Staffing a telemetry unit

ark-two · Feb 17, 2006

I thought our staffing was bad. When I was first hired as a new grad. I was the only RN on the floor 23 beds and generally had 2 LPN's. I had 7 pt's and they had 8. Now there are usually 2 TCU RN's and 1 TCu LPN. Kentucky has become lienient on LPN job descriptions. They are able to perform IV therapy, no new cardiac gtts for the first 24 hrs, they can monitor blood but cannot spike, and can perform IVP on certain drugs. Our floor has telemetry, we are required to be NIH stroke certified (no TPA) and perform peritoneal dialysis on the floor. At times this is a heavy load. Have you seen the NIH stroke scale assessment?!! This is nights. Days are primary care. The NA passes trays and I&O and accu check. Generally day has HUC, MW, nurse ratio of 4:1 and charge RN. Night we do have a Monitor Watcher, NA. It can be bad at times. I've been on the floor on a night when we had 3 codes 23 patients and 3 nurses. We have a rapid response team and a House MD 24x7. Do other TCU's have moitor watchers?

zacarias, ASN, RN · Feb 17, 2006

ark-two, can you explain about the stroke scale assessment for stroke-certified hospitals? Our hospital is looking to become certified and the floor I work on is a candidate the "stroke" floor....:/

lee1 · Feb 17, 2006

Check your state regs. In NJ you cannot have more than 6 telemtry patients. Hi acuity hospitals should have less as you ARE supposed to staff by acuity in NJ

ark-two · Feb 17, 2006

The NIH stroke scale isn't hard, but just time consuming. We follow ACLS in ER. If the pt has began symptoms of stroke within 3 hr or less we attempt to put them on TPA. They need to have a CT that is read in 1 hr or less from the time they hit the door to evaluate for a bleed. The NIH start with a swallow eval that our ER has been pretty good about performing. If they fail they are held NPO until dietary can perform a swallow eval.

NIH

1a LOC 0 for alert 1-arousable 2- strong stimualtion for response 3-flaccid or reflex motor movements

1b LOC What mo is it? How old are you? 0-answers both correctly. 1-answers one correctly 2- answers neither correctly Anyway it goes on and on. There are a total of 11 steps with substeps for a total of 17 complete steps. It usually take 1/2 hr for a cooperative patient. In order to become certified you can go to www.NINDS.NIH.gov. The assessment in shown on the website and how to score each step and determine the total number for the scale. Then you take the test and if you pass you print off a form for your certification. The test is not hard, but some of the assessments performed are confusing. Ex: hard to hear response due to background noise or hard to see what exactly the patient is doing due to the view is far away.

stn2003, RN · Feb 18, 2006

The tele/step-down unit I am on has 32 monitored beds. On days, the try to keep the ratio at 1:4 for a primary and 2:8 for an RN/LPN team. On nights, it goes up a bit to 1:5 and 2:9. There are 2 PCTs on days and 1 on nights when we are lucky- they do fingersticks, some baths, and stocking for us. All in all it is pretty decent.

Nightrn16 · Feb 22, 2006

I work on a 39 bed telemetry floor. One bed is non-monitored, the rest are montiored. At night, normally a nurse has as many as 9 patients, most of which are on critical drips such as nitro, heparin, argantroban, integrillin, dopamine, dobutamine ect.

Our floor setup is kinda complicated (which is why it's gonna be redone in like 2 years). There are 3 hallways (3 nurses stations), a normal night is

First hallway: 9 beds - 1 nurse (normally the charge nurse) has all 9 patients and she has a CNA .. or .. there is the charge nurse and an lpn (but normally its the first scenario)

Second hallway: 13 beds - 2 nurses (or 1 rn and an lpn) assignment split evenly. If an lpn, the nurse backs her up doing IV pushes and new assessments on pt's and stuff like that.

Third hallway: 17 beds - Normally just two nurses (or an RN and LPN).

Now if we're lucky, the third hallway gets the CNA at night (as long as the charge nurse doesn't get her on the first hallway), but if for some miracle there end up being 3 nurses on the third hallway, the CNA goes to the second hallway.

So that's how our unit is staffed during the night. On day shift they normally have 2 nurses on the first hallway, 2 or 3 on the second, and 3 on the third, and all hall's have a CNA on them.

Very stressful at night (but that's another thread lol).

michelle95 · Feb 23, 2006

How do hospitals get away with this crap? I can't believe some of your ratios.

I've had an eye opener since I started telemetry. We have 5 patients 80% of the time...with 4 and 6 being the other 20%. I think 5 is too darn many. I had 4 last week and ALL 4 were train wrecks. I would leave one room and situation only to have to go to another room and situation. Then, at 3 that afternoon I got a direct admit. Of course, I didn't get to chart until shift change that night.

