View Full Version : Against medica advice

03-13-2009, 02:27 AM
Hi everyone! This is a great site but I am really new to this so help me if I am doing this wrong. I was looking for a site to get some opinions and advice. I work on a Telemetry unit in a hospital that does not have enough tele for the patient demand. In the last year our cno decided that when all the tele units are being used and there are more admits waiting for tele that the nurses on the unit will choose who they think is the most stable patient to come off tele and place the pt on a portable tele monitor. The portable units sit in the "chosen" patient's room with no one monitoring. Our cno says that we should just turn up the alarm volume on the portable monitor and that is just as good as someone continually watching for changes. I don't know if everyone is familiar with a tele unit but there are all kinds of alarms going off all the time, and by the time you find where the alarm is coming from the event is over, hopefully with no harm to the patient. My problem with this is a doc has ordered for their patient to be monitored. Who am I to decide their patient should receive inferior care? What if the chosen "stable patient" suddenly decides to be not so stable? We have no policy to refer to on this and if something bad should happen who do you think will take the fall? Not the doc who's order is not being followed, certainly not the hospital who has no written policy for chosing a stable patient to come off tele against dr orders. It will be the RN who decided at fault. Can you see it in court? just wondering if anyone else has been place in a situation like this? I feel like my license is on line every time we are made to this. Any advice?:egg:

03-13-2009, 05:05 AM
Once is enough thanks

Mother Jones, RN
03-13-2009, 08:16 AM
I refuse to do anything that makes me feel like my license is on the line. I worked too hard to become a nurse. There are always other jobs out there. Find one.


03-13-2009, 12:34 PM
I would get the heck out of's obvious that the CNO has only dollars and cents in mind and not patient safety anymore. I can only imagine the stress you are feeling with you constantly feeling like your license is on the line, I would get out of there, because as I've learnt the more stress you under the more your job satisfaction goes down and the more chance you will make a mistake.
Run while you can! There's pleanty of other jobs out there.

03-14-2009, 01:35 AM
Do you have polciy for level of care in the tele unit and is this stated in it with what procedure to follow? If not I would not do this unless I called the doctor who ordered the monitor and explained to him what the super wants to do and obtain his permission. Is the supervisiors who ask you to do this the same nurse who is in charge of your dept or nurse manager because then you may have to speak with Risk Management? Does your hospital have a Critical Care Comm. to go to also does the Medical Director of your dept and Director of Nurses approve this? I can not believe JACHO allows your hospital to do this. If this continues and nothing changes you should transferr to a different dept or hospital. You should also speak with a Nurse Att. with a copy of your tele unit policy on patient care just to see the where you stand in all this legally that will decide if you want to stay in that dept.
Good Luck

03-16-2009, 02:10 AM
Thank you all for your response. I am currently looking for a different job. I find it hard to believe JCAHO would allow this either. No there is no policy anywhere for this, they just started doing it about a year ago. The cno says that the docs are misusing the tele units...and this her answer.

03-23-2009, 05:50 AM
You say that this CNO says that (in her opinion) the Dr's are misusing the tele units, I guess she means that Dr are ordering patients to be monitored who don't fit the parameters for actually requiring it. She wants to make the nurses solve a medical treatment issue, too many people on telem and some of them not actually requiring monitoring. I think it would be better for medical staff to be asked to solve this, by getting them to decide which patients can come off and to ensure that the hospital has guidelines for ordering a patient onto telem. It amazes me how nurses are expected to solve or manage issues that stem from a medical action. I am not bagging Drs, (I work with some fine folks) it just seems silly to get us to fix something that has to do with their work.

03-23-2009, 03:46 PM
I was just wondering how they can call it a tele floor with not enough tele to even cover all your patients? I work where just in the last few months everyone had to become tele certified(mandatory) and every floor has tele in every room. The hospital did it though so all the floors would be forced to take any kind of patient (no matter what the problem is) and put them in any available bed. We are a 700 bed hospital (that is just the main) not counting L&D, ICU, etc. Women's hosp is a seperate building as is the Cancer Institute. This forces you to be a jack of all trades and a master of none. Which is not the what most nurses want to be. We used to have floors for every thing. Now every floor is just like every other one. Right now we have on my floor Ortho, CA patients, fresh surgery, medical, and isolation patients with MRSA, VRE, and C-Diff. But all management wants is all the beds filled, all the time.

07-26-2009, 09:16 PM
At our hospital all bed requests go through a central register. If a doctor wants a patient to be admitted overnight (if a day case) they have to contact bed assignment and find a bed for them.

It is the same with a patient who needs a monitored bed. When the request comes in all the monitored beds in the hospital get their patients re-evaluated. If someone needs it more they loose their bed. My last experience was by patient code blued on me (our ward is not designed for HD) so the patient had to be shipped out. He was classed low need until he coded twice more in the next 3 hours. He eventually got a monitored bed. He passed away two days later after being palliated.

My point is, that our hospital it is the doctors who have to find beds if they want something not offered on our ward, not the nurses.