state laws re: cardiac telemetry monitoring

My hospital did away with telemetry monitoring techs recently and I'm concerned about patient safety and nurses legal liability when no one is watching the monitor. We are supposed to be checking it frequently, but in reality this is not so. We may be tied up in another patient's room. Sometimes people's rhythm changes ie to atrial fib and we do not know when it actually happened. I relayed my concerns to manager and even to the hospital risk manager, whose response was that perhaps I needed a job change. She stated the nursing literature proved that telemetry tech monitors were ineffective and unnecessary. I was wondering if anyone knows anything about this and if they work in a state that requires an actual person, telemetry tech, watching the tele monitors.
I don't know that the states require tele monitor techs. I wonder if your nurse manager needs a job change? How many patients do you have and how many of them are monitored? I have worked on a unit with a 4 patient load and monitors above the bed and one in back of me. I felt safe with this ratio. How do you know whose alarms are ringing? How would you know whose leads are off? How many monitored patients are on the floor? The hospital will go down if there is a problem. I have worked on some 40 bed tele units and even 25 bed tele units. Every nurse would not be able to respond to every alarm. That is what it takes to ensure safety for the patients. With a low nurse to patient ratio, 4 patients, you are safe. More and something is going to happen. Research would be valid in a small unit, not in a large unit with the monitor at one end of the unit, and nurses assuming it is someone others alarms. I hope their policy has made it to print. This is what will protect you. If the nurse is following hospital policy and procedure, you will be ok. Find it in writting. I would not be happy working on a large unit without a tele monitor tech.

What is the sense of even having telemetry on a pt if there aren't a pair of eyes watching for rhythm changes or ears listening for alarms? Especially on a floor when a nurse can have an assignment of 5-7 pts? I remember a commercial that can be used as an analogy,where a security guard is so into his donut (patient?) that he doesn't see the burglars on the security monitors robbing the place blind.

The truth is that your hospitals has decided to cut staffing and they will find statistics to back them up because they want to. The reaction you got when you expressed concern it typical. "Perhaps you need a job change" is a disgraceful way of dealing with your concerns. I have worked at places where no continous monitoring of telemetry was done and things get missed. Sometimes the things that get missed have serious consequences for the patients. Managment does not care about that because they have someone to blame when it happens. YOU! Maybe the person who gave you that advice was right.

I'm working on a 40 bed tele unit without a monitor tech. But there are a few things that make up for not having one. One of them is that, aside from the main nurses' station and monitors, there are 4 other stations throughout the unit, 3 of them with a monitor (to keep it all in proximity). The fourth we are pushing to have a monitor put in after it became abundantly clear that we need one. Also, apparently when the unit I work on was smaller, they did have monitor techs...who are now our unit coordinators. It is a part of their job description to be able to read those monitors and keep an eye on who is off. As for knowing when your patient's rhythm changes...for stuff like A Fib (which many times will start out with a rate that is far too high) and the lethal ones, there is a LOUD IRRITATING alarm that goes off and since everyone on the unit can read those monitors, that stuff doesn't get missed. I think the only way it can work not having a monitor tech is making sure the other, non nurse, staff knows how to read them (we even have a few secretaries who took the dysrhythmia course) and having those monitors close enough that when you leave ANY patients room you will be able to see them. It seems to work well where I am at.Indeed.

Ok what do you guys think about this.... I work in a 12 bed ICU that is rarely full. We range between 3-6 pts a day. In this unit we also have 20 telemetries that the nurses are also responsible for. We are usually staffed w/ 2-3 RNs no unit clerk no nurses aid no telemetry tech. The nurses do Q 4 hr assessments Q 1 hrs vs. Are there any other hospitals that require their ICU nurses be responsible for the floor telemetries plus manage their pts too????

No tech's watching our tele......we count on the alarms and our ward clerk, aids, or LPN's to chase us down if they do alarm!

i read an article last year that cited the nurse-patient ratio for telemetry patients was 1:3. Now i'm despirately trying to find that article as a means to get out step-down unit ratio changed to 1:4. Anyone else read that article? Got a title??

Quote from ceecel.deeNo tech's watching our tele......we count on the alarms and our ward clerk, aids, or LPN's to chase us down if they do alarm!

I had never heard of telemetry techs before reading about them on this board. We have monitors on either end of the floor and in the patient rooms. The alarms are loud enough that they're easy heard from anywhere on the floor. There's usually someone at the nurses' station. If we need to see when a change occurred we go back in the monitor's memory and can review their rhythm for the whole time they've been monitored.

At another hospital, I worked on a telemetry floor on which there "used to be" telemetry techs.When I worked there, the RNs were responsible for the monitors, the alarms, all of that. Our ratio?1:6 on days, 1:9 on nights.Yeah, I didn't stay there too long...

I worked on a 30-bed Telemetry floor without a Tele Tech. We had beepers that would alarm us and show the rhythm-even if we were in another room.

I feel for all the nurses who have more than 3 or 4 patients. I am a tele tech, and after my horrible day yesterday I started wondering if there were state laws regarding how many patients the Tele Tech should watch. I've read elsewhere that Tele Techs are "just sitting" at their desks in front of the monitors and, therefore, should also have secretarial duties. This is stunning to me that anyone thinks this. I am the sole Tele Tech for a maybe 40 bed tele unit, as well as the west side which is probably the same, AS WELL AS 3 additional floors all totalling up to 80 beds that we watch! Probably only because that is all the monitor space we have. Not only must we watch all of these patients, MANY of whom are critical and have constant arrhythmias, we also have to answer the patient call phones and overflow of the unit phone when the secretary cannot get to it. Imagine that I have a critical alarm, try to call the nurse, cannot reach her, cannot reach her unit, and three patients are calling on the pt call phones wanting their pillow adjusted or a cup of tea with some sweet n low, or continuously mistaking the call light for the TV controller....over and over and over.....beep beep beep beep beep beep beep beep beep beeeeeeeeeeeeeeeeeeeep WAIT there's still a patient who just had 17 beats of VT! STILL can't get a hold of the nurse! And now there are 4 patients who have critical arrhythmias, you have to track down each and every one, still call the nurses on your unit for the tea and freaking crumpets, and now a doctor has walked in to the Tele room and wants to discuss all his patients with you by walking in the room without bothering to greet you after you've said hello, how are you. When he is gone, and I finally do reach the nurses whose patients have had VT, they are short and snotty with me. When I call the MA to get the tea or prop up the pillow.....or take a poor old lady to the bathroom whose now been waiting about 45 minutes, I hear a big exasperated breathe and the phone goes dead.Apart from all of this..........you've missed other alarms because, contrary to what some have said, alarms do not always go off for even VT, and sometimes alarms ring CONSTANTLY for rhythms that look like VT. Yesterday I had 3 patients who rang Asystole all dam day long no matter what lead I changed them to. We MUST have our focus on those monitors and nurses in stations walking by occasionally just would never cut it.Keep in mind, after all is said and done, I make about $10 an hour. Yes, I am educated. Lost my job, thought this would be a foot in the door to a new career. OVER IT after a year and a half only because of this new hospital I work at. Tele Techs do not get the respect nor pay they deserve. It's the absolute worst job I have ever had hands down simply for the rediculous volume of people that I have to watch along with other duties which only add to the insanity inducing noise in the tiny tele room.