Differences between these: Tele, step down, and intermediate care

[wanderlusthomebody]

Hello!

I've been poking around some more into the different opportunities available for traveling and I have no clue what the differences between step down care, intermediate care, and tele would be. The postings I have found at various websites do not really give much information on the type of job it is and some give you absolutely NO information other than the location, the number of hrs/week, and possibly pay. Anyone currently work in these that can give me a sample of some procedures you do on a regular basis? Stressful postings? Level of stability for pts? Pt load? I assume the level of care would be somewhere between ICU and MS level. Similiar type of pts between them, or do certain types of patients fall under different units?

[NedRN]

Not an expert, but these labels do differ wildly at different hospitals, thus the lack of Google info.

Tele can be exactly the same as medsurg on some assignments. No doubt you will be tested on rhythms, but there will be only a tech on many such floors actually looking at them in real time. In smaller hospitals, you may be the person assigned just to monitor a central display, or each nurse will monitor their own patients (with the help of alarms).

Intermediate care could be step down, or it could just be patients who need just a little more care than medsurg ratios allow.

Step down is often post op day two or three, or patients with drips, or intubated. This is perhaps the most difficult of all units as you may be weaning one pt off vent, managing a second patient's drips, and getting a third patient ambulating post op for the first time. This is where I started, and it takes serious organizational skills and ICU level knowledge base. Of course, I was doing CVICU step down so that is perhaps worst case scenario for the new grad that I was.

[Swellz]

As Ned said, it really varies by hospital. I've had as few as two and as many as five patients in the intermediate care/stepdown/PCU world. You're going to have to ask your recruiter for specifics. A lot of places will expect you to have vent experience.

[RNlove]

Hi I work at a step down unit right down. The man differences is the nurse to patient ratio, I can only give you information about California though since I do t have experience working in other states. ICU is 1:2, step down 1:3, and med surg/tele is 1:4 or 1:5. , patients at a step down unit needs closer monitoring of V/S and ECG, non titratable drip.

The acuity the patients also depends on the hospital you choose to work. At smaller, rural hospitals you can have a step down patient in the ICUs. I know at bigger cities the acuity is higher. Some Kaiser Hospitals got rid of their step down unit and labeled it as “tele” but your basically taking care of step down patient with your ration being 1:4. The pay is higher but your also working harder.

[jaxxiepoo, BSN, RN]

I have to respectfully disagree with Ned. In my experience, the intermediate care postings have been the most acute of the bunch. At the last hospital I worked, the step down was much lower acuity than I am used to. My current assignment is for “tele” and I ended up getting placed on a straight MedSurg unit with a 1 to 6 ratio. I am going to be avoiding tele units in the future, even if this bad experience happened to be a one time thing.

[NedRN]

Your disagreement is so respectful, I couldn't spot it! ?

[jaxxiepoo, BSN, RN]

10 minutes ago, NedRN said:

Your disagreement is so respectful, I couldn't spot it! ?

? I should have clarified, though, you are 100% right about it varying from hospital to hospital. Why did I have to choose the weird in between space for my specialty?

[NedRN]

Jack of all trades is a good spot for a traveler.

[NedRN]

Maybe I should have said Jaxxie of all trades!