How hard really is intermediate Care

[RN_Student14]

I read a lot of post saying things like, "intermediate care has you running around all shift, it's hard etc etc." Now what I want to ask is, what is truly hard and what are people exaggerating. I have worked on a medical step down unit as a tech and I have never seen nurses "running around". (I am a float tech). Once they are done charting, passing meds etc, they have time to chat and take breaks. It could be I never floated to the unit when it was hectic, but that's what I want to know, how often is it usually hectic??( Mind you the step down unit is very small, they only have 14 beds). Each nurse is assigned 3 or 4 pts. I am NOT saying intermediate care is not hard and you do not have nights where you want to just quit, but please can someone elaborate on the nights when things are running smooth and you actually have time to breath and sit??

[RN_Student14]

Anyone?! Lol

[SycamoreGuy]

I worked in a PCU for a little while, I thought it was a lot less hectic than med-surg. The patients weren't usually that much sicker than the more acute med-surg patients and we only had 3-4 of them sometimes only 2. That's just my experience, I can imagine it being different in other hospitals.

[vegnurse21]

I am on my feet literally for at least 10+ hours of the day on a step down unit. Sometimes the whole entire shift. It's so crazy because we have tons of post op patients who are out of the critical