Calling for all opinions!!!

[askater11]

How does this potential new job sound?

It's a 41 bed step-down unit at a 250 bed union hospital. The supervisor was friendly. I was basically immediately hired because of passed step-down experience. (though most step-down is solely cardiac...so I need your input) I spent a good hour asking 101 questions about how the hospital/unit ran.

The patients are a mixed bag...neuro, cardiac, surgical, obviously monitors, they've taken O.B. patients also (not in labor though with "other" complications), cardiac drugs....(some minor titrating of drugs maybe included)

Ratio....1 RN:5 patients(she makes it sound like all shifts)...1 P.C.A.:8 patients. 2 secretaries. 1 day charge nurse (7 A.M. to 7 P.M. no team...no 7 P.M. to 7 A.M. supervisor) No I.V. team. Telemetry is at the desk. (no telemetry tech) Have a phlebotomy team. P.C.A's do E.K.G.'s, B.G.M's and all other basic care. How does the nurse patient ratio sound?

Another thing I'm wondering is equipment. This unit had full equipped rooms....but minimal equipment. All rooms have manual B.P. cuffs....only 3-4 automatic B.P. pumps. I only seen a minimal amount of computers. (I think 2 computers...one for each secretary) Does that sound adequate?

One more...the nursing desk was chaos...though the patients rooms had minimal staff in it. I don't know if the desk was so chaotic b/c the charts weren't out in front of the rooms (like where I work) or if it's a chaotic floor. (time was 10 A.M. so it is a busy time) Do you keep charts at your nursing desk...does the desk get chaotic?

[canoehead, BSN, RN]

The docs may have just visited, hence the desk was a mess. What about mandatory OT, downstaffing, benefits, etc. Where were all the nurses, and what were they doing?

As for regular BP cuffs, they are fine for routine vitals, you'll just need to get used to them again. So long as there is an automatic for emergencies.

[RNConnieF]

I work in a step down PCU, the 5:1 with only 1 tech for 8 pts. sounds heavy to me. We do work 5:1 with 10 pts to each tech but that's on 3-11, on 7-3 it's 4:1 with 6 pts per tech. It sounds like your patient load may be a little heave for a step down.

[terrina]

I think 5:1 ratio on a step down unit is too much especially when you are titrating, get all types of patients. I work 4:1 ratio on the general floor and that is heavy at times! (course there are no CNA's to help and RN's do everything!

[NCTraumaNurse]

I currently work on step down with all sorts of patients, dopamine to 10 mcgs, nitro, dobutamine, etc. and we can have 5 patients with one being on a vent and anywhere from 1 to 2 aides for 22 patients. Much too difficult, in my opinion.... Looking for a job elsewhere as I feel my license is on the line here!

[Brownms46]

Here are my thoughts.

First you say you're not sure the 5:1 is on all shifts...sounds vague. This is something I would find out for sure about.

Second...5:1 is pretty heavy for the pts mix you describe...especially with titrating drugs.

Third...if there is only a day charge...who makes out the assignments for the rest of the shifts?? Who runs interference when there are problems?? Who handles the call in?? Who handles any problems that come up??

Fouth...if the monitors are at the desk, and there is no monitor tech...who's watching the monitors???

With only 3-4 nurse on sticks...for 41 pts...how do you handle freq vs?? And it has been my experience that half the nurse on stick don't work...at any given time.

And 2 pc for the unit definitely shows too little to me. You have at least 8 nurses on the unit, and only two secretarys. So if the two are busy helping a couple of nurses with admits, and putting in orders...how long do the others have to wait to check labs, or CXR reports, or order supplies...etc???

Sounds to me...like chaos is probably the rule on that unit!

[MollyMo]

Originally posted by Brownms46

Here are my thoughts.

First you say you're not sure the 5:1 is on all shifts...sounds vague. This is something I would find out for sure about.

Second...5:1 is pretty heavy for the pts mix you describe...especially with titrating drugs.

Third...if there is only a day charge...who makes out the assignments for the rest of the shifts?? Who runs interference when there are problems?? Who handles the call in?? Who handles any problems that come up??

Fouth...if the monitors are at the desk, and there is no monitor tech...who's watching the monitors???

With only 3-4 nurse on sticks...for 41 pts...how do you handle freq vs?? And it has been my experience that half the nurse on stick don't work...at any given time.

And 2 pc for the unit definitely shows too little to me. You have at least 8 nurses on the unit, and only two secretarys. So if the two are busy helping a couple of nurses with admits, and putting in orders...how long do the others have to wait to check labs, or CXR reports, or order supplies...etc???

Sounds to me...like chaos is probably the rule on that unit!

Very well put, Brownie. I was wondering all that myself.

I turned down a traveler's position because it had a mixed bag of patients like that. Askater, the fact that you're asking to me suggests that you have reservations about it as well. I wouldn't do it. But that's me.

[BBFRN, BSN, PhD]

Are all of your Pt's on telemetry? I'm assuming they are, and if so, with no telemetry tech and a 5:1 ratio, that sounds pretty rough. Do your secretaries do the monitoring? Or the charge nurse? And, I like having access to a computer myself- not having to ask the secretary to pull stuff up for me.

[Brownms46]

Thanks MollyMo, and I agree with you. I thinking the same thing. I only ask questions about something like this, if I'm not feeling too good about it.

I think the biggest thing that would bother me is, who is watching the monitors.

[BadBird, BSN, RN]

I think the assignment of 5:1 is a ploy to get nurses, even that is too high when titrating medications, Not enough pneumatic cuffs for titrating, who is watching the monitors? You can't be if you have 5 rooms, it sounds like they are telling you 5 but the reality is 8 or 9, as it was in my first nursing job. I personally would not accept a position on that floor, good luck.