Cardiac Stepdown unit 5:1 patient ratio...is this normal??? - page 3

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... Read More

  1. by   VANurse2010
    Quote from 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.!
    I know this is an old post - but O My.

    F*** that S***
  2. by   KeepItRealRN
    I didn't look at the date, you're right.
  3. by   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!
  4. by   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.
  5. by   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
  6. by   sugarmagnoliaRN
    Quote from 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.
    6 patients including LVADs? That's rough.
  7. by   JustKeepSmiling
    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.
  8. by   BeatsPerMinute
    At a large hospital in MN we had 3:1 and SOMETIMES 4:1 (rare), 5:1 was common on nights only
  9. by   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.
  10. by   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.
  11. by   KBRN15
    I work on a CV Tele/Progressive unit, and on a bad day/night, it’ll be 4:1. Most of the time 3:1, but last night I only had 2 patients and an “admit” bed that never got filled. We have gtts, chest tubes, etc but no vents and we also can’t titrate gtts unless its heparin or insulin.
  12. by   nursetawnya07
    I work on a cardiac unit and we can have as many as 5 pts depending on census. 5 is crazy tough with assessments meds ivs drips insulin etc
  13. by   marcuchos08
    I work in a neuro step-down unit. We're lucky if we only have 5 pts, a lot of the time we get 6 pts and if we have a discharge we get one admission right away. I've been there for a year and I'm ready to quit but I'm scared I g won't get hired anywhere else because I've only been there for a year.

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