I am a new RN and have been working on a med-surge floor for about 9 months now. When the patient census on our floor is low we are often required to float to other units in the hospital. Of course, nobody likes to float to other units, but we do what we must when needed, it's simply part of the job.
Recently though, we are now being floated to Telemetry units, even though we are not Tele certified and are completely unable to read Tele monitor strips. This has caused a great deal of fear in most all of the nurses on my unit.
During a recent staff meeting we expressed our concerns and unease to our nurse manager and were told that when we float to Tele, the charge RN should interpret our strips for us, and that if we are given a patient on a Nitro drip (like one of our nurses was made to do last week with no prior experience) that another nurse should titrate and sign off on it for us.
This did not sit well with any of us as we consider this the equivalent of having someone else draw up a med for us and tell us to push it. Ultimately, the patient is in my care, while I'm being told to base my care on another nurses interpretation of what it happening with my patient.
No matter what we say, we are simply being told that if we have questions or concerns while floating on a Tele unit, to ask someone else for help. But I'm left thinking if there are so many people around available to help, to interpret my strips, and to titrate my meds, why am I floating there to begin with?
I wonder if there is any "standard of nursing" that prohibits a non-certified nurse from caring for Telemetry patients? I am less concerned with "feeling uncomfortable", as I am with putting my license on the line, or harming a patient. Myself and the other nurses of my unit feel we have no where else to turn to with out concerns, since our nurse manager has been made aware, as has the nursing office/supervisor, and we are still being told that we are to float to Tele when needed.
JaxFSmith
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February 21st, 2008 at 3:06 am
You have an interesting way of looking at the problem. I’ve often gone to work in various areas to help out. They staff are usually very grateful and very helpful, and usually give you an easier patient to look after.
As for the drugs, with those intravenous drugs, I’m assuming the states is like everywhere else where they need to get checked by two people. So if you are checking with an experienced RN it should be fine as you are involved, and not just ‘pushing it’ as you suggested.
As for ‘basing your care on another’s observation’ we do that all the time already. For example, when we look at obs charts, patient history, fluid charts etc, we base our care on accurate recordings for previous measurements by other people. We also do this when we follow a doctor’s instructions.
Make sure when you document that you state who you got advise from, who interpreted what etc etc. Cover youself as always, but in twelve years of nursing it’ generally hasn’t been a problem.
You can
February 26th, 2008 at 8:49 pm
The only other thing i might add is that if this is a frequent occurrence, you might want to ask if the hospital offers any basic ECG courses, or ask if you could do some cross training with the tele unit so you feel more prepared and qualified to care for their type of patients.
Getting some basic ECG training is probably a good next step anyways since you have now had some basic experience in the med-surg area already. Don’t short sell yourself – broaden your horizon and try learning a new skill.
I think in the future more and more units are going to include telemetry monitoring as an option instead of always sending pts to a telemetry unit – that is how it is being done now at my hospital (any unit is capable of having a patient on telemetry).
FYI, Laura Gasparis Vonfrolio wrote a book called “12 lead EKG stat” and it is an excellent resource on interpreting EKG’s etc… She is great at bringing tough subjects down to earth and making them seem simple:)
Good luck!