Was wanting some input from others who have experience in an Intermediate Care unit or step down unit. What I would like to know is how often are assessments done and vitals collected? I would also be interested in the staffing ratio and if your experience included CNA's and unit secretary?
Last edit by awsmrn on Jun 1, '12
: Reason: spelling
Jun 2, '12
depends on the situation. fresh plasty's get q15x4,q30 minx 4 q1hr x4, and more often if it warrents it( ie- not stable). if i have someone on nitro i q 15 then for a bit to see where their pressure will hang out,.art lines i check q 1/2 hr.minimum of q4 hr vs if on tele. new drips warrent more frequent vs. usually get 4 pts but sometimes 5. its not easy.we dont have vents tho, but do have Bipaps and c paps, hi flow o2.assessmenst are required per shift, but if ptt condition changes, obviously thenn more frequenyt assessments( ie- heading toward flash pulm. edema, etc.
i didnt have prior exp. as secretary. in my last semester of NS i did a program that had you work as a tech( cna?) , soo i did gain 3 mos experience doing thatt before starting the job.
hth- if you have more questions feel free to ask.
Jun 2, '12
just going to apologize for my horrible (lack of)editing above- sorry. fat finger syndrome and im exhausted
Jun 6, '12
Thanks for you input. The CNA and unit secretary....I was wondering if your unit uses them both or just one or none.
Thanks so much!!!!!!
Jun 7, '12
We have a ratio of 3-4:1 on days, 4-5:1 on nights. We do have PCTs and a telemetry tech as well as charge nurse and unit secretary. No unit secretary at night, but the others we still have. Standard vitals are q4h. The nurse collects the first set but the PCT the rest. When we are short on PCTs (they often get pulled to sit), then the nurse collects them all. Obviously the frequency can be changed depending on individual patient situations (drips, etc). Neuro checks are q4h unless written otherwise. I love my stepdown unit. I especially love it when the floats remark on my floor being a hard floor to work on. Makes me feel good that I am surviving there as a new grad.
Jun 7, '12
My hospital has a little different set-up for stepdown. We have several stepdown beds on each nursing unit. The ratio for stepdown is 2-3:1. (Ratio for the floor is 5:1.) We do total care and don't have techs for stepdown. We do have a unit secretary usually.
Vitals and assessments and I's and O's are charted at least q4h unless there is an indication to do them more frequently. The patients are on tele with monitors at the bedside as well.
Jun 8, '12
Do your units have a high turnover rate of patients????
Jun 10, '12
Hi- we usually have techs but sometimes we dont, so we make do.That makes for craziness, as we do get confused pts on bed alarms who all decide to get up at the same time :-( usually have a secretary during the day and at least half eve shift. none on nights. we went to EMR so that "supposedly" cut down the need for secretaries.This is a 26 bed unit.Id say we do have a high turnover of pts - some stay for weeks, mi's usually stay for 3 days, depends on the situation. But there are times that my "pod" of 4-5 pts has 3 d/c's and then i get bombarded again.HTH
Jun 15, '12
Depends on the situation. Typically unit routine is VS Q4H. If they have had a procedure (such as a cardiac cath), VS are Q15min x4, then Q30min x2 then Q1H x4 hours then they go back to being Q4H. If I have a patient with a wonky blood pressure, I might have the BP done Q1H or sometimes Q30min. Same goes for if the patient is on a drip, such as cardizem - I will monitor the BP and HR much more frequently.
We usually always have a secretary. Once in a blue moon we won't and one of the RNs will get pulled to be the secretary/monitor tech. We usually always have two-three CNAs, though someone may get pulled if we have a 1:1. Our nurse to patient ratio is 1:4, sometimes 1:5 if we're short a nurse.
Detailed head-to-toe assessments are done Q4H. If a patient is on neuro checks, that might be done Q4H or Q2H...depends on the order. For a post-cath patient, CMS checks are to be done Q15min x4, Q30min x2 and then Q1H x4. Urine outputs are recorded at 0000 and 0600, but if I am emptying a urinal or emptying a foley that is getting pretty full before that time, I will just go ahead and chart it at the time I empty it.
Jun 15, '12
Define "high turnover"? The average stay on our unit is 1-3 days.
Jun 15, '12
We have a ratio of 3:1 both days and nights. We have a secretary most days, unless we have a low census. Depending on census, we will have a CNA or a resource RN, sometimes both (rarely). We do vital signs q2, urine output q4. Full assessment, we're actually in the process of figuring out policy, but at least twice a shift, however it's only charted once.
Jun 18, '12
I used to do Progressive Care. We did vitals q4 unless they were on a cardiac monitor and drips. Assessments were twice a shift. Our ratios were usually 3:1 but sometimes 4:1. Our unit was divided into 2 teams/halls. We almost always had 1 secretary per hall. CNAs varied greatly. On nights, we had anywhere from 1 CNA per hall to none. Days often had 2+ per hall cuz they were expected to bathe everyone and change linens.
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