Tele unit problem

[RNKPCE]

I work on a telemetry unit. We are a med-surg unit with patients on tele monitors. Our hospital also has a ICU and an intermediate care unit called TCU.

If TCU is full we are getting sent the TCU patients. Our opinion is that if they need TCU and they are full they should go to a higher level of care ICU not a lower level of care. Last week both ICU and TCU were full and of course our unit felt the effects.

This is not fair to the patients or the staff. Our manager gave her okay for us to take these patients.

Do other tele units have to deal with this? Even when those higher acuity units aren't full, we have docs wanting the patient to come to us for closer nursing care from regular medical floors. This is usually when the patients heart has nothing to do with the need for closer nursing care.

Any information or opinions would be helpful.

[Tweety, BSN, RN]

Our progressive unit gets the cardiac patients you describe, except for fresh stents, the go to another unit overnight. Our ratio is no more than six, for all shifts. Kind of sucks for days because sometimes nights has six and the day nurse has six as well. We have techs, a tele tech/secretary and a free charge, so there are resources.

If you are taking care of five or more patients, obviously you can't do the observation that critical care patients need.

We do get overflow cardiac patients.

[cannoli]

The hospital I work at considers the telemetry floor to be part of med-surg. They do a lot of drips on that floor among other things, cardioversion, etc. The regular staff get inserviced in the drips, etc., however, floats do not. One, of course, can not refuse to float there. I, and other nurses, consider it critical care and do not feel particularly comfortable or safe working there.

The floor has a revolving door as far as staff goes, and some of the core staff are the nastiest people on the planet, including the charge nurses.

They have used a lot of agency, including a lot of agengy LPNs, I guess because they can't get anyone else. I don't think that is particulary safe either.

I think most hospitals would consider that type of floor to be part of critical care. An interesting note, they pay agency RNs one dollar more an hour to work that floor. However, they insist the dollar more an hour is not because it is critical care.

Oh well, a nurse is a nurse is a nurse (not). The hospital, supervisors, etc. don't care if one feels safe or comfortable working there, and it's not their license that is on the line. Their only concern is staffing the floor. Warm body syndrome.

[RNKPCE]

Tweety what is the ratio in your progressive care unit and the unit that gets the fresh stents?

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

Wow. I wish we could have ratios like that.

Days are 1:5 as well as PM's. Nocs are 1:10, but we fight really hard to keep it to 1:8.

No drips on Tele, except for insulin drip. Step down has to do all the drips. There is no way that we can monitor drips with the acuity and ratios that we have.

We get the dialysis patients, GI bleeds, MI's, recovering angios, CP, CHF, COPD, any surgical that needs tele, multi-system patients.

Fresh stents go to the CCU for the night and come up within 24 hours.

I can answer why I am getting burned out. It is because I have to be in charge, take care of 5-8 highly acute patients for the floor and precept new nurses. Whew, I am tired....

[Tweety, BSN, RN]

Originally posted by batmik

Tweety what is the ratio in your progressive care unit and the unit that gets the fresh stents?

They go to either CCU or a new unit called "Post-Procedure Cardiac Care" where the ratio is no more than 3:1, plus they get an aide, usually just over night. The post-procedure unit hasn't been open this week because CCU has had plenty of beds and staff this week. That's usually not the case, especially in our busy winter here in Florida.

I've heard of post-angio ratios being 4:1 in some facilities.

Post-stents have such potential for bleed, reocclusion and MI that they should be monitored carefully. They should not be on a medical tele unit, unless they have adequate ratios, with adequately trained nurses. IMHO.