[governess]

The hospital that I work for has a Critcal Care area and a special care area. The special care is a progressive care or step-down type of unit. They take vent patients, a few drips such as sedation, dopamine, nitro, milrinone. The staffing has just been changed to 2:1 which is what we have in Critical Care. No one disputes the need for this as they frequently have a high number of chronic vent patients which are high acuity. What is objected to is that now they want to change their name to ICU! Everyone in the true ICU/Critical Care is having a cow! The quality of care is much better in the ICU/Critical Care unit and how would the differences in care be explained to the patients and family? While they mat have the same nurset. ratio the focus is vastly different there. Does anyone have similiar units in their hospitals and how are the differences handled?

[Michigan RN]

I worked in progressive care and we didn't have sedation. Only ICUs have continuous sedation gtts. In progressive care, we would have insulin, heparin, dopamine, amiodarone and nitro and vents. The patient to nurse ratio should have been 2-1 but was 4-1. The quality of care is not always better in the ICU. It should be because nurses have 1-2 patients but I've sent many patients to ICU who had no bedsores and came back to me with stage 4 decubs. So I'm a bit insulted by the statement that the quality of care is much better in ICU. Progressive care is critical care and is recognized as such by AACN. No one should be having a cow over that. Perhaps they want to change it to an ICU. They certainly sound like ICU to me.

[kriseh]

The care is "better"? Don't you mean that the patients are more acute or something along those lines? I'm just letting you know. Some progressive care nurses, and others, I'm sure are going to be upset about the "better" care you provide.

It sound like the patients are pretty acute for progressive care. I'm sure the hospital could work with the dept. to find a name more suiting to the nursing care the patients recieve in that area.

Also, it sounds to me to be a little petty. "You can't be called intensive care- we are!" kind of thing.

Maybe someone with asimiliar experience can help you more.

[Michigan RN]

Aren't there better things to fight over than whether or not a unit should be called ICU? Grow up.

[CHATSDALE]

maybe they could compromise on something like
icu-2
sd-icu [stepdown icu]
it would let the families feel like some progress is being made in loved one's condition

[Michigan RN]

Stepdown ICU is probably a good description for what that unit is becoming. Perhaps the patients would be more stable than the typical ICU patient.

[trent]

ours is called the ECU (enhanced care unit)

[yeSICU]

To make things more complicated... my unit is a 20 bed ICU that has 6 surgical progressive level beds. Funny thing is that the pt's in those rooms just shuffle back and forth from our ICU beds back and forth it seems, or we get Dr. family members camped out for the ICU nursing care in a progressive level bed (all single rooms to boot). I see a definite need for the type of unit you described. People are getting sicker and sicker, and the icu level pt tends to be very complex. When you have these chronic vent type pt's just sitting there with their only critical need being pulmonary hygiene it takes valuable space away from pt's that really need it. I think the 2:1 ratio is great because I swear it is probably just as difficult if not more difficult in some respects working progressive care where pt's regularily crump. I talk to my mom who manages a CPCU and she has had nights where there are 6 crash carts open on a 60 bed unit with a ratio of 4-5:1 (scary to me). Throw in smaller semi private rooms and lack of resources and you have some serious hurdles to overcome as a nurse. Critical care is not easy on any level, but we like the challenge... Right ladies and gents? lol
Maybe they could call it an intermediate unit? I have heard the type of unit you are describing called that somewhere or another.

[governess]

Sorry! I din't mean to imply that the care was better in all ICUs, I also worked in our Progressive care unit and when I transferred to Critical Care found the focus and quality much different.

[mpccrn]

our stepdown unit ratio is 5 to 1 nurse.......in icu it's 2-3 to one nurse (3 being very very bad days) our staff rotates through both.....no wonder we like icu days more!