Doctors and nurses work together to provide patients the best care. But you know that everyone has a pet peeve. In this six-minute video, new medical resident Siobhan Deshauer, MD talks with nurses about how physicians get on their nerves. What follows is a transcript…
Siobhan: Hey, guys. I’m Siobhan, a first-year medical resident. I figured today we could talk about how doctors and nurses get along, specifically the things that doctors do that really annoy nurses. It’s really tough as residents because we just kind of parachute into these ICU teams, which are really well formed. They all know each other well. They know how things work and we just need to figure out how it goes on the fly really quickly. The reason that I think this is so important is because this is a team. If we work and communicate better together, it should be better for patient care. Let’s go figure this out. The number one pet peeve that doctors will do.
Pet Peeve: Respect Nurses and Patients
Female Nurse #1: Not introducing yourself when you come into a patient’s room. Like I was telling you before, there was a doctor that walked into my room this morning wearing a winter jacket, boots, and no ID on him whatsoever. He came up and started reaching for my chart instantly. I was like, “Hi! Sorry, why are you touching my chart? Who are you?” Like, any indication? Introduce yourself! Introduce yourself to the patient and the nurse.
Siobhan: We can do that. We can do better at that.
In a Shared Workspace, Respect the Nurse’s Computer
Female Nurse #2: Respecting the nurses’ workspace because you do have your own personal workspace.
Female Nurse #3: I was also going to add that it’s a shared workspace. But sometimes when you’re thinking and you’re thinking for a really long time, that space is just…
Female Nurse #2: There’s a lot of people.
Female Nurse #3: Yeah, there is a lot of people and sometimes you just need… we need that space because it’s the only one we have.
Siobhan: Yeah, you’re actually working on a computer…
Pet Peeve: “RING! RING!” Pick up the Phone…
Female Nurse #3: Yeah. It’s kind of like, “Can you do that stuff and get out?” Because I need to be there. But it’s a shared space obviously and we all respect that for each other. I was just going to say pick up the phone. If it’s ringing, pick it up! It’s not my phone.
Siobhan: You mean even if it’s the phone, even if someone is paging us back?
Female Nurse #2: Yep, wherever you are.
Female Nurse #3: Any phone. Any phone. If you’re walking down the hall and the phone rings…
Siobhan: Just like…
Female Nurse #2: You pick it up.
Female Nurse #3: You’re part of the team. Pick it up. “Hello, ICU. Hang on. Okay, I’ll get you somebody else.” Just pick it up. Usually what happens is you’re sitting in the workspace and you’re taking up this workspace, and we’re probably sitting there like, “Okay. Well, fine, I’ll go do something.” You come back and they’re still there. The phone’s ringing and nobody’s answering, but they are still in the workspace. The phone is still ringing. Pick it up.
Siobhan: That’s amazing. Thank you! I will pick it up. Wow! This is actually very useful to hear all these things just even as a reminder. Let’s go see if there are some more nurses that have a minute to give us their feedback. The number one pet peeve, things that doctors do that you just hate, okay.
Pet Peeve: Again, Respect the Nurse’s Computer, Communicate, and Remember That You Are Not the Nurse’s Boss
Male Nurse #1: Maybe not number one. But when residents or doctors just hop on your computer and look up all these different patients under your name, which compromises my license. Thanks, guys.
Siobhan: Yeah, that’s really bad. That’s really bad. What would be the number one piece of advice that you would give to residents?
Female Nurse #4: Just communication is key. Communication, patient safety, and respect for your colleagues. Don’t think of yourself as we’re in a hierarchy. Again, when I worked on a ward, there was definitely a hierarchy between physicians and nursing staff. Whereas, it’s kind of like you’re not my boss. No. We are meant to work together. We’re a team. We all, I think, some doctors forget that I’m here mainly as a patient advocate and I spend 12 hours a day with them. I spend 12 hours a day with their families. Whereas you guys, yes, you’re all highly intelligent, but you have numerous other patients to see. Just kind of taking into consideration what nursing staff and other members of allied health have to say.
Siobhan: What would be your number one piece of advice for new residents like me?
