If you have been assigned 5-6 med-surg patients and an admission needs chemo or telemetry, I was told my co-workers will absorb one or two of my patients. So where is continuity and quality of care for those patients?

[SmilingBluEyes]

: So where is continuity and quality of care for those patients?

very good question. Keep on asking it.

[purplemania, BSN, RN]

I worked on a pedi unit that had telemetry for every bed. Sometimes we just attached the pulse ox, sometimes the whole thing. It was convenient to have the equipment available when needed. All nurses were RNs and PALS certified. We did not do much EKG interpretation though because it was not a tertiary hospital and pedi's are more apt to have respiratory problems. Not always, of course, but we did not routinely care for cardiac problems. I think competencies is a real issue and will have to be addressed.

[mommatrauma, RN]

The last hospital I worked at had a floor similar...It was med-surg/tele/oncology...assignments were acuity based for the most part...chemo patients were in one section on the floor and only chemo certified or onc nurses took those assignments...It worked very well actually and at times there were some issues, ie Chemo nurses couldn't care for patients with MRSA/VRE in case their Chemo patient was neutrapenic, so it may have taken a little shuffling around of nurses or assignments...but noone really seemed to mind...Worked well for us...we were a 57 bed unit...with 16 Telemetry capable beds....which could be anywhere, because it was a port telemetry unit that transmitted to "slave" monitors in the hallway and at the desk...ONC patients varied daily....and the rest were mostly post-ops with an occ med patient thrown in for good measure...

[PeachyOrthoRN, RN]

We also have tele on almost all floors. My floor which is mostly all orthopedic only takes stable ortho tele. It's so our ortho patients can stay on our floor. We also have a central tele station that gets monitored by atleast two tele techs and we have an arrythmia RN on every shift as well for back up. The unstable tele either go to the ICU/CCU or stepdown units. We can't give most IV push cardiac meds unless it's the ARN doing it and they are going to be transferred elsewhere.

[julieK]

The last hospital I worked at had a floor similar...It was med-surg/tele/oncology...assignments were acuity based for the most part...chemo patients were in one section on the floor and only chemo certified or onc nurses took those assignments...It worked very well actually and at times there were some issues, ie Chemo nurses couldn't care for patients with MRSA/VRE in case their Chemo patient was neutrapenic, so it may have taken a little shuffling around of nurses or assignments...but noone really seemed to mind...Worked well for us...we were a 57 bed unit...with 16 Telemetry capable beds....which could be anywhere, because it was a port telemetry unit that transmitted to "slave" monitors in the hallway and at the desk...ONC patients varied daily....and the rest were mostly post-ops with an occ med patient thrown in for good measure...

I'm an ONC nurse and take care of neutropenics and contact patients together in one day all the time. Sometimes it's the same patient! Makes me wonder how safe that is. We do universal precautions and gown and gloves for contact isolation, but still....

Anyway, re: the tele patients, we have every bed in the hospital as a tele bed and there's a big room in another building that is monitoring every tele patient in the hospital. Like someone else has already said, it's not that big a deal b/c it's not like you're sitting in front of the monitor all day. How could you? You rely on the techs to tell you what's what.

In terms of the chemo, I work on a chemo floor and give it often, and I still need help every time I do it. I never give it without consulting with either the chemo nurse (with 35 years experience), our charge nurse, or our clinical nurse specialist. There are many considerations and a lot to remember, not to mention patient education. Good luck!

-Julie in NYC

[RN-PA, RN]

Anyway, re: the tele patients, we have every bed in the hospital as a tele bed and there's a big room in another building that is monitoring every tele patient in the hospital. Like someone else has already said, it's not that big a deal b/c it's not like you're sitting in front of the monitor all day. How could you? You rely on the techs to tell you what's what.

In terms of the chemo, I work on a chemo floor and give it often, and I still need help every time I do it. I never give it without consulting with either the chemo nurse (with 35 years experience), our charge nurse, or our clinical nurse specialist. There are many considerations and a lot to remember, not to mention patient education. Good luck!

You and some others have mentioned monitor techs, but as far as I've heard, we won't be using them. It seems like it'll be tough to keep an eye/ear on monitors while I'm running around (as usual) caring for a variety of patients.

Also, you're very fortunate to have such great resources for chemo. Unfortunately, we don't use charge nurses and on 3-11 shift which I work, any nurse educators are often not available. We have a few nurses who are already experienced in chemo, but they all work part-time and you never know if you'll be working with them or not.

*SIGH* :stone As I think about all this and read the responses, I can feel a long letter to management starting to formulate which would voice all the concerns mentioned here.................