Unit secretary turned tele tech

[tokmom, BSN, RN]

Our hospital has decided to make our med/surg tele floor unit secretaries into tele techs. The training they got was the assistant manager spending a couple of hours going over strips and teaching them to measure. They are responsible for printing out and measuring the strips. The RN is suppose to come around every 4 hrs at measuring time and sign the strips. I have issues with this.

For starters, the RN would like to use the e-caliper that comes with the tele machine. Why should the secretary measure and then the RN come behind and measure? I'll be darned if I'm going to measure a print out with manual calipers??

Isn't the RN who has those patients responsible for those pre measured strips if they are measured incorrectly?

Those that have tele techs, what is their scope of practice and education?

[CCL RN, RN]

I still use calipers... What's the big deal with measuring using those? In my ICU we didn't have monitor techs ...what a luxury!!

Just eyeball the strips. You can tell if the measurements are off nest by looking. No big deal.

And yes, you are responsible for them being correctly measured.

[tokmom, BSN, RN]

Because we don't have calipers. They tell us to use the machine. So at 0800, the secretary measures, and then the RN comes along and measures...again. These people are not true tele techs. They answer phones, leave the desk to xerox things and run all over the floor.

We never had these people doing this before and we nurses are happy watching and measuring our own strips. So for management to give our secretaries more things to do on top of everything else, to me is just plain silly.

[CCL RN, RN]

Huh. I bet you could just eyeball the strip over the shoulder without having to take up any real time. Then measure at the end of shift.

I always have calipers in my nursing bag, can't imagine working tele without them.

[Lennonninja, MSN, APRN, NP]

Tele techs at my hospital have a 16 hour class before they're allowed to do these things. Having just a little bit of informal training sounds dangerous. The central tele nurses come around and check all of the strips for floors that don't have their own monitor/tele techs (basically anywhere that's not a cardiac unit or critical care). We have manual calipers too. I actually just bought some of my own for when I take the tele class this spring.

[NurseGuy30]

Tele techs practice under the RN's license. So they don't really have a scope of practice any more than a unit secretary has a scope of practice. They just have a list of things they can't actually do.

Your hospital should be training you. It took a lot of training and even a couple of shifts before I became comfortable in tele, but then we can take forty plus patients at a time.

As for the strips, you can see a lot of things by "eyeballing"--a-fib, obvious arrhythmias. You may not find a bundle branch block (sometimes it's no so obvious), or a 1st degree heart block.

[CathyLew]

Ok, who is responsible if a patient goes into V-tac or something? they were talking about doing the same at my old hospital.... but the unit clerks are as you say, on the phone, running errands, taking off orders... who is responsible for watching or monitoring the tele not just running the random Q4H strip? who's licence is on the line if a rhythm goes unnoticed for an hour?

[NurseStephRN]

all the telemetry units (except ICU) at my hospital have monitor techs. our secretaries are secretaries only and the monitor tech is responsible only for the ekg monitoring.

they take an intensive course on ekg readings, etc. and have check-up competencies every year or so. they are BLS certified also. as the RN we check in every 4 hours and get updates, but if something changes it would be sooner than that. we are a small unit of 20 patients so we are always close to our monitor techs who know much more about ekg than some of the nurses i work with. a little scary... i know. my monitor techs have even gotten in deep discussions with cardiologists and electrophysiologists about a patient's rhythm! lol.

if there's a code, of course the nurses/mds are responsible for running it, but the monitor tech is expected to be proficient in all kinds of ekg reading and can recognize lethal rhythms.

[CCL RN, RN]

Ok, who is responsible if a patient goes into V-tac or something? they were talking about doing the same at my old hospital.... but the unit clerks are as you say, on the phone, running errands, taking off orders... who is responsible for watching or monitoring the tele not just running the random Q4H strip? who's licence is on the line if a rhythm goes unnoticed for an hour?

The same person who was responsible before the unit clerks became tele techs....YOU!

Always and forever, you are responsible for your pt.

[sevensonnets]

One more example of dumbing down patient care! Measuring is one thing; being able to recognize a lethal rhythm and what leads up to it is not something a secretary who knows absolutely nothing about arrythmias can learn in a 2 hour class. You can teach them to measure all you want but to the untrained eye all strips look like a bunch of squiggly lines. This is a BAD idea that ranks right up there with RN's making toast.

[blondy2061h, MSN, RN]

We've never had a tele tech, and we measure our own strips. If you want to use the e calibers, just tell the secretary you'll take care of your own. It takes like 45 seconds to run a strip.

[blondy2061h, MSN, RN]

Ok, who is responsible if a patient goes into V-tac or something? they were talking about doing the same at my old hospital.... but the unit clerks are as you say, on the phone, running errands, taking off orders... who is responsible for watching or monitoring the tele not just running the random Q4H strip? who's licence is on the line if a rhythm goes unnoticed for an hour?

The monitor should be beeping if the patient is in vtach. Hopefully it doesn't take an hour for someone to notice an alarming monitor. If the secretary/tele tech notices something amiss, or something they're not sure of, they can just grab an RN.

We all just watch the monitors on my unit.