I tried searching for a similar thread - I had no luck, but if I'm missing something obvious, I'd love someone to point it out. This was kind of a difficult term to query for.
I'm a new grad who went to school in a large city and recently moved for my first job in a general, mixed medical/surgical "stepdown ICU" (called an SCU, Special Care Unit) in a small, rural hospital. It's been a great change and I'm loving the fresh air. Having spoken to some friends who've started working back in stepdown units in the city, I wondered if some better-travelled critical care nurses could offer some insight on this subject.
I'm basically wondering if any of you believe the admission criteria and general acuity in a rural stepdown unit is different than that of urban. For example, might patients considered 'stepdown' in my small rural hospital just be general med/surg in a large, urban, academic medical center? And conversely, might patients considered stepdown in a large urban facility be admitted to the ICU of a small rural one?
I ask because I'm just wondering how my workload compares to that of urban new grads. Doing clinical in NYC, I was on what were considered med/surg floors with the odd tele-rooms with 4/1 ratios. However, working at my new job, I get a bit of the feeling that some of these stepdown patients in my unit would just be thrown into a general med/surg unit in the city. I know this is not the case with DKA, day 1 post PCI/cath, carotid endoarterectomy, and r/o MI, but we rarely even get drips, and vents are strictly prohibited. The most compromised airway we would see is a BiPAP, and the only drip we titrate is insulin. Other vasoactives like dobu, cardizem, and nitro are allowed but no titration - and these seem rare, a bit to my dismay. The ratio is never more than 4/1, even on nights, which is wonderful for learning but seems atypical.
Could anyone comment on differing experiences having worked in urban and rural critical care? I just ask because I'm young and inexperienced, and would love to hear from some nurses who have worked in ICUs or stepdowns in varying settings who could just shed some light on this - curious for your thoughts.
Thank you so much for your time and patience!