I've decided I'm probably going back to LTC soon. It's hard work and yeah...you might have 30 patients..but, if they're sick...they get sent out to the hospital and they are not your problem anymore.

A lot of days at work...I feel like I'm holding on to the edge of a waterfall...drowning because I can't keep up. Add that to the fact that while I was in RN school (I was an LPN first), I realized I didn't want to be a nurse anymore....and, well, burnout is going to come quickly. :eek:

steelydanfan · Mar 24, 2006

My Heavens, I'm glad I nurse in California. Our nurse-patient ratio requirements got us shut of a lot of the abuse I see our sister nurses taking. (Though the managers still try)! Telemetry is NOT Med-Surg with monitors. Telemetry is VERY sick patientswho need 3 hours of care instead of two. Where the hospitals got the idea that it was ok to staff at 2 hours, I don't know. The working premise seems to be that if it becomes common, it becomes standard; ie: The more you do, the more they want you to do.

So, DON'T. I know that a lot of you cannot file Assignment Despite Objection forms, but at least make a big noise about it. Do yourselves, and your patients a service.

CSA

Jennerizer, ASN, RN · Mar 26, 2006

Y'all are making my hospital look good. I work on PCU - all beds are monitored. Our ratio is either 4:1 or 5:1......never do we get more than 5. I think 5 patients is too much...especially when the majority are new admits & very sick.

Having a PCT is another story. Sometimes we have one, many times we don't. If they could get that position staffed properly, I'd be quite happy.

momdebo, BSN, RN · Apr 1, 2006

we are just dealing with this where I work, had an incident 2 weeks ago that spurred me to go to the powers that be, our nurse-pt ratio is between 6 and 7 per nurse, we have techs that can do accuchecks and pt care, I had a team 2 weeks ago where 5 of the 6 pts were very,very high accuity including 2 that were having chest pain/sob,both still being worked up and 2 other pts. that were having extreme blood pressure issues that were unresolved, my one stable pt wound up going into flash pulmonary edema and we coded him, after I managed to get the attention of management and we met to discuss staffing issues, how teams are assigned simply based on number of pts with no regard for pt. accuity. we are now looking at using some kind of accuity system to help prevent this from happening again. anyone out there use an accuity system that they like?

telehead · Apr 21, 2006

Hi all,

This looked like a good thread for my first post. I'm in PA on a tele/med-surg overflow floor.

Day shift: 4-6 pt (charge has no pt) with 2-4 aides.

Evening shift 4-7 pt (charge can occasionally have pts) with 2-3 aides. Night shift (my shift) 7-9 pts (charge has 6-8 pts) with 2-3 aides. I usually volunteer for charge at night so I can have 8 pts instead of 9 plus that whopping extra dollar per hour for charge!!

We usually have a monitor tech for each shift. However, that isn't always the case. 2 weeks ago, the nursing assignment was 8-8-9-9 with one aide for the whole floor and NO MONITOR TECH! The nurses rotated through the MT station, covering for each other on the floor.

We have an IV therapy team (1 person for the whole hospital on nights), a respiratory therapy team (1 person for the whole hospital on nights, 3-4 days/evenings).

There are mornings I go to give report and can barely remember any details about the pts I "cared for" overnight. Mix in the cardizem/amio/heparin/dopamine/insulin/nitro/protonix drips, the c.diff pts requiring the iso garb each visit to the room and it's frustrating. This isn't safe health care by any stretch of the imagination. I've only been nursing this for a year and a half and I can certainly understand burn-out!!!

Oh well. Sorry for the rant on my first post.

zookeeper · May 25, 2006

I have worked tele for about 15 yrs. We have 33 beds divided into 3 modules that used to be split 11 each but we remodeled the floor about 8 yrs ago and mod 1 has 10 pts, mod 2, 11 and mod 3, 12 pts

A typical day is 1 RN to each module with and LPN so 2 licensed people and hopefully one tech sometimes 2 split the floor. Module 3 is always the bear. We do caths, r/o's, AICD's, perm. pacers, PCI's pre-operatively and pre-op CABG's. We have pretty much the same staff for days as we do for eve's and nocs. We are an extrememly busy floor. So busy we seem to have a revolving door especially for the LPN's. Our hospital recently changed from JCAH and went to HFAB (I think it is) as apparently they are about 50,000 cheaper than JCAH so now the RN has to assess all pts, as HFAB requires, BID. Basically all the LPN gets done is passing meds. We sometimes have a float RN to do admissions and discharges----but 1 person isn't enough to go around. We cry about staffing to no avail. We have the same staffing we did 15 yrs ago when we had 8 monitored beds and only did caths in a big truck 2 days a week. No CABG's or PCI's back then either nor did we have an EP guy. In fact we only 2 cardie boys back then, we have 7 now. No gtts back then either except Lido. (Eastern IN)