All General Step-down Nurses....I need your input!!

[askater11]

Since graduating from nursing school 7 years ago, I've worked step-down. 2 year's on a general step-down unit....it was a 34 bed unit....8 of the beds were step-down. I always worked down the step-down hall and the nurse patient ratio was 6:1 R.N. and that was a bit much.

Now I work a cardiac step-down ward.

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Well I've decided to return to general step-down unit. (or some other speciality)

I had a job interview today. I'm not sure if the units a "good" nurse patient ratio.

An idea of the unit, it gets any and everything. (surgical, titrating drips, etc.) It's a non-teaching hospital. The patient ratio is 5:1 R.N. and about 8:1 P.C.A.'s (aides) The manager didn't mention about A-lines and C.V.P. lines but there's a syllabus of things I'd need to know and be tested....and C.V.P. and A-lines are on the list.

So what do you think of the nurse patient ratio????

[sharann, BSN, RN]

5:1 sounds high if you are titrating drips, and especially if you would care for pts with A-lines and CVP's. The latter belong in the ICU. (if sick enough for lines they do). Are there any LVN's to help with meds and procedures? I would ask upfront if this unit accepts lines. If they say "only rarely" look out! I also tend to add 2 patients to their stated ratios. Just my opinion from my experiences. I was GUARANTEED 4 patients max on day shift and 6 on nights. This never occurred. The norm wa 6-7 on days and 8-9 on nights. These pts (or insurance co's)are paying for specialized care. What they are recieving is regular med-surg ratios, but they are high risk patients.

[whipping girl in 07, RN]

I agree with Sharann; those ratios sound too high to me. I don't really like it when I have to titrate drips on TWO patients in ICU. I can't imagine doing it on 5 or 6. We don't ship 'em out if we're titrating, period. The closest thing we have to a stepdown unit where drips may be titrated is PCU (pulm. care) and even then, we don't send them there when we're still actively titrating, only when the drip has been at a certain level for a certain amount of time. Then, after the patient is transferred, the nurse can titrate as needed, but if the patient craps out we get him/her back. And they have a ratio of 1:3. Mostly we send them chronic vent patients who still need the vent but don't need ICU anymore. Usually drips are not even an issue, as the drips are usually just renal dopamine or Cardizem for a-fib

[live4today, RN]

I agree with the rest......five to one is way too high on a floor like that.....I wouldn't have taken that job for that reason because I've already "been there...done that" in a past job that still gives me nightmares when I think about it!

[MollyMo]

Any drip titrated for any reason should be in the ICU. Any line hooked up to a transducer should be in the ICU. If you've got an A-line or CVC not hooked up and not needing zeroed and all that good stuff, fine. But the ratio still needs to be lower. You still have to check frequently for distal pulses in the extremity with the A-line. I think 4:1 should be the max.