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.

[KeepItRealRN, BSN, RN]

when they call me for my exit interview they are going to hear a ton from me!

As much as you want to and probably need to do this I advise you not to. Administration already knows how much the place sucks.

When you have the exit interview thank them for the experience and opportunity to work there and how it has helped you be ready for your next job.

No matter how s**ty a place is I advise never burn bridges. Reason being is that it is a small world and that person who you have your exit interview with may be in a position to hire you somewhere else you really want to work at.

Believe it or not, not all people in admin are evil. Some are that way because their boss expects them to operate like that or they will find someone who can.

I have had previous managers who were in a position to help me get a good gig years after I worked for them. I always left on a positive note.

Years from now that exit interviewer may be interviewing you for your dream job somewhere else, or may be interviewing you for a grad program. You never know.

It is a small world.

[VANurse2010]

As much as you want to and probably need to do this I advise you not to. Administration already knows how much the place sucks.

When you have the exit interview thank them for the experience and opportunity to work there and how it has helped you be ready for your next job.

No matter how s**ty a place is I advise never burn bridges. Reason being is that it is a small world and that person who you have your exit interview with may be in a position to hire you somewhere else you really want to work at.

Believe it or not, not all people in admin are evil. Some are that way because their boss expects them to operate like that or they will find someone who can.

I have had previous managers who were in a position to help me get a good gig years after I worked for them. I always left on a positive note.

Years from now that exit interviewer may be interviewing you for your dream job somewhere else, or may be interviewing you for a grad program. You never know.

It is a small world.

I'm sure this nurse had the exit interview as she posted 3 years ago

[VANurse2010]

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.!

I know this is an old post - but O My.

F*** that S***

[KeepItRealRN, BSN, RN]

I didn't look at the date, you're right.

[Kimberlyace]

I know this is a late response, but in the event someone else comes behind and reads up on the topic, I wanted to throw in my two cents!

I currently work night shift on a cardiac stepdown/PCU... We have been short staffed for many months and I have up to 7 patients on nights of terror. I average 5-6 on night shift. The average load will include one post pacemaker and/or one post cath (with TR band still in place), one or two on cardizem gtt, and one on heparing gtt, the rest may be overflow that needed a stepdown unit. But these are always intense floors.. I hope after my time here, I can go almost anywhere with the all the time management practice I've had!

[blackvans1234]

Since this has been brought back, i'll give my 2 cents.

At my hospital we can have anywhere from 4-6pts per nurse on days / nights. The other night I had 5 and was next up for an admission.

We don't do open heart, we get hep drips, cardizem drips (no titrating), amiodarone drips, post caths, chf'ers, septic patients, resp failure patients on bipap. I recently had 2 hep gtt patients (one also was a cardizem gtt). The facility is usually pretty good about preventing multiple heparin drips per nurse though.

[lindarn]

I believe that, in situations like this, with short dangerous staffing, nurses need to keep a log, of their patient loads, any near misses, to be used as evidence to get nationwide nurse staffing.

Having concrete evidence to debate the issue is/will be, invaluable in the debate.

JMHO and my NY $0.02

Lindarn, RN, BSN, CCRN(ret)

Somewhere in the PACNW

[sugarmagnoliaRN]

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.

6 patients including LVADs? That's rough.

[JustKeepSmiling, ADN, BSN, RN]

IMHO a stepdown unit should be 3:1 if high acuity and no more than 4:1. That fifth patient can send a nurse over and jeopardize patient care. Much like the 6-8th patient in M/S can send you overboard.

I second asking to shadow for at least 4-5 hours. Talk to as many nurses as you can, PCTs, even the secretary.

[BeatsPerMinute, BSN, RN]

At a large hospital in MN we had 3:1 and SOMETIMES 4:1 (rare), 5:1 was common on nights only

[nrsbecca]

Yes. We started out having 6 patients when I worked step down. We had pod 1 Cts patients that were on insulin gtts which were titrated every 1-2 hours. We had cardizem, amio, dopamine, dobutamine, heparin, and other gtts. We watched our own monitors too. We had a 30 bed unit and sometimes only 2 pca's. This is why all states need to push for ratio mandates.

[RNbubu]

3:1 where I work. The only drips we can titrate are heparin and insulin. All other drips we cannot titrate in the stepdown unit, if that is the case the patient is moved to ICU. We also have lots of patients on ventilators or who are total care. and no CNAs or phlebotomists. I could not imagine having more than 3 patients.