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

by jaznia15

12,283 Views | 27 Comments

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... Read More


  1. 0
    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
  2. 0
    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!
  3. 0
    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???
  4. 1
    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.
    Bap9762 likes this.
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    Quote from pmpkn42
    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.
    calivianya and delphine22 like this.
  6. 0
    Quote from KeepItRealRN
    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
  7. 0
    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***
  8. 0
    I didn't look at the date, you're right.


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