A Different Approach to the Monitor Staff Role
Concord Hospital in New Hampshire has developed a unique AvaSys position, a hybrid of video and telemetry monitoring with a “flier” role linking the central observation station to the medical units. The goal is to create a tight-knit team trained for cross competencies whose members stay engaged throughout their 12-hour shifts. The three roles allow the opportunity to rotate to each position every 4 hours.
The idea came about organically, said Jennifer Dongarra, RN, BSN, MM, Director of Medical Specialties/Oncology Patient Care Units at Concord, a 295-bed community hospital with a Level II trauma center. “We were in the process of developing our video monitoring system. We had talked about the monitor tech role and how a full shift of that would be such a long time for somebody to be sitting in front of the monitors and staying focused. About the same time, we were getting ready to implement telemetry on two units, and saw an opportunity to create a Central Monitoring Department that combined both telemetry and video monitoring.”
Creating the team “was really kind of fun,” Dongarra said. Eighty-five candidates were interviewed for the 16 positions that make up the 24-7-365 team. A variety of licensed nursing assistant candidates, including a few with telemetry background, applied. A few external candidates were hired to bring a “different kind of vibe” to the team, she said.
Dongarra and Tom Gullage, RN, the nurse manager for the Central Monitoring Department, created an orientation program before the department went live, so that everybody got training together in video and telemetry, including two days of classes in dysrhythmia. There were team building classes and sessions in the hospital’s simulation lab to recreate the experience of being on the video monitor.
The hybrid position is a step up in the pay grade from LNA, because of the telemetry piece. “More than the pay, though, people are just interested in joining the monitoring team,” Dongarra says. “It’s different, because they still get to have patient interaction when they’re in that flier role, but they also are doing a technical job that changes all the time.”
The flier role has complete responsibility for the AvaSys room units, moving and setting them up when a decision is made to have video observation, then removing them and cleaning them when a patient is taken off monitoring. The role also involves patient and family education on video monitoring. When the flier is not needed in Central Monitoring, they are able to assist with patient care on the medical units.
The monitoring room is spacious, allowing for the two large monitoring screens and chairs. “If the video monitoring is very active, the tele tech or flier can act as a second set of eyes,” Gullage said. “And having everyone cross-trained means the staff always feels like they can take a break when they need to.”
When the program started in June 2015, policies, procedures and work flows were established, but the team quickly made them their own, Dongarra said. “This is probably one of the most engaged teams that I’ve ever worked with, and they’re very vocal, so they’ve been very helpful in changing those work flows when they need to be changed.”
Having such an engaged team out on the floor has had a significant impact on falls, particularly in the two medical units, which experienced a more than 50% decrease in the first year post go-live. The successes have led to greater use by staff.
“Sometime last year, we started seeing the shift where we didn’t have to sell the camera as much. Nurses were coming to us, to the point where we typically have a significant waiting list,” Gullage said. “The leadership on the units has helped also promote the use of the cameras. When they have a patient requiring a 1:1 sitter, they are quick to assess whether or not the patient is appropriate for the cameras.”