Telemetry patient ratio

Mkakids · Jul 23, 2018

Im not sure about CA, but Im in IL on a stroke /tele floor (we also get dialysis, post ops, wounds, ETOH, etc...) and our day ratio is supposed to be 4:1, but is usually 5:1.

Triddin · Jul 23, 2018

That sounds like a fairly normal ratio

Sour Lemon · Jul 23, 2018

Hi Nurse Beth, I came here to get some enlightenment. I'm currently working at a Med surg unit here in Cali. Our nurse-patient ratio is 5:1. We have patients with combination of stroke patients, cardiac monitoring, ETOH withdrawal, dialysis patients, post-op patients, complicated wounds with wound vac maintenance, and other high acuity comorbidities.
On my previous job, the hospital was very strict with the ratio of 4:1 if you are assigned even with 1 patient on telemetry monitoring.
Is there a law that describes telemetry nurse-patient ratio in California?
On my current job, we can get assigned up to 3 telemetry patients out of 5 patients. The rationale that I hear from the higher ups is that the telemetry patients are not real telemetry patients and that we are not pushing meds that control blood pressure or heart rate. Thus, when a telemetry patient assigned to us gets a heart rate of over 130, we have to transfer them to Stepdown ICU for cardiac management.
I would really appreciate your inputs on this topic. I am very concerned about this type of workplace environment.
Thank you!

California has actual mandated ratios, so it's a different ball game. My previous employer (in CA) told me the same thing about our telemetry patients, though. They were "observation", so we just couldn't have more than three tele each (five patients total). I never thought to question it, because on my dedicated, all telemetry floor in Texas, the ratio was 7:1.

I'm interested in the answer, too ...but I don't know what it is.

MunoRN, RN · Jul 23, 2018

At least based on my understanding of the California law, you should max out at 1:4 if there is even one telemetry patient in your assignment. Your employer seems to be confusing telemetry patients with step-down patients. Here is how California defines "telemetry" for the purpose of the law:

A "telemetry unit" is defined as a unit organized, operated,and maintained to provide care for and continuous cardiac monitor-ing of patients in a stable condition, having or suspected of having acardiac condition or a disease requiring the electronic monitoring,recording, retrieval, and display of cardiac electrical signals(California Code of Regulations, Title 22, Section 70217, 2005)

(PDF) Mandated Nurse Staffing Ratios in.... Available from: (PDF) Mandated Nurse Staffing Ratios in... [accessed Jul 23 2018].

styx876 · Jul 23, 2018

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Per SEIU, California Mandated Ratio for Telemetry Unit is 1:4. Our unit is considered Med-Surg Unit with 1:5 ratio but they mix telemetry patients in our assignment. They're saying that our Stepdown Unit is the true telemetry unit. But how come we are getting patients with irregular heart problems (e.g. a-fib, heart block, with pvc's, bradycardic patients, etc). On top of this, we are always short of CNA's forcing the nurses to be interrupted to help patients going to the bathroom, feeding, ADL's, etc.

I'm very grateful to have this job. Many of my co nurses think that there's something wrong with this picture but no one wants to speak up.

I really appreciate all your comments!

styx876 · Jul 23, 2018

Per SEIU, California Mandated Ratio for Telemetry Unit is 1:4. Our unit is considered Med-Surg Unit with 1:5 ratio but they mix telemetry patients in our assignment. They're saying that our Stepdown Unit is the true telemetry unit. But how come we are getting patients with irregular heart problems (e.g. a-fib, heart block, with pvc's, bradycardic patients, etc). On top of this, we are always short of CNA's forcing the nurses to be interrupted to help patients going to the bathroom, feeding, ADL's, etc.

I'm very grateful to have this job. Many of my co nurses think that there's something wrong with this picture but no one wants to speak up.

I really appreciate all your comments!

Daisy4RN · Jul 23, 2018

I think they can get away with this because of the wording. If you are on a med-surg "unit" it is not considered a tele "unit". Loophole.