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by Artemis2

I have been hired to help with transitioning a med-surg unit into an Intermediate Care Unit and I could use the help of the nursing community. This is not a cardiac strpdown (we have one of those) but a stepdown from the general ICU's. Our floor already has a pulmonary focus so I am anticipating a lot of trachs, CPAP/BIPAP and the occasional vent. I'm curious, though,....

How many beds do you have?
What is your nurse-patient ratio?
Do you use nurses aids or techs? How many per shift?
What does your patient population look like? What kind of diagnoses?

Thanks for your insight. I need to educate and prepare my staff for what is to come as well as educate and prepare administration about how to do it right...if you know what I mean.

[scizzerin]

Re: What does your Intermediate Care Unit look like?

I work in a smaller hospital, so we combine our cardiac w/ icu stepdown, it's a PCU.(progressive) we have 20 PCU beds and 8 ICU beds. we have cardiac, trachs, bipaps and others in PCU, but vents only in ICU. In ICU, RN to pt ratio is 2:1 max, and PCU is 4:1 max. Techs are employed with 4 for the whole unit, usually no more than 8 pts per tech. We have LOTS of cardiac caths, since we have a cath lab, and the next closest hospital doesn't, lots of respiratory issues. I LOVE being in a smaller hospital, and everyone works well together. My sis was in a PCU in Cincinnati they had 5:1 patient ratio, but they had only one tech for a 40 bed unit (yikes!) doing q4 vitals!
GOOD LUCK!!

[Emmanuel Goldstein]

Re: What does your Intermediate Care Unit look like?

25 years ago, the first hospital I worked opened a brand new IMCU. There were only about 15 beds; each private with monitors, etc. But mounted in the center of the ceiling in each room was a wide-angle camera. Two techs or nurses sat at the station; one watched the tele, one watched the video bank.

It was downright creepy.

[RNperdiem]

Re: What does your Intermediate Care Unit look like?

At my hospital there are separate stepdown units for medical and surgical patients. Those stepdown units have a 3:1 staffing ratio. The rooms are identical to ICU rooms, and are all private rooms.
There is a unit secretary and I think a nursing assistant.
Stepdown units tend to have a high rate of patient turnover, and the beds are very much in demand. I work in SICU, and we can have several patients waiting for a stepdown bed to become available.

[carrie13]

Re: What does your Intermediate Care Unit look like?

I interviewed for a job in a medical telemetry/PCU. I can tell you a little about the medical floor from what was discussed in my interview. It is a 24 bed unit for medical telemetry and 6 beds for PCU. The ratios for the medical part are 3:1 or 4:1 max. The PCU ratios are 2:1. Techs usually have a ratio of 8:1 but they don't cover the PCU beds. The unit is pretty heavy so lots of sick patients. It is considered a step-down from the medical ICU. Lots of post-ops that can't go straight to med-surg, respiratory problems, etc. They do stable vents on the PCU but unstable vents go to ICU.

I accepted a position at this hospital in cardiac tele/PCU. But my friend will be orienting on the medical floor next week. I'll let you know if she has any more info to share.

[KeechieSan]

Re: What does your Intermediate Care Unit look like?

Originally Posted by Artemis2

How many beds do you have?
What is your nurse-patient ratio?
Do you use nurses aids or techs? How many per shift?
What does your patient population look like? What kind of diagnoses?

I work on a PCU at a small hospital, so I guess that is what most would consider an IMC. We have 36 beds, mostly semi-private. The nurse patient ratio is anywhere from 1:4 to 1:6. We have CNA's, 4 for the whole floor. I think there ratio is like 10:1 or slightly less. The patient population is very broad at my hospital. On one hand you have alcohol withdrawals, on the other you have CHF. We have a LOT of pulmonary issues, such as trachs and cpap/bipap. We are the only floor that can handle those (except ICU of course). Very very rarely will we have a vent, and if we do it is someone who has been vent dependent for years. I'd say a majority of what I see is CHF and pneumonia.

[Artemis2]

Re: What does your Intermediate Care Unit look like?

Thanks everyone for your reply's. I need to gather as much info as I can so that when I present my "Vision for Intermediate Care" to the hospital leadership it will carry some weight. Here is another question...

Many hospital units increase the nurse-patient ratio during the night shift. Should the ratio stay the same in an Intermediate unit given the higher acuity of the patient demographic no matter whether it is day or night?