Tele unit problem

moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS · Oct 1, 2003

I feel your pain. I currently work on a tele/step down combined floor. Acuity is increasing everywhere. Our hospital has recently gone back to two cardiothorasic surgeons. This along with the fact that in the state of Wisconsin there is ONE long term ventilation unit and it is always full. Therefore, the step down unit has the vented patients that are really stable and can be discharged but there is no place for them to go. We are talking 3-4 patients sometimes waiting weeks++ for a bed. So with the increase in CABG, Thoracotomy patients, etc. They are much quicker to come to the floor. That is great and all, except that staffing ratios haven't changed to meet the increase in acuity. And we are killing ourselves. There are only two floor units with telemetry capabilities in my hospital. Med-surg is not one of them. So in addition to all the cardiac, medical-cardiac, we also get surgicals that require IV cardiac meds.

So back to the point. Is it fair? NO. Is it going to change? Well staff as a whole maybe address their concerns in a UNITED front, maybe. However, I truly feel that this is only the start of the ripple effect of the increasing acuity combined with the lack of nurses in the field.

Just my humble opinion.

Good luck

nursemaa · Oct 1, 2003

We have the same problem on my tele unit. The docs want to admit non-cardiac patients for "close observation". However, our unit is configured the same as med-surg so it's not as if the patients will be viewed at all times like in an ICU. We do have a SLIGHTLY lower patient:nurse ratio. Our case managers have taken a very active role in helping to ensure appropriate bed utilization, and tracked inappropriate admissions (patients who do not meet criteria for tele) for several months. They have presented this information to the VP of Medical Affairs, who has addressed it with the docs. Our bed placement coordinators will challenge the docs if the admission isn't appropriate for our unit. The problem has decreased a little over the past year, but sometimes it's political: no one wants to make the docs mad. I think this is a common problems in most hospitals.

cannoli · Oct 1, 2003

I was once told by a supervisor about something similar, unsafe procedures on the floor, that nursing doesn't want to tell the doctors that they (nursing) can't do it. So the docs get whatever they want, no matter how unfair or unsafe it is for the nurses, (and the patients).

Tweety, BSN, RN · Oct 1, 2003

I work on a tele unit and feel that is not safe. If a patient needs critical care, then they don't need medical tele. Never do critical patients ever go to med surg units.

However, when I worked step-down neuro, we would sometimes get people with ICU orders. But we didn't have to staff then. They were staffed 2:1 with a critical care qualified nurse.

As a house supervisor on occasion, I can appreciate when critical patients need to go to an overflow unit, but they need to be staffed appropriately and with appropriate ratios.

Is this happening where you work? If not, do the docs know? Whose license is at stake here?

RNKPCE · Oct 1, 2003

In some instances the docs order the transfer to us from a med-surg floor for closer watching, so yes they are aware. They may not be aware when they are sent to us because the critical care units are full.

cannoli · Oct 1, 2003

For those of you who work on a telemetry floor, does your hospital consider your floor to be critical care or med-surg?

nursemaa · Oct 1, 2003

Critical Care.

Repat · Oct 2, 2003

We are in the critical care trio (ICU, TCU, us - monitored med-surg), but it's the "monitored med-surg" title that allows us to admit just about anything from vasoactive drips to detox patients. We do not staff appropriately for the acuity of the patients. I often come home feeling that things are not safe....

RNKPCE · Oct 2, 2003

We are in what is called the Critical Care complex. It is includes ED, TCU, ICU and us med-surg tele. It sounds like a lot of tele unit have the same issues.

Another big issue we have is that when it comes to floating we get bumped from both directions. If med- surg needs help but we aren't overstaffed and ICU is they send an ICU nurse to us and we send a nurse to Med-surg. If TCU needs help and we aren't overstaffed, they send a med-surg nurse to us and we float to TCU. They actually allow us not to float to subacute, whoopie! ( actually thank god)

What drips and meds do you all give on your tele units?

We give Lidocaine(not often anymore) Procainamide gtts, Dilt gtt, Integrillin, Renal dose dopamine and dobutamine, Adenosine, Corvert and fenlodapam.

Tweety, BSN, RN · Oct 2, 2003

Originally posted by cannoli
For those of you who work on a telemetry floor, does your hospital consider your floor to be critical care or med-surg?

Med-Surg. We have Cardiac Critical Care, Progressive Care (which is PCU and they do cardiac progressive care, and cardiac telemetry) and medical-telemetry, which is us. We do mostly noncardiac stuff, never do drips, or if we do we send them to PCU asap. We also take a mishmash of all kinds of other med-surg patients.

We're the floor where the respiratory patients and gi bleeders, and other medical patients whom need tele go to.

RNKPCE · Oct 2, 2003

Tweety,

How many patieints do you care for. Currently we have 4-5 on days, 4-6 on pms and 5-7 on nights. It will change to mandated ratios in January of all shifts having 5 patients. Good for nights but not necessarily days.

I like the pt that is primarily cardiac whether it is for an arrythmmia, CHF, open heart or cardiac intervention such as stent. It is the other medical patients with mulitisystem problems that are the sickest and need the most nursing attention. We are also frequently getting patients in their 90's that are no codes.