Med-Surg v. Telemetry/Step-down

  1. Just a curious soon-to-be nursing student...

    What is the difference between med-surg and telemetry/step-down units in terms of pt load, acuity, etc.? I've seen the two used interchangeably but I've also seen them be listed as completely different.
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  2. 3 Comments

  3. by   marienm, RN, CCRN
    It depends on your hospital... at mine, we have med-surg floors where patients may or may not be on telemetry. The nurses are expected to pay attention to the central telemetry (cardiac & oxygen saturation) monitor and respond to alarms, but these patients aren't on any cardiac drips (continuous medications to control rate, rhythm, or blood pressure). Some of the floors at my hospital don't have any telemetry capability, and their patient:nurse ratios are typically a little higher (each nurse has more patients, but presumably they are believed to be stable from a cardiac standpoint).

    All of our step-down units have more-advanced monitoring capabilities, such as a full bedside monitor that can measure blood pressure and other parameters. These patients are less stable and/or require more frequent interventions (multiple dressing changes, lots of antibiotics or blood), or are on certain drips for cardiac rate/rhythm that require titration and can lower or raise blood pressure so the BP is checked every 15 minutes. The nurses on these floors usually have 3 to 4 patients at my institution.

    Does that help? Good luck with your studies!
  4. by   MassNurse24
    Many hospitals have different definitions of this. The stepdown floor at my hospital has extremely sick patients requiring vents, continuous bipap, cardiac drips, insulin drips, etc. All of the patients on this floor have bedside monitors, the ratios is 3:1, this is where I work now. Med surg/tele floors can differ. At one of the hospitals I was at we had a "hard" tele floor, all patients were monitored and you could give cardiac drips, the ratio there was 4-5:1 with high turnover. Other floors consists of med/surg patients with some tele beds, from what I've seen the cardiac meds you can give on those floors are limited, the patient ratios are still 4-5, sometimes 6 from what I've seen.
  5. by   aksti1018
    The med/surg floor I work on has a lot lower acuity patients than the tele/step down units (those are like the above posts have described). Our patients are basically "obs" but may require longer stays because they need IV abx, blood transfusions, TPN, chemo (it's an oncology floor), or are pending placement to a SNF/rehab, etc. They aren't connected to any monitors (only continuous pulse ox if they have a PCA), we do v/s q6hrs and I haven't seen a code yet *knock on wood*, we do see a lot of DNR/hospice pt's that do pass away on the unit but it's expected. Med/surg is great if you don't like very stressful situations- although it does get stressful but I'm sure nothing compared to the step down units.

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