Pet Peeve: Respect Patients’ Privacy
Female Nurse #5: Carry around an awareness of how immune to privacy, invading people’s privacy, nudity, things that are just commonplace in the hospital. You know what? We’re all guilty of it, walking through that curtain that’s drawn, because we’re trying to address a patient issue. Patients and their families, nurses at the bedside, really appreciate just like a quick hello from the other side of the curtain. “Hey! It’s Dr. so-and-so. Do you mind if I come in?”
Siobhan: I wouldn’t walk up to your room and just like walk in your bedroom door. Right? Like that just seems…
Female Nurse #5: That’s what I am saying.
Siobhan: What if you are changing or anything, right? Just knock. It’s the same thing, right? Pet peeve from doctors.
Pet Peeve: Nurses are Not Your Servants. Clean Up.
Female Nurse #6: One of my pet peeves that I have experienced is that the doctor will come in and do a procedure requiring sterile towels, dressing tray, lots of sharps, and sutures, and they’ll leave it all. They’ll do the procedure and then they’ll leave, leaving the nurse to clean up everything. Really, they should take care of the sharps and ask, “Where can I put these things?” I’d be glad to tell them.
Siobhan: Yeah, that’s so incredibly reasonable and a good reminder.
Female Nurse #7: Just being aware of everyone around that’s participating in rounds.
Siobhan: So not like doing this. [TURNS BACK]
Female Nurse #7: That’s right. Don’t turn your back to the nurse.
Nursing Students are Still Naive. Treasure Them.
Siobhan: As a nursing student, are there things that doctors do that just really bother you?
Female Nurse #7: As a nursing student, I wouldn’t say I’ve had too many negative experiences yet.
Female Nurse #7: I would say a lot of them are positive. You guys are very informative and easy to talk to, so overall a positive experience with residents.
Siobhan: That’s awesome! We’ll see. We’ll ask you in like 5 years.
Female Nurse #7: Yes, ask me again in 5 years.
Siobhan: Thank you so much to all of the nurses who helped out with this film. It was fantastic. It was really fun and it gave me a lot to sort of think about and good reminders. Don’t forget to subscribe if you haven’t already and I will be chatting with you guys next week. Bye for now.
Siobhan Deshauer, MD, is an internal medicine resident in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.
Sherry Cameron, a medical recruiter for correctional facilities across the US, recently wrote a post for DailyNurse as the first part in this Three-part series. (For part Two, see What to Expect as a Correctional Care Nurse). Now, she’s starring in the latest DailyNurse podcast, “What is it like to be a Correctional Nurse?”
Nurses in correctional facilities work so closely with other members of the healthcare team that Sherry describes it as a “family-oriented environment.” Often looking after inmates who have never received regular medical care, these nurses perform the usual nursing tasks such as administering medications, blood sugar checks, and tending to injuries incurred in the kitchen or carpentry shop.
Also, correctional facilities offer the opportunity to experience one of the most gratifying aspects of nursing. Corrections nurses act as educators for people who have rarely had any sort of relationship with a healthcare provider. Sherry recalls, “one nurse said to me that ‘it’s a very special moment when you see a patient come to tears because someone took the time to finally talk with them and educate them about their health.’ That to me is a true nurse at heart”.
In this episode of the DailyNurse podcast, you will hear Sherry discuss the character traits that she looks for in potential correctional nurses, the concerns they have when they first consider a career as healthcare providers in a correctional facility, advice for those interested in correctional nursing, and much more.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a volunteer puppy raiser.
In 2017, Catherine Burger, BSN, MSOL, RN, NEA-BC, now a Media & Brand Specialist for RegisteredNursing.org, was in the midst of building her own home-based business after having retired from corporate nursing. Along with her husband and their youngest son, Burger had moved from Sacramento to San Diego, California, and she was looking for a volunteer opportunity.
“I kept seeing puppies with yellow vests in my area,”
recalls Burger. “We had lost our dog several years prior, and it took many
years before I was ready for another dog. I told my family that I believed we
were meant to raise a service puppy, so we looked into it more.”
Burger had friends already involved with Canine Companions for Independence (CCI), so she and her family were able to talk with them and ask lots of questions. After completing an online application, as well as a home visit by a CCI staff member, they were approved and placed on a list to receive a nine-week-old puppy to raise.
