Patient ratios progressive care units - page 3

by kaylasmommy

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I work on a progressive care unit which had a pt:RN ratio of 3:1 when I started 3 years ago and now we are moving to 4:1 ratios now. The facility/mgmt has stated that 4:1 is the national standard for progressive care units now. ... Read More


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    I work on a PCU that is supposed to be primarily an open heart step-down unit. We get all the open heart pts that come out of the recovery unit (with all their drips, pressors, insulin, chest tubes, pacers etc.) as well as other cardio-thoracic surgery pts (thoracotomies, VATS, etc), post cath pts, CEAs, anyone on an insulin gtt (we're one of only 2 floors other than ICU that can have insulin gtts), and anyone who gets admitted from the ER that the MD checks "admit to telemetry". Our pt load is 1:4-5 on days and 1:5-6 on nights. It's always busy and it gets tough when your pt load is pretty acute. I agree w/ what others have said...4 pts is busy, but manageable...adding that 1 extra pt, though, makes it 10 times worse!
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    We currently taking 4-5 pts, having that one extra to make 5 just throws you over the edge. If team leaders would room by acuity if might be better, but you can get a day 1 open heart then a post cath that still needs a sheath pull and then drips with the others. Needless to say, it makes it one very hard day to try to give the care you want too. Famlies aren't happy cause they feel like your not in there, pts upset cause it took you more than 5 mins to get to them, and then the lovely 2 pts decide to code back to back.....I like what I do, but everyday my license is on the line. I am moving on with a different career path, and leaving the hospital all together. CEO's and upper manangement don't care anymore, its all about numbers and we are all replaceable.
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    I worked on a cardiac/step-down unit (not technically termed "progressive care" but the same thing) for about 18 months after graduation. We got as many anginas as we could, outpatient heart cath or pacemaker and/or generator change, drips w/ titration (amio, cardizem, nitro, heparin, insulin, dopamine, dobutamine, occasionally a lidocaine, etc.), thoracic surgeries with fresh chest tubes, bad lung patients on high O2, nonrebreathers, or bipap, cardioversions (inpatient or outpatient). We had a high turnover rate because the if an angina patient's 2nd troponin came back negative chances are they'd go home. If the heart cath was clean they'd go home. Those coming in outpatient would usually go home. The outpatient ones in particular might mean you have THREE patients in a single bed in a single shift (first patient goes home early, get outpatient generator change who goes home that evening, and you get another admit). At first when I was working day shift (on orientation) was at 1:4 which was busy, but doable. Went to nights when I got off orientation and it was 1:5. Still doable since night shift isn't quite as hectic (mostly) and docs aren't writing orders to pull this and start that. When I FINALLY got back to days they had increased ratio to 1:5. CHAOS. How can a single nurse give blood here, assist with a cardioversion here, do q 15 minute post-cath checks here, all while monitoring a dopamine drip with a BP of 70/40?

    Then to make matters worse our hospital combined a regular med-surg floor onto our cardiac/step-down floor. These nurses had to learn to be comfortable with the cardiac monitoring, reading telemetries, cardiac drips, fresh chest tubes, vascular surgeries, etc. SOOOOO while they acclimated the original cardiac nurses got essentially all of the more complex patients....at a ratio of 1:5. I want to say with this about half of the nurses transferred elsewhere or quit, myself included (yay for home health!). If I remember correctly not long after many of us left they decided to put the ratio back to 1:4 "if staffing permitted." Had they done that before running me completely RAGGED and making me dread my job I might would have stayed.......

    Oh and we don't have med nurses or admit/discharge nurses. We did everything. Our aides were usually ran ragged too and ultimately the patient care falls to the licensed nurse so guess who did plenty of turning and butt wiping?? Lol!


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