Safe telemetry unit?

Specialties Cardiac

Published

Hi! I an a new-ish grad working on a medical telemetry unit. A 32 bed unit. We are specifically a heart failure floor, but we deal with a lot of other diseases as well. Afib, gi bleeders, even detox patients. We really can get anything. Our patients are generally high acuity. We can have patients on amiodarone, cardizem, heparin drips. Many are q2 turns, and most are incontinent. A lot of our patients are older and are fall risk and frequently confused. A lot of staff members have described our patients as being on "deaths door" and it's true because we have quite a few codes, and situations where rapid response is called and the patients go to the icu. Anyway, I'm on night shift and while we finally have enough staff, most of our staff have 1 year experience or less. We have one staff member who has 10 plus years and occasionally RNs who float in will have experience. I'm just speaking of RNs. On nights we usually start at 4 patients and can go up to 6, many of our patients being high acuity. There have been times when 2 staff members had to go up to 7! Because we were full. And our aids are always pulled as well. Usually we have one aide by 3AM. And on a floor with so many patients who are confused and are fall risk, not to mention with heart problems as well, we are severly understaffed.So getting to my question, those of you telemetry nurses with experience, is this a typical unit, or is this out of the norm? I think about getting another job, just because most nights, I feel like I'm working in an unsafe place, and I don't feel supported but then I hear "with the way I healthcare is now it's just as bad everywhere else". A lot of the times, I have a question, I go to the charge nurse and they may not really know, because they've never had to do it before. Now that I have to get acls certified, I'm probably next to be in line to be charge nurse. And I will likely be charge nurse at 9 months of experience, working with a new team of new grads who have 2 months of experience. And I feel wholly unprepared. My question is, is it really this bad everywhere else?

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Specializes in Cath/EP lab, CCU, Cardiac stepdown.

On my cardiac progressive floor we have 5 patients on night shift. I have gotten 6 but that is not the norm. I get cardizem, amio, heparin drips as well. We also have insulin, dobutamine, and lasix drips at times too. Our patients are mainly hearts post op day 1, Stemi/nstemi, chest pain, chf, kidney failure, tavi, pvi, lobectomies, endocarditis, and arrhythmias. Frequently there are confused patients and very limited mobility patients. We use tabs and poseys on them. But yeah there are a lot of new grads on my floor now and we are usually short on nurses, techs, or aides. I personally feel that an experienced charge nurse is necessary which I am lucky enough to have every time. If you feel that you are stretched so thin that you cannot safely provide care for your patients then it is time for you to look for another job as backup. Refuse to clock in when assignments are unsafe because it is your license on the line.

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Specializes in MICU, SICU, CICU.

https://allnurses.com/general-nursing-discussion/really-is-this-1017679.html

No. It is not like this everywhere. This thread from last week goes into all of what you are experiencing in great detail.

Even if you have a telemetry monitor tech it is still very unsafe.

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Specializes in Critical Care.
https://allnurses.com/general-nursing-discussion/really-is-this-1017679.html

No. It is not like this everywhere. This thread from last week goes into all of what you are experiencing in great detail.

Even if you have a telemetry monitor tech it is still very unsafe.

It's worth pointing out that the supposed "step down" unit in that other thread turned out to be cardiac tele, not step down, those are two different things.

For cardiac tele 4:1 is about the best ratio you'll find, although that will often go along with little support in terms of UC, CNA's, "rover nurses" etc. Based on typical acuity 7 would be excessive, and 5 is pretty typical, 6 if some are walkie talkies.

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On a typical shift with 6, if I'm fortunate I have one walkie talkie. Most of my patients are upx1-2, or cocompletely immobile and are q2 turns. And of course almost every one of them are on iv lasix. Throw in 2 confused patients and that's a typical night for me.

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I have worked on a tele unit that I describe as nursing boot camp. We have similar patients as you but never really go above 4-5 pts. Jobs like ours are what you make of them. Give your meds and do vitals etc. but if you can't get to everything you can't get to everything. Also, patients fall, they pull out lines, they complain to management. This stuff has been happening for decades. Just do your best, you can't control all the variables and nobody expects you to.

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Specializes in Telemetry; CTSICU; ER.

Yeah unfortunately I think staffing like this is more the norm for many hospitals, except in California maybe. The telemetry unit I worked on primarily got CHF patients, a lot of drips, we usually always had 1 or 2 detoxers on the floor, and quite a few alzheimer/dementia patients. More than half the floor would be up all night needing to go to the bathroom or wanting pain meds for chronic pain issues. The floor was a 36 bed unit and nurses on days could have 4 to 5 patients with 3-4 pcts and nights it was 5 to 6--always 6 patients at 11pm with only 2 pcts to half the floor. This floor was considered a cardiac telemetry/med-surg floor and yet got treated like a step-down unit, but nurse to patient ratio was staffed as a telemetry/med-surg floor. High turnover and mostly only new nurses on floor now.

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Sounds really unsafe. Come to California where we have ratios except in extreme situations.Tele ratios are 4:1 with few exceptions.

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for a minute i thought you were talking about my floor :-) except we only ever have one aid at night! (if we are lucky). I guess because we are the pre/post-cath floor most of our patients are supposed to be independent after bedrest? news to us! we also get the afib/CHF/detox/overflow. To be fair we have a few more experienced nurses, but the problem was that it was a very stable floor with lots of long term employees, but then a lot of them moved/retired within a year or two! staffing is getting better even within the year i've been there (not the one aid at night though)

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*Shudder* reminds me of when I was a floor nurse.

It doesn't sound safe at all to me. But maybe it is the norm.

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