“Canine Companions for Independence, a nonprofit
organization, was founded in 1975 to provide expertly trained service dogs to
enhance the lives of people with disabilities,” explains Burger. “These dogs
are not just providing help with daily living by being the arms, legs, and ears
of their partners, but also open to opportunities to live with
greater independence and confidence.”
CCI provides these dogs to adults, children, veterans,
and professionals, depending on their needs. The breeds used are yellow and
black Labradors, Golden Retrievers, and mixes of these two breeds. “Most
service-dog programs charge up to $40,000 for a trained assistance dog. Through
volunteer puppy raisers like us, plus donations and sponsors, CCI is able to
provide the trained dogs at no cost to the recipients,” says Burger.
When they started working with CCI, Burger and her family received a lot of training. “CCI provides mentoring, guidebooks, and many areas offer weekly training classes. As a puppy raiser for CCI, you commit to attending at least two puppy-training classes each week. There are professional dog trainers available for consult as needed if the puppy has any specific issues,” says Burger. “It is an extremely supportive program and community of puppy raisers. For example, we watch each other’s puppies when anyone is traveling.”
Burger and her family are raising their second puppy for
CCI. Their first puppy, Nancy VI, is now a Change of Career (COC) dog, and they
adopted her. Unfortunately, Nancy wasn’t able to get over having car anxiety. “We
worked closely with the professional trainers to try to break her of the panting,
drooling, and stiff body language,” says Burger. “While we were thrilled to
adopt Nancy as our own COC dog, we were disappointed that she was not able to
move into professional training to offer help and hope to someone in need.”
As puppy raisers, Burger and her family volunteer to provide everything for the puppy for the first 10 months of its life. Then they turn the puppy in for professional training. “We pay for the food, vet bills, vaccines, anything the puppy needs,” says Burger. “We are responsible to teach around 30 commands to the puppies at home — which are modeled through puppy class sessions — such as sit, down, back, side, heel, up, car, off, etc. Along with this training, our most important role is to socialize the puppies in public to get them ready to handle numerous situations in order for them to provide the most support to their future handler. Puppy class also provides field trips for the puppies to experience trains, buses, and even practice with getting through TSA and onto an airplane. The more confidence through varied experiences we can provide to the puppy, the more prepared they are for professional training and better prepared to be a strong assistance dog.”
Although they give so much to CCI and the community through raising puppies, Burger says that she and her family get a lot back as well. One of the best experiences has been seeing how the lives of those who receive dogs from CCI are radically changed. “Parents of an autistic child who, after receiving a dog for their son, were able to sleep through the night for the first time in 8 years because having the dog in bed gave him so much comfort,” says Burger. “I have also participated several times at Paloma Valley High School’s ‘Paws for Finals,’ where puppy raisers in the area bring their puppies to the school during finals. The kids are able to come pet and love on the dogs to minimize their stress. It brings tears to my eyes every time when I see a group of the popular kids, the geeky kids, the Emo kids, the shy kids, and the athletes all sitting around with their hands on my puppy, sharing dog stories together. It is also interesting that the puppies are absolutely exhausted after this stress-absorbing time with the kids!
“We are very proud to be associated with such an organization,” says Burger.
When people experience sexual assault,
they may sustain more than just physical injuries; trauma also affects short-
and long-term mental health. The medical treatment needed may require a
provider to examine parts of the body that were recently violated, which can
cause more distress. When reporting an assault, survivors often lack the
information they need about how to proceed.
Sexual assault nurse examiners
(SANEs) are trained to help survivors across this spectrum of patient care.
From providing evidence-based treatment to performing assessments to collect
forensic evidence that can be used in a criminal trial, these nurses play a
critical role in supporting survivors at the beginning of their recovery
What Is the Role of a Sexual Assault Nurse Examiner?
When a sexual assault survivor comes to a SANE-certified hospital or community health center, a sexual assault nurse examiner is the first point of care, according to Kim Day, forensic nursing director for the International Association of Forensic Nurses (IAFN). SANEs ask the patient if they would like a forensic exam, which can be completed even if the patient decides to not report their assault to law enforcement.
“Just going through the process with
someone and providing holistic patient-centered care for that patient during a
traumatic time in their life can really impact the way they leave the
hospital,” Day said.
