Balloon pumps and swans on a stepdown??

[boston.nurse]

Hello all, I was hired for a cardiac stepdown unit. Where the ratio is 3:1. The stepdown gets patients on chest tubes, vents, cardiac drips etc, lvads. Now we are being told that the stepdown unit will soon be taking patients that have swans and balloon pumps. Swans and balloon pumps have always been ICU where the ratio is 2:1. I've never heard of a stepdown having balloon bumps and swans. So is it still a stepdown unit??

[Been there,done that, ASN, RN]

It's still a step down unit if the staff buys management's bs. The MAN is forcing unsafe care to boost the almighty bottom line.

Unless the IABP patient or the Swan-Ganz patient have a separate technician to monitor them.. I would walk.

[boston.nurse]

Exactly. And nope, they will not have a separate technician to monitor them. Plus I'm a new grad,, this seems very dangerous. Most of the nurses on that unit are new grads. I specifically applied to the step-down side. I don't feel like I'm ready to handle any type of ICU patients. I really dont see the point of this. Hopefully it is a while before the changes take effect

[Been there,done that, ASN, RN]

Double whammy with new grads. They don't know the acuity... and they don't know what management is up to.

IABP patients should be 1:1 without a tech. I have seen 2 patients lose a limb without adequate monitoring.

[MunoRN, RN]

Balloon pumps definitely shouldn't be 3:1, patients vented by ET tube should usually be 2:1, and frequently titrated cardiac drips should be 2:1. But patients often go home with an LVAD, so unless it is newly placed they should at some point transition to lower acuity ratios. Chest tubes often go to a surgical floor with ratios well above 1:2, a patient vented via trach should be able to be 3:1, and I don't think Swans necessarily have to be 2:1. While I would agree much of that seems excessive for stepdown, we tend to focus too much on the devices and not enough on the nursing acuity of a particular patient. There are patients with PA caths that are perfectly fine for stepdown, and there are patients without any of those devices that should be 1:1. Device does not necessarily equal nursing time demands.

[KRVRN, BSN, RN]

What would make them an ICU pt if that didn't?

[tcvnurse, BSN, RN]

Sorry-that is an ICU patient. The balloon can migrate unexpectedly and as someone said, occlude circulation to L arm, renal arteries...I've had paint with an AIBP lose pulses in feet suddenly. Run do not walk from this situation.

[xaxxax]

Run. Those are ICU patients for a reason. Ultimately it's your license on the line and it'll be you that takes the fall of something bad was to happen despite the unsafe staffing ratios.

[nuangel1, BSN, RN]

No way those are icu pts .iabp definitely not 3 to 1.swan is icu also.