Cardiac Stepdown unit 5:1 patient ratio...is this normal???

[jaznia15]

I had an interview for a position on a cardiac stepdown unit. The unit receives patients who have undergone cardiac procedures such as open heart, cath lab, and etc. She said a lot of patients come down with drips and what have you and I was quite shocked when she said the patient ratio was 5 patients to 1 nurse. I graduate in May with my BSN and am currently precepting in an ICU in a small rural hospital where the patient ratio is about 1 to 2 maybe 3 sometimes. But usually nurses who receive a drip pt only have two patients to care for that day. I guess things are different at a bigger hospital but I just wanted to ask to be sure. The interviewer did mention they had the highest turnover rate in the hospital for patients with many of them being discharged everyday. I didn't think to ask if these were discharges home or to the floor.

[michellehoong]

I think a 5:1 assignment is ridiculous and unsafe. I work at a small cvicu and occasionally I take 3:1 assignment of step down acuity pts. Just the other day I had 1 pt on heparin gtt who was constantly on his call light, a confused pod1 cabg who's pressure was tanking and while I'm waiting on the doc to call me about that pts bp I check my post cath pts groin to find a huge hematoma with blood everywhere. Ur telling me some places do 5:1?? Unsafe.

I agree.. 5:1 is ridiculous.. unless u realy hands on or hv the real experience.. then only u can tell...In my unit.. the ratio is 2:1... sometimes post opt cabg pt who is restless and uncooperative will be difficut to manage even u share with a post cath patient who is demanding and attention seekers...

[matthewrn03]

Move to california or a state with protected patient ratio's. 5:1 step down is insane. and you say "drips". are you titrating those drips? if you are actively titrating, than the patient belongs in the ICU.

[mpccrn, BSN, RN]

I currently work in a rural community hospital where I rotate between ICU and stepdown. Our ratio is 5:1. Most days it's a nightmare....there is something about that 5th patient that makes the goal of the day to stay just one step before impending disaster. We are currently working really hard now to get that ratio decreased to 4:1......and it looks like we'll win! Can't wait!

[sooperdooper]

If your unit is anything like mine, I couldn't imagine having a 5:1 ratio. During the days, my unit is 3:1, however at night it is 4:1.

[worked hard and long]

As a new grad Just getting use to the new surrounding Docs and personalities, policies procedures and medical equipment can be overwhelming. Unless you have been a CNA with a fantastic nurse mentor things can be overwhelming. PLEASE people this is a new nurse we don't want them burnt before their time. Because they are the one working beside us. Skills are learned gradually. General medical is the best place to start. If the step down has drips that are non titrating that might be OK. If the CVICU is in a crunch that new grad might have to deal with an aline unsupervised, or a chest tube that might be problematic and without advanced skills would be difficult to deal with. Does the floor have a qualified telemetry tech. I have worked and seen several scenarios. No tech but secretary oversite, trained adjunct staff but depending on their experience and willingness to coach a new grad can make or break positive outcomes. I have also worked a floor where the nurse from the floor rotated monitor duty. Even that depended on the nurse experience in arrhythmia detection and how much they were on the phone.

[calijaz]

I work on a unit like this w/a very very high turnover rate (many outpt caths). We take 3:1 by ourselves, 4:1 with a PCA, 5:1 with an LPN or 6:1 with both an LPN and a PCA. The LPN or PCA usually has 10+ patients. Sometimes its so slow and sometimes its so fast paced with high acuity. And sometimes MDs forget we are not an ICU!

[emilyBABSNRN]

This is the norm where I used to work. We activley titrated ALL THE TIME most everything except dop and lido...although we could have low-dose dop and lido patients who were DNR (go figure). And it was not abnormal to have 5-6 patients sometimes on day shifts. This type of floor is only for the most ambitious new grad. With patients coming in and out with clean caths daily, it was not uncommon to have a total of 8 patients in one day with people coming and going. Needless to say the floor has an absurdly high staff turnover (BURNOUT) rate. I worked on this unit as a new grad and literally went in a sleep coma after my shifts. It was hard to get the motivation to go into work most days becuase you knew it was going to be ****. It was great experience, though, that is for sure.

[elthia]

Normally 5- 6 pts, drips no titration, sometimes PCA's epidurals, CABG, thoracotomies, AAA's, fempops, carotids, PTCA/PCI's, Class III/IV CHF on inotropes, LVADs, heart transplant, pacemaker, ablations, etc.

I take that back, occasionally we get an insulin gtt, and titrate that, but not very often.

[mpccrn, BSN, RN]

our ratio for Cardiac SDU is 5:1, working hard to cut it to 4:1. Is 5:1 do-able? sometimes, does it suck? Always. There is something about that 5th patient that just puts the assignment over the edge

[pmpkn42]

I work at a stepdown unit and our ratio is 4:1, but we often go up to 5:1 without CNA help. We also have opened the critical care waiting room and "transformed" it into patient care areas. Mind you we put 4 patients in the waiting room with NO suction set up, and portable O2 tanks. Can you say ridiculous!?

We also actively titrate Dopamine, Dobutamine, Cardizem, Nitro, etc, take post Op day 1 CABG patients, neuro patients that require Q2 hour neuro checks, and we take all the chest pain patients and all the PTCA patients. We have to have a minimum of 20 patients to have 2 CNA's, otherwise we just have 1, and sometimes NONE. Did I mention we take trached and vented patients? Oh, and our charge nurses are expected to take a full load of patients 75% of the time. The acuity is extremely high.

We have an incredibly high turnover rate and are always short staffed. No agency wants to send us there nurses because they can't handle our unit. And to make everything more wonderful we currently have NO manager for our unit. The administration is ridiculous and all they care about it making $$ and not patient care or safety.

I recently left (the 5th RN this month alone), and when they call me for my exit interview they are going to hear a ton from me!

[Bap9762]

Hi @fancypantsRN !

I've worked on a PCU for 3 years, and I'm now changing hospitals so I applied to their CV stow down unit. Do you think it's harder or more difficult than PCU? I know you're not getting as many GI bleeds, overdose, ETOH withdrawal, vents.. Etc but the ratio of CV stepdown is 4-5:1. I've only worked on 3:1 and now more often 4:1. Will it burn me out???

[delphine22]

Our ratio at night is 4-5, during the day anywhere from 3-5. We get float nurses often and we are careful with giving them a pt that is a heart or lung, vs a pt that really is less acute than our floor needs. (We have lots of private beds so we will often get the random isolation the semiprivate tele floor has no room for.)

We get cabg pod 1 or 2, lots and lots of chest tubes, our surgeons are very visible on the unit and want their pts walked 4x/day. We can get post ptca (usually they go to telemetry), we can pull lines but I haven't seen that done in a while. If you are pulling lines I'd insist on no more than 4.

We may also get CEAs come with a-lines still in place, but if they need pressors and are really unstable we'd ship them to csu or icu.

We don't get vents, in fact our hospital does not even allow rescue bipap on the floor at all, they have to go to the unit. (My other hospital routinely puts bipaps on the PCU, not step down, floor.)

A lot depends on the charge nurse the shift before you. It's their job to make the assignments based on acuity, not overload one person, and demand more staff/transfer some pts if warranted. The hardest thing to do as a charge nurse is to convince the supervisor that you need another nurse based on acuity, when the numbers don't seem to back you up.