Forensic exams are meant to document
trauma from the assault and collect evidence that could be used in a criminal
trial. This includes taking a medical history; documenting scratches, bruises,
abrasions, and other injuries on a body map diagram; taking photos of injuries;
collecting DNA swabs to be processed; and observing the patient’s behavior. In
cases where toxicology information is relevant, SANEs will also perform those
tests on a patient.
In addition to performing a forensic
exam, the main duty of a SANE is to provide holistic nursing care for the
patient. Survivors of assault may need access to testing for pregnancy, as well
as prophylactic antibiotics to prevent the contraction of diseases. Depending
on the patient’s needs, SANEs also provide referrals to see other specialists,
such as a licensed professional counselor, who can help them in their recovery
The SANE in Court: It’s Not Like “Law and Order”
Beyond working in the clinical
setting, SANEs are qualified to testify in court if a patient’s case goes to
trial. The specialized training SANEs receive prepares them to effectively
answer questions regarding evidence discovered during a forensic exam. However,
while SANEs can play a critical role in the trial process, the legal aspect of
the job is not the main focus, Day said.
“If the nurse goes into this work
thinking that they’re going to get the bad guy and put him behind bars, they
will fail at this… because that is not what we do,” she said. “The work we do
is nursing. We take care of the patients.”
This is a key factor to consider when choosing to become a SANE. Nearly 80 percent of sexual assaults are not reported to law enforcement, according to a Justice Department analysis of violent crime in 2016 (PDF, 669 KB). While performing a forensic exam and being prepared to provide evidence in court is a requirement of the job, the emotional and medical needs of a patient come first.
SANEs are trained to work within a multidisciplinary team, also known as a Sexual Assault Response Team (SART), which includes survivor advocates, members of law enforcement, and mental health providers. Together, these professionals coordinate the response to survivors of sexual assault.
What Is a Sexual Assault Response Team?
SANEs and other trained health care
providers: When an individual decides they
would like to have a sexual assault forensic exam (SAFE), health care providers
like Nurse Practitioners (NPs) or SANEs address the initial physical and
psychological needs the patient might have as a result of their assault.
Survivor advocates: Individuals who need access to information and emotional
support can work with an advocate to navigate their path to recovery. A
survivor may reach out to an advocate via a crisis center, or one may be
brought in to support someone who has decided to seek treatment at a hospital
or report their assault to the police.
Law enforcement: In cases where an individual decides to report their
assault, police officers and detectives are responsible for taking statements,
coordinating with the hospital to receive the results of the forensic exam, and
investigating the alleged assault.
Prosecutors: In cases where the survivor has chosen to report their
assault and enough evidence is present, prosecutors are tasked with making the
decision on whether to bring the case to court.
Therapists and counselors: In the aftermath of an assault, whether a case goes to trial
or not, survivors need additional support to continue their recovery process.
Mental health professionals trained in working with sexual assault survivors
may provide care at any step in the recovery process, from coping with the
immediate aftermath of an attack to navigating long-lasting trauma.
SANE education programs are designed
to train nurses to address survivors’ specific needs. After completion of this
training, SANEs become uniquely qualified to treat this vulnerable patient
group. This means that they can provide trauma-informed care to minimize the
harm of invasive exams that may trigger a patient. In doing so, they can also
equip their patients with forensic evidence that can be used if they decide to
report their assault.
One of the key challenges of
completing a sexual assault forensic exam (SAFE) is examining a patient’s
physical injuries without retraumatizing them. To help survivors feel
comfortable, SANEs ask for consent during each step of the way while providing
information on why they are doing each test.
“Consent is not just a piece of
paper with a signature on it,” Day said. “It’s a process throughout the exam.”
In practice, the process of asking for consent may resemble the following:
will inform the patient what body part they will examine and ask permission to
do so. “I’m going to examine your neck now
to see if there are any injuries. Do I have your permission to do so?”
patient grants this permission and the SANE notices something that may require
a sample collection, the nurse will again ask for permission to collect a
specimen and explain why collecting that evidence is appropriate. “I notice a scratch that wasn’t
mentioned when I documented your health history. There may be DNA or other
materials near this wound, so I would like to swab it. Is that OK with you?”
In any instance where the patient
does not want a test performed, the SANE is directed to honor the patient’s
request. This integration of consent throughout the exam is meant to give the
patient a sense of control, a feeling that may have been lost during their
What Are the Requirements to Become a SANE?
