Difference between step down and ICU

[anxiousnscared]

Can you tell me the differences between step down and ICU? Is one more stressful than the other? More demanding? I am in my critical care rotation and I really have enjoyed myself. I'm thinking about doing ICU. Problem is, is that I am a really anxious person and I can be kind of timid. I can understand the knowledge about critical care but actually doing it is different. When I talked to my instructor about it she suggested that I start off on a step down unit and work my way to to ICU because it would be tortuous to throw myself in the ICU setting first. What are your thoughts?

[Here.I.Stand, BSN, RN]

Stepdown units take patients who are not critically ill or unstable, but not well enough to go to the floor. Stepdown varies, but in my experience they don't take vented pts, vasoactive drips needing titration (amiodarone being one that is not titrated -- MD orders dose, and it stays at that dose until the MD writes the new dose or d/c's), sedation, invasive monitoring (for hemodynamics or the brain), ECMO or CRRT, assessments required more than q2hrs.... I'm probably leaving something out, but you get the idea.

The stepdown units where I work do get the post-cath lab pts, DKA pts, stroke pts (except if they had been given tPA in the past 24 hrs, intubated, get brain-monitoring devices, etc.) -- all of which make for a busy shift!

Nurse: pt ratios are generally 1:3 for stepdown, 1:2/1:1/occasionally 2:1.

What I find stressful about stepdown is that the pts are sick enough to need extra nursing care, but well enough to be a thorn in the side. ICU is stressful because if a pt decompensate there is no higher level of care for them to transfer to. Pts may be actively trying to die. It's very common to have to scramble to get the more stable pts transferred because there's a very critical pt in the ED but no bed or RN who can take an admission.

If you're truly "anxious and scared," an ICU will probably be intimidating. That's NOT to say you're not ICU material, but that it's good to overcome those new-RN jitters while taking care of more stable pts.

[VerticalHorizon]

The first reply pretty much told it all. But it really depends on the hospital and step down unit. My PCU floor at a very large level 1 trauma hospital takes almost all drips, and vents. Our ratio is supposed to be 3:1 but it's usually 4:1 and occasionally 5:1 due to the hospital wide staffing shortage. An ICU and stepdown both have their pros and cons, you will obviously have higher acuity patients in an ICU but you will have a lower ratio. My PCU patients are just a mixed bag, some would be okay on a normal medsurg floor and some should be in an ICU. Try to shadow on as many units as you can to get a feel for them because they are all different.

[Here.I.Stand, BSN, RN]

Nurse: pt ratios are generally 1:3 for stepdown, 1:2/1:1/occasionally 2:1. [/Quote]

"1:2/1:1/occasionally 2:1" for ICU -- sorry about that!