Stepdown vs PCU

[mochajchips]

Hi all,

I'm sorry for the huge wall of text. I have recently started traveling and I have been redirected from applying to many PCU positions and instead encouraged to do med/surg tele. Now I have no issues working in whatever floor they place me because I'm in this for the experience. I would like some help understanding what other people do in different parts of the country.

Just a quick background; I have 3 years working in a post surgical cardio-thoracic step down floor. Many of the patient's we took care of were POD# 1-4 CABG/valves/TAVR and straight from PACU thoracotomy and esophagectomy. We could manage drips, patients on cpap/bipap, do moderate sedation etc. It was a moderately acute floor with ratios being between 1:3 and 1:4.

I have been told that to work on most PCUs you need to be able to work with vents. Where I used to work most patients that we're not critical enough for ICU went to a specialized intermediate critical care floor. Do I not have enough experience to work on PCU? My question is how often do you see vented patients on your floors? How acute is your patient population and what are your typical responsibilities.

[SRDAVIS]

It really just depends on what region you work In. I've worked on floors that are called step down but can't do insulin drips can do stable vent patients, have a 1:3 ratio. Not labatalol drip only cardiazem. No sheaths etc... It's no hard fast rule. In traveling I'd err on the side of less acute, for CYA. Don't wanna get in over your head and as a traveler don't want to be the nurse I can't take this patient or that patient. Definitely not a good luck.

[delphine22]

Even in one region it varies widely. In my town I work at two hospitals, one won't allow bipap anywhere but in ICU, the other (of similar size) will allow trachs with vents in the surgical PCU. You sound very experienced and I don't think it's out of line to say "I can do this this and this, but I'm not comfortable with vents." These types of floors get floats from other units, I'm sure, that don't take the vents. Work with your recruiter, or call the client directly to get a better idea of what the floors are like.

Last time I worked with an agency (not the best one, I might say), they would send the nurses over but the nursing supervisor did the assignments. I had a fellow traveler with me, her first assignment, on a cardiac PCU who did not have ACLS and couldn't read strips. :-( So make sure your recruiter knows you and your strengths/weakness, and always check with the client yourself (it's not a sin to call and ask a question) if you're unsure.

[qaqueen]

Never

[turnforthenurse, MSN, NP]

The PCU that I worked on did not have patients on vents, only CPAP/BiPAP. Vented pts had to go to ICU.

Vents used to be on the PCCN (progressive care certification) because you will see vents on PCUs but they took it off because they realized that not all PCUs are created equal.