Because SANEs work with a patient population that requires specialized care, nurses are required to meet certain expectations in order to take on this role. While some nurses go through training at the local level or through smaller programs, IAFN offers the most recognized certification for SANEs. Nurses can become certified as a SANE-A to care for adults and adolescents or a SANE-P to work in pediatrics. Some nurses elect to pursue both certifications so they can provide care to patients across all age groups.
Steps to SANE Certification
Education: To become a certified SANE, a nurse must have the minimum of a registered nursing (RN) license.
Experience: Prior to starting the certification process, a nurse must have at least two years of clinical experience working as an RN or at a higher level, such as an NP.
Training: As part of the certification process, nurses are expected to complete 300 hours of SANE clinical skills training.
Testing: The final requirement to become a certified SANE is to pass a certification examination. IAFN holds exams two times a year.
Health care is a field that requires compassion — but this is especially true for those working in correctional care. It requires the ability to see beyond someone’s criminal record and provide the best possible support for every patient, many of whom did not have access to health care prior to being brought into custody.
Understanding the Correctional System Population
Working in a correctional setting
means working with a vulnerable and underserved population. A 2016 report from the Bureau of Justice Statistics
on the health issues in American prisons and jails (PDF, 910 KB) found that incarcerated individuals were more likely than
the general population to experience chronic conditions and infectious disease.
Of those surveyed, 40 percent reported having a current chronic medical
condition, while 21 percent of individuals in prison and 14 percent of
individuals in jail reported a history of tuberculosis, hepatitis B or C, or
other STDs (excluding HIV or AIDS).
The prominence of health issues in
correctional facilities is compounded by the fact that many incarcerated people
do not have consistent access to treatment, meaning they arrive with
“We see our patients at their
worst,” said Richard Hammel, the nursing program manager for the Denver Sheriff
When an individual arrives for the intake process, Hammel and his colleagues are tasked with performing an initial medical exam. He said that many of his patients find out for the first time that they have an existing condition like hypertension or that they have contracted an infectious disease. Others may show signs of substance abuse, in which case they are taken through a detox process. Many incarcerated patients also show symptoms of mental illness, (PDF, 454 KB) which necessitates further care from clinicians.
What Is the Role of a Correctional Nurse?
Nurses are critical in the continuum
of care for people who are incarcerated. While procedures can vary from
facility to facility, nurses are typically the first point of contact.
Correctional nurses perform intake exams, distribute daily medications and
assess when a patient may need to see a specialist for further observation.
Given the responsibilities of a
correctional nurse, paired with the range of health issues they encounter, it’s
important to have a broad skill set that includes dealing with chronic medical
conditions, substance abuse, mental health, infectious disease and injuries.
Having experience in an emergency room setting, for example, may help a nurse
more easily transition to working in a correctional setting.
Correctional nurses are also
expected to work autonomously in most cases, which can be a desirable aspect of
the job to many in the nursing profession.
It takes a team to care for an
incarcerated population. Below are some examples of the points care providers
offer to meet the physical and psychological needs of those in correctional
When individuals are incarcerated, they undergo an initial physical assessment to determine what needs they will have during their time in custody, including chronic health issues, mental health and substance abuse.
Who provides this service: nursing staff, including registered nurses, nurse
Patients with chronic conditions may need daily medications, which are distributed by a provider to ensure adherence.
Who provides this service: licensed nursing practitioners, registered nurses
Some chronic conditions, such as asthma or hypertension, require additional treatments and monitoring.
Who provides this service: registered nurses and specialists, including nurse
Incarcerated individuals who have sustained an acute injury or serious illness may need specialized treatment from an inpatient facility, such as a hospital.
Who provides this service: radiologists, respiratory therapists, phlebotomists,
pharmacists, physical and occupational therapists, registered nurses and nurse
practitioners and specialists such as surgeons, gynecologists and oncologists
Patients may have existing conditions such as schizophrenia or bipolar disorder or may need aid if they experience trauma within a correctional facility.
Who provides this service: behavioral health care specialists, counselors, nurse case
managers, social workers, psychiatrists
How Does Working in Correctional Care Differ from Traditional Settings?
