"Universal Beds" Concept

[RN-PA]

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".)

[fotografe]

Can someone tell me what monitor/tele techs are and how they are trained?

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.................

[RN-PA, RN]

Can someone tell me what monitor/tele techs are and how they are trained?

Good question-- I have no idea and hope someone will answer. I have a friend who used to work with us as a Unit Clerk with no background or training in the medical field and she's now a Unit Clerk/Monitor Tech at another hospital. I can't really imagine how Monitor Techs do their jobs and what it must be like to be staring at a bunch of screens for hours.

[live4today, 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.

Ditto! Doesn't sound like a good plan to me either. :uhoh21:

[mommatrauma, RN]

I don't get this whole tele tech monitor reader business....I have worked places that have them..but...sorry if my patients on the monitor...I want to look at it...if my patients on a cardiazem gtt...I want to be able to look at the monitor and see how their hr is doing...I don't want to have to walk to the end of a hallway and look at a bunch of rhythms every time I need to check how my patients rhythm is...I don't want to have to call to a monitoring station to "see how my patient is" As a tele nurse I think you should be able to recognize and treat any rhythm...its ACLS...its not brain surgery....If you don't do it, you lose your skills, and I am just not comfortable enough with relying on someone else who's eyes are crossed because they are watching 30 rhythms going across the screens...tell me when my patient is having rhythm disturbances...I like to be responsible for my own patients...call me a control freak, but whatever...my patient, my rhythms...just my opinion.

[TiffyRN, BSN, PhD]

I've worked 5 different tele units, only one had the monitors remote from the nurses desk. All the tele units I worked for had monitor techs but of course the RN was responsible for the verifying the rhythm and any good nurse would regularly scan the monitors for his/her patient's rhythms. The MT's usually have only OJT with generally about 6 weeks training that sometimes included a formal classroom training on strip interpretation.

As far as universal beds, I know I have wished we had monitoring with remote stations for some patients. We often had transfers to telemetry for very stable cardiac patients that were in the hospital for orthopedic or oncology issues. This often required chest pain/arrythmia patients to be held over in ER or admitted to ICU (when ICU not required) because our tele beds stayed so packed. Often MD's would admit anything to tele so they could be more closely monitored saying basically if the patient started to die we would at least see it on the monitor (only reason they could come up with for admitting 96 yo DNR with a GI bleed).

I guess I a little biased because for years I worked a float pool based out of telemetry so I floated all med/surg areas and was knowledgeable in ortho/neuro/medical/surgical/oncology plus well versed in cardiac and ACLS certified. I was no specialist in any area except cardiac but I didn't hang chemo or set up traction. There were resources available to me though. I'm not sure I would have liked the "universal" bed concept though having "universal" monitoring would have been nice.

[zacarias, ASN, RN]

I think it's absolutely critical to have monitor techs. They are great!! They monitor and can alert nurses quickly if there's a rhythm change or something really bad. A nurse could have a patient who is on the other end of the unit that goes into symptomatic bradycardia and how is the nurse gonna know unless you have monitor techs.

If you have a monitor tech, it's not like you are gonna lose your cardiac arrhythmia skills. You will still look at the rhythms quite often as you walk by the nurses station. Plus, you are the one who will have to administer meds, call doctor, and/or implement the correct protocol.

Monitor techs are generally CNAs that have taken an EKG class (usually four or five whole days) and passed a test. They then sit with current monitor techs and learn the practical role for a few days before they are on their own watching the monitors.

[pickledpepperRN]

I think it is unsafe to have a nurse (like me) suddenly asked to take a class and administer chemotherapy without experience.

I also think it unsafe to have nurses assigned to patients requiring cardiac monitoring who don't even have ACLS.

Someone trained and competent needs to observe the rhythms at all times.

The RN responsible needs to interpret the strip and observe the monitor often, it goes with ongoing assessment of the patient.

The nurses need to hear alarms and visualizt their patients rhythm.

Staffing needs to be according to the needs of each individual patient, not the census.

Sounds like a cost cutting sceme to me. Write that letter, get your colleagues to sign it, and collectively advocate for your patients (and your license).

[nursemary9, BSN, RN]

Hi

I work on a 34 bed Med/Surg/Onc. unit. I am OCN Certified & from all three shifts, I am the only OCN certified Nurse. We do have Hospital Chemo certified nurses on all three shifts, tho.

We get all the Peritoneal dialysis patients also, plus LOTS of Isolation pt's because we have 15 private rooms.

I work only nite shift. Our ratio is 1:7!! Sometimes this is just too many patients, esp. with admissions.

Last week we heard that they are now thinking that instead of having insulin drips on monitered beds, they should have them down here!! We said. our staffing isn't good enough for that. They really don't care about our opinion, tho.

I really hope if they do this they will adjust our ratio.

Mary Ann

[RoxanRN]

Our entire hospital (450+ beds) is telemetry capable. We have a primary cardiac floor (post CABG, ablations, new on-set cardiac [after they've been to the CCU], etc) and a med/surg floor where cardiac is playing a large part in the patient admission (but not primary). With the exception of the primary cardiac floor (they have their own MTs) and 6 out of the 7 ICUs (MT costs/personal are shared), all tele is watched by Rhythm Central (they watch CVICU). They are located such (adjacent to the CVICU) that if they have a strip they can't figure out (which is extremely rare), they have immediate access to an RN. The med/surg tele floor also has monitors so the RNs can see the rhythms without having to call RC. Obviously, the ICUs have monitors in each patient room and the RN can ID the rhythm on their own with the MT constantly watching for abnormal stuff.

Can someone tell me what monitor/tele techs are and how they are trained?

I was originally hired at a MT. Because I am an EMT-P, I was only required to pass/CLEP the test. All others are required to take "Essentials of Cardiac Monitoring" and pass the test. They then spend several weeks with a preceptor before sitting at the monitors on their own.

[mommatrauma, RN]

I think it's absolutely critical to have monitor techs. They are great!! They monitor and can alert nurses quickly if there's a rhythm change or something really bad. A nurse could have a patient who is on the other end of the unit that goes into symptomatic bradycardia and how is the nurse gonna know unless you have monitor techs.

If you have a monitor tech, it's not like you are gonna lose your cardiac arrhythmia skills. You will still look at the rhythms quite often as you walk by the nurses station. Plus, you are the one who will have to administer meds, call doctor, and/or implement the correct protocol.

Monitor techs are generally CNAs that have taken an EKG class (usually four or five whole days) and passed a test. They then sit with current monitor techs and learn the practical role for a few days before they are on their own watching the monitors.

I don't agree...I think it makes a nurse lazy...oh, the tech will call me if there is a problem, no need for me to worry about checking the monitor...I'm too busy...I can hear it now. And I agree, you are the one who has to administer the meds, call the doctor, and or implement the correct protocol...so you should be the one monitoring the rhythms that you are treating...and four or five whole days, certainly doesn't make anyone an expert on reading monitors...And that's why they have slave monitors for floors that don't have techs...Its a monitor that is placed every couple rooms, or in certain spots in the hallway that alarm and the nurses station, or nurses carry those little beepers, so that they can be alerted when something is going on with their patient even when they are down the hall. The monitor tech is only going to tell you that the patient is bradycardic...they aren't going to be able to tell you your patient is symptomatic from the desk they are sitting at, you're still going to have to go in and check the patient yourself. Like I said, its just my opinion. I like to be in control of monitoring my own patient's rhythms.

[BGSRN]

I think it's absolutely critical to have monitor techs. They are great!! They monitor and can alert nurses quickly if there's a rhythm change or something really bad. A nurse could have a patient who is on the other end of the unit that goes into symptomatic bradycardia and how is the nurse gonna know unless you have monitor techs.

Where does the accountabilty and responsibility for the patient lie w/monitor techs? If they do not recognize or alert you to a problem and harm is done (I read a case a long time ago about a dead battery and the battery was not replaced for one reason or another and the patient subsequently was found dead by her husband). It would seem that similar to clinical aides that the nurse is responsible for the pt and harm done by a problem r/t monitoring.

Any insight?

[lsyorke, RN]

I don't agree...I think it makes a nurse lazy...oh, the tech will call me if there is a problem, no need for me to worry about checking the monitor...I'm too busy...I can hear it now. And I agree, you are the one who has to administer the meds, call the doctor, and or implement the correct protocol...so you should be the one monitoring the rhythms that you are treating...and four or five whole days, certainly doesn't make anyone an expert on reading monitors...And that's why they have slave monitors for floors that don't have techs...Its a monitor that is placed every couple rooms, or in certain spots in the hallway that alarm and the nurses station, or nurses carry those little beepers, so that they can be alerted when something is going on with their patient even when they are down the hall. The monitor tech is only going to tell you that the patient is bradycardic...they aren't going to be able to tell you your patient is symptomatic from the desk they are sitting at, you're still going to have to go in and check the patient yourself. Like I said, its just my opinion. I like to be in control of monitoring my own patient's rhythms.

Being in "control of monitoring" is a wonderful concept, but just how does one do that when you have 6-7 patients to take care of? I personally trust a monitor tech to pick up a subtle rhythm change before I would trust an automatic alarm! I don't understand the difference in being alerted by the "monitor" and being alerted by the monitor tech?? This does NOT make a nurse lazy. It makes her on top of what's going on with her patients without the interference of nuisance alarms constantly. It's the nurses responsibility to assess the patient with any change in rhythm regardless of who picks it up. I'd just rather have a monitor tech who has been watching the patients strip for days and know the "norm" for that patient calling me.