Starting a position in ICU Stepdown

[ambianco9]

I have been an RN on a surgical oncology/medical surgical unit for close to a year. In July I'll be relocating and starting a new position on an ICU Stepdown unit. What topics should I review ahead of time to make the transition easier? Any tips for being a successful nurse in a more critical setting? Also if you have worked on a Stepdown unit what can I expect the day to be like and what kinds of things should I be sure to be prepared for?

Thanks!

[us2uk4u]

First, congratulations on your new position. I work in a cardiac stepdown unit during the day shift and I love it. Sure, it's busy every single second and sometimes you want to pull your hair out but at the end of the day I could never leave. My suggestion is to shadow a nurse for a shift just to see what you will encounter every day. And choose a Monday to shadow. That tends to be very busy.

[snsbelcher]

I work in a progressive care unit (formally titled step down), and have been here for about a year and a half. In my opinion, the step down I'd ra totally different kind of busy than the icu. No, you're not going to be in the patient's room consistently monitoring cvp, or titrating they're drip, but you'll be responding to more call lights, coordinating with more physician's (depending on the service lines on your unit). You will still have some drips, but hopefully not as many. My unit seems to be a mixing bowl of patients. I see multitudes of different disease processes. It isn't just cardiac or surgical or whatever. You will probably learn so much, and do a little refreshing every shift. I would find out the three most common patient types for the unit, and the and review the drips and any protocols they run. I agree with the idea of shadowing at least one day, and hopefully they orient you well tootheunit. Good luck, and enjoy!

[WorldDay]

it will be like onc/med-surg busy shift on steroid.

[ixchel]

I interned on a step done and start working on it in 10 days. Most of what we saw was a combination of things. We'd have someone get the flu, only, they had DM and COPD. Or, someone with CHF and afib with pneumonia. It wasn't so much that we would have any set of regular types of patients. It was normally people who had a lot of cards stacked against them and something simple went really wrong. Not sure if this helps any. If you're feeling the call to get some good baseline knowledge going in, brush up on DM, CHF, COPD, and other circulatory and respiratory disorders that are fairly common.

(For the sake of disclosure, I'm a new grad with extremely little experience on this unit, but these things are the theme I noticed most each shift - combinations of normal things going wrong.)

[ambianco9]

Thank you all for the advice! I appreciate it

[applewhitern, BSN, RN]

I worked step-down (Progressive Care) for 5 years. The one I worked on was extremely busy, constant admits/discharges. Rarely had an empty bed. We did tons of drips, cardioversions, and stable vent patients with trachs. The problem with step-down is that the patients are usually alert and NEEDY. The call bells were incessant. The patient turn-over was incessant. We rarely had the same patient for more than a day. If you are going to brush-up on anything, I would pick different cardiac drips, refresh yourself on different cardiac rhythms, cardioversion, etc. In my particular step-down, it was mostly procedures, like pacemakers, bedside bronchs, post-caths, etc. Patients that were alert, oriented, but needed either a procedure done or a cardiac drip. The typical COPD, pneumonia, etc. type patient went to the med-surg floor.

[alwaystheoptimist]

Ambianco9, do you mind me asking where you will be starting your new stepdown job in July? I'm also starting a residency program in July and will be on a stepdown unit as well!

[AmyRN303, BSN, RN]

I start in July too!