While the mission of a correctional
nurse is the same as any nurse—to provide the best possible care for every
patient—working in a correctional facility has some distinct differences from
traditional health care settings.
Correctional facility protocols are, in a word, strict. Because the presence of a deputy or corrections officer is required during exams, for instance, it can be difficult to maintain patient-provider confidentiality. Also, when an individual knows someone else is listening, they may feel uncomfortable or even be unwilling to speak openly about their health problems.
While the safety and security measures of a correctional facility may be unfamiliar to those who have only worked in traditional health care environments, correctional nurses can still provide compassionate care for their patients. For example, Hammel said that he and his staff are trained to assess whether it is safe to ask the officer on watch to step out briefly during an exam. This helps build trust with a patient, and makes him/her less likely to withhold any relevant information that may impede their care plan.
The need to be vigilant and
protective of one’s personal information is another aspect of the job that may
feel foreign to health care providers outside of the correctional environment.
Providers are advised not to share any details about their life outside of work
with patients who are incarcerated, which can create some barriers for building
trust and showing empathy.
“Sometimes nurses like to use
themselves as a tool in treatment and share stories [to empathize]. That is
just something you can’t do here,” Hammel said.
Instead, Hammel implements the
following strategies when building rapport with his patients:
Ask questions to gauge a patient’s fears, concerns and general thoughts about their health issues.
Take time to appreciate a patient’s perspective.
Follow through with what you say you can do for a patient.
There is also a common perception that treating individuals in a correctional setting is less safe than working in a traditional environment. Hammel, though, says that in his experience, this perception is largely a myth.
“I have never felt afraid or been attacked [in the workplace],” he said, because “there are deputies close by to step in and make sure everyone is safe, both the patient and the health care worker.” Other correctional nurses have voiced similar sentiments, saying that working in a correctional facility often feels safer than in a hospital. There is not current data to compare the experiences of correctional nurses to those in traditional settings, but safety and security are top priorities for correctional facilities. The presence of correctional officers, the access to call buttons in every room, and training to identify the early signs of escalating and agitated behavior are all factors in preventing incidents between patients and providers.
Correctional Health Care and Employee Burnout
While compassion fatigue is a common term known among health care providers, clinicians and other correctional care providers may experience a more specific feeling known as corrections fatigue.
Corrections fatigue is “the
cumulative negative change over time of corrections professionals’ personality,
health and functioning” that results from poor coping strategies or a lack of
resources necessary for the requirements specific to working in correctional care,
said Caterina Spinaris, executive director of Desert Waters Correctional
Outreach in Florence, Colorado.
When someone experiences a series of stressors during their day-to-day life, as a result, “these stressors interact,” Spinaris said. “They are cumulative.”
How to Avoid Correctional Burnout
Build your support system This can include your partner, family members, fellow colleagues and friends.
Practice mindfulness Find activities that help ease your stress and process your feelings. This can include journaling, meditation, exercise and other calming activities.
Find activities that don’t intersect with work Finding a balance and separating your personal life from your work life can help avoid burnout. Hiking and outdoor activities, for example, put you in an environment that is completely different from your job.
Get help If serious symptoms such as depression, panic attacks or substance abuse begin to manifest, consider seeking help from a mental health professional.
Telemetry is widely-used by hospitals and health systems as a means of providing continuous cardiac monitoring for designated patients. While internal development of these programs has been the norm, the ongoing management of these internal programs has absorbed significant resources for many hospitals and hospital systems. As a result, health care organizations are increasingly turning to remote telemetry monitoring (RTM) services in an effort to decrease internal resource burdens while simplifying and enhancing care delivery. Marcia Murphy, Vice President of Clinical Operations and Nursing for Advanced ICU Care, sits down with DailyNurse.com to discuss this developing trend.
How have hospitals traditionally addressed cardiac monitoring in house?
In-patient cardiac monitoring is often relied upon by
hospital bedside teams as a means of continuously evaluating hospital patients
with certain medical conditions, those with cardiac-related co-morbidities, and
individuals on specific medications who require that extra layer of
observation. This monitoring is frequently provided to patients throughout the
facility and is rarely restricted to a cardiac unit. Traditionally, a
high-quality in-house program relies on trained technicians or nurses who are
responsible for the real-time monitoring and interpretation of patient cardiac data
transmitted via waveforms and the engagement of additional clinical personnel
when changes or abnormalities are noted. In some instances, hospitals use an
on-unit approach, while others use a centralized facility-specific approach.
