Who is watching the monitor?

[ICURN92]

I work in an ICU where we currently have a monitor tech watching the monitors at the desk, at all times. We only have one monitor at the desk and of course in the patient rooms. A directive has recently come down from corporate that we are no longer budgeted to have a monitor tech position. The nurses are to watch the monitors for their patients at all times. We are not set up for this. Our room monitors will allow you to see your other patients monitor but one just that one, so if you are in another nurses room, helping with a bath or admission, no one is watching your patients, as we have no CNA/techs either, not to mention a code situation. Corporate doesn’t want to provide us with extra staffing for a CNA/tech and have instructed us to have the Charge nurse watch the patients. Often times our charge nurse has patients so that’s not a help. Our management has asked for ideas to present to corporate to assist us with this transition, so my question to the group is, how do you handle this in your ICU?

Thanks in advance!

[MountaineerFan57, BSN]

We have never had a monitor tech. We set appropriate alarm parameters and are very conscious of alarms. There are different sounding alarms for lethal arrhythmias and everyone is pretty aware of those and immediately checks on a room if they hear it.

[righteousjenn]

4 hours ago, MountaineerFan57 said:

We have never had a monitor tech. We set appropriate alarm parameters and are very conscious of alarms. There are different sounding alarms for lethal arrhythmias and everyone is pretty aware of those and immediately checks on a room if they hear it.

This is true for us as well... if we are helping bathe we always tell a neighboring nurse just to keep an ear out Incase we don’t hear.... alarms and appropriate volume is key

[MunoRN, RN]

I've never worked in an ICU that used monitor techs. I've worked at one that trialed ICU monitor techs but is was short lived because the nurses hated it.

I would agree that it's not really a good use of resources to continuously have eyes on the monitor, that's what the alarms are for.

[adventure_rn, MSN, NP]

15 hours ago, ICURN92 said:

Corporate doesn’t want to provide us with extra staffing for a CNA/tech and have instructed us to have the Charge nurse watch the patients.

I agree with the above posters, and would add that part of our unit culture is for everybody to keep an eye out on the central monitors (not just the charge nurses). We have a central monitor with audio at each of our nurses stations. Any time any alarm on the unit sounds, somebody who is sitting up at the nurses station (either the charge nurse or someone else) is going to glance up to see if it's serious. If I'm sitting at the nurses station charting and look up to see a patient who is bradycardic with an O2 sat in the 50s, I'm going to investigate, even if it isn't my patient. It's fairly rare for us to have any point where nobody is looking at the central monitor.

Honestly, I feel like it is probably more practical to have nurses keep an eye on the monitors than techs, anyway (since I'd rather have a nurse recognizing/responding to a potentially fatal arrhythmia than a tech).

In that kind of a system, I feel like it's also important to have certain logistical elements in place. For my unit, that means that we need our monitor alarms to connect to our phones (so if I'm away from my room, I know if I need to check my monitor because my phone will alarm). It also means that we have to be able to pull up any monitor from any room fairly quickly (so if I'm helping a neighbor with a bath and my phone alarms, I can easily pull up my patient's monitor to check that everything is ok). As everybody has mentioned, your alarm parameters need to be appropriate. Finally, like @righteousjenn said, it requires communication, i.e. letting your neighbor know to keep an ear out for your patients if you're stepping away.

[kataraang, BSN]

We have monitors along the walls throughout the unit, not just at the desk. Each hallway has 2 monitors at each end. From any computer, you can see monitors. No patient names, just room numbers.