Cardiac Nurses please help!!

  1. My question is, what is a good ratio for patients in a cardiac stepdown unit? I just interviewed for a position on a unit that sounds like it is perfect for me because I want to work in the cath lab eventually. It is a cardiac post-procedure unit (caths, EPS., etc.) This floor is also being renovated to add a CCU unit which I will eventually float into. The nurse manager told me that the ratio ranges from 1:3 to 1:5 and can vary throughout the day due to rapid admits and discharges. She said that if we were in the CCU it would be no more than 1:3, but in the post procedure area it could go as high as 5. Does anyone know if this is too high? I would like to take the job, especially for the experience, but don't want to get in over my head!
    Thanks a million for any input!
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  2. 13 Comments

  3. by   oMerMero
    From my experience cardiac stepdown units are usually staffed 1:4.
    CCUs, if a true ICU should be staffed 1:2
  4. by   heartlover07
    Thanks for your reply. Another question I have is if this is appropriate experience for a goal of the cath lab eventually? What type of hours do you normally work in the cath lab? I know that you have to be on call, but on a scheduled day what are your usual start times and end times? thanks again!
  5. by   mom2michael
    We are a tele unit that takes post caths, EP studies, pacers, etc.. We can do drips, but no titration. We generally staff for a 1:4-5 ratio but we've gone as high as 1:7 before but it's not often. We are generally staffed on nights no more than 1:5-6. You are busy, but it's doable.

    We are in the process of getting a 6 bed "step down" unit, which will be staffed 1:3 with 1 tech for the 6 beds - but only in that area. These will be our complicated cases and those that need to have titrated drips.

    We can usually admit up to 10-15 patients a day and d/c up to 20 a day - we have a LOT of turn over which is normal for post caths, obs chest pain patients and post pacers, who usually in our facility do not have a long stay unless there are complications. Our long termers are our pneumonia patients, COPD patients and resp distress patients.

    Most of our cath lab nurses have worked on Tele and CCU/ICU. A couple of them worked CVICU. Most have 4-5 years of experience before the cath lab will let them come to work there. They work 6-???? They take call about 1 weekend a month and 4-5 days (nights) per month as we run a 24/7 cath lab.

    They run a 8/80 schedule, so anything they work over 8 hours per day is paid at 1 1/2 times - this allows them some extra when they don't have cases scheduled, because they only get paid when the docs work.
  6. by   heartlover07
    Mom2Michael
    This sound exactly like the unit that I will be working on. They are also in the process of making a four bed "stepdown" for post CABG patients that will be staffed 1:3. I just accepted the position on Thursday, and I feel good about it, exactly what I was looking for in terms of experience since I am very interested in anything cardiac related. Thanks for the information!!
  7. by   fromtheheartRN
    The unit I work in is "Progressive Care," aka "step-down" or "telemetry." We have a 3:1 ratio if no tech, 1:5 with a tech. We do all of our own blood draws, orders, ECG monitoring (via stat view), and follow up phone calls. In short, it is a heavy workload floor. I would question this variability re: admissions and discharges. The MOST busy day is when I have a high turnover of patients. I would inquire (if I were you) about the turnover among NURSES on the unit. This can speak volumes about the work environment and expectations.
    But....I just noticed that you already took the position, so I guess this suggestion would be outdated. BUT you can always opt to go back to your previous unit if it doesn't work out for you (depending on your hosp policy).
    Good luck!
  8. by   Ubernurse
    :heartbeat I currently work in a CV step down unit. We get the post angiogram patients along with CABG, CP r/o MI, CHF, tele, etc. Our ratio is 4-1 which is great. it's 3-1 if we have an integrilin of insulin gtt. At the moment we are having severe nursing shortages though to where we are goin gout of compliance. In the past 4 shifts, three of them I had to have 5 patients at once. It was tough, but do-able. I love the floor. It was just really busy. but everyone is so supportive on dayshift so I always had a helping hand if I needed one. So, it is do-able.:heartbeat
  9. by   heartlover07
    Ubernurse,
    I see that you are a fairly new nurse, how was it starting out on this type of unit? Also, how often do you have patients that code or (if I may ask) have any passed while you have been there? The only reason I ask is that I am on an oncology unit for clinical and just had a patient pass-I found it very difficult and I know that it is part of the job, but I am just curious about how much of this you have seen. I hope it's not a weird question
    Thanks a million!
  10. by   Ubernurse
    It was fine starting out on a CV step down unit. I externed there for about a year first and got hired right out of school. I have been working there as an RN since June 1st. So in almost two years I have yet to have a patient code on me. I have had one patient die, but it was almost planned d/t her pulmonary fibrosis so the family and docter were well informed. I just happened to work on that unlucky day. I would think that on an oncology unit you get to know the patients more than I would because they are there longer so I could imagine that it would be more difficult when they die. I hope any of this helped. I LOVE where I work
  11. by   georgieporgie282
    You all sound as if you enjoy your jobs. I just accepted a position on a telemetry floor; I'm very nervous. I have been a nurse for 11 years, but all my experience is in SNF/LTC and as RN Supervisor of a 121-bed facility. This is all very new to me. The hospital has assured me I will be well trained before they turn me loose. I am wondering if any of the skills I already have will be of any use, since the turnover rate is so high; I'm used to knowing my patients pretty well in most cases. I am working out my notice this week and start my new job (orientation) a week from today. Am I crazy? I hope I can handle it, not that LTC is a picnic! It's hard work, very busy and overwhelming at times, but in a different way. I worry I won't fit in with my new co-workers; I've seen a lot of acute care nurses look down on SNF/LTC nurses. Any advice?
  12. by   Joanne1033
    I think you will do great. I started on a telemetry unit as a new grad...with 3 other new grads starting at the same time......we are now just into month 5 and all doing well. So, i am sure your experience will be more helpful than you are giving it credit. Good luck and I hope you enjoy the change.
  13. by   ohiorn_78
    I wouldn't take that workload if you want to provide appropriate and safe patient care. I work on a cardiac step-down unit right now that staffs 1:4 most of the time and that is a bit much the majority of the time. A good nurse to patient ratio would be 1:3, in my opinion.

    Our unit takes patients with drips and also pre and post-op CABG. Post cath pts. can vagal and go down hill very quickly without warning then your ACLS kicks in. That is way too much when you have other pts. in the same kind of status as that one or worse. Post-op CABG pts. are a tremendous responsibilty and things could go wrong within seconds.

    Don't risk your license or your health by taking on too big of a responsibility. Good luck with your decision!!
  14. by   Praise,RN
    1:4-5 seems about right depending upon stability of the patient. This can becoming overwheling however at any time....

    Remember: know your limitations (protect your license)

    Praise, RN,BSN

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