Both approaches can eat up significant management time and can create a wide
range of clinical and administrative inefficiencies.
What are the potential limitations of such an in-house approach?
Launching and maintaining an on-site telemetry program is neither simple nor self-sustaining. Rather, programs can often pose a significant burden to clinical leadership who are more accustomed to supervising clinicians at the bedside than monitoring teams in a “clinical bunker”. On-going management, supervision, and 24/7 staffing of the telemetry program includes continuous recruitment efforts, periodic training, and detailed direct management of an hourly workforce. In the case of an on-unit approach in which dedicated telemetry technicians are not assigned, the time available for continuous monitoring can vary and therefore the quality and consistency of monitoring can fluctuate. For example, nurses tasked with bedside patient responsibilities as well as telemetry monitoring can be inundated with perpetual tugs on their time, forcing difficult decisions regarding exactly where their bandwidth is best spent.
What does a remote telemetry monitoring model look like versus a build your own approach?
I feel that implemented appropriately, RTM delivers both the
enhanced clinical benefits associated with a specifically trained and focused monitoring
team as well as the elimination of the bulk of related administrative costs and
headaches. In addition, RTM can free up
both budgeted headcount and space in the hospital.
With a partnered telemetry model, hospitals benefit from the
same 24/7 continuous cardiac monitoring by certified technicians or nurses that
one would expect in an in-house program. Utilizing telemetry monitoring systems
that allow for remote patient observation, trained personnel can monitor
hospitalized patients’ cardiac functions, review alerts and when necessary
collaborate with bedside care teams to assess patients that require clinical
attention. In these instances, recruiting, hiring, training, and productivity
management for the monitoring personnel are all off-loaded to the selected
clinical services partner.
Rather than working to sustain a fully staffed and well-managed telemetry program, a partnered solution allows hospital leadership to focus on clinical improvements and allows nurses to attend to patient care rather than the constant monitoring alerts. Further, working with a telemetry partner enables an on-demand monitoring resource supply that flexes based on a hospital’s census and patient risk profile. This approach assures that cardiac care is not constrained by staffing unavailability and, conversely, the risk of costly overstaffing and operational inefficiencies due to mis-estimated patient census expectations.
How have care teams traditionally reacted to the adoption of a RTM solution?
In my experience with Advanced ICU Care since we introduced our RTM services, client acceptance has generally been very positive. As with any change, the disruption of the status quo needs to be thought through and managed in advance. What I think is key to the success of our telemetry partnerships is building collaboration and ensuring that bedside nursing teams know what to expect and understand both the programmatic and personal benefits that come with such a program. In selecting an RTM solution, it is important for the bedside leadership team to screen for a partner that listens well and is focused on appropriate collaboration.
I also think it’s important to reinforce the fact that the
bedside nurse’s voice ultimately leads on all care-related decisions. RTM is a
supportive function intended to allow bedside nurses to focus on the treatment
of their individual patients more closely which should be viewed as a positive
benefit. Just as with any introduction of new
methods or processes into the delivery of patient care, there will be a
smoother implementation and improved synergy among stakeholders with proper
communication that reinforces how the telemetry process adds additional support
for the bedside care team.
How does remote telemetry monitoring lessen the resource burden on care teams?
At the end of the day the primary goal of telemetry monitoring is to ensure that hospitals and health systems are offering outstanding care 24/7 to some of their most at-risk patients throughout the facility. With RTM dedicated remote telemetry technicians make this possible by allowing bedside care teams to make care and treatment for patients with urgent needs their top priority. This is accomplished by removing the distraction of the bedside caregiver’s valuable time driven by simultaneously managing all cardiac monitor alarms. Having all readings monitored in a central place around the clock allows bedside nurses to be more focused on their patients and their care delivery and diminishes false alarms and the alarm fatigue frequently experienced on units outfitted with telemetry infrastructure. These high-quality, remote telemetry programs include trained telemetry technicians that provide real-time interpretation and immediate notification to the appropriate nurse or physician. Ultimately, remote telemetry monitoring allows a nursing staff to focus on our number one goal: providing the very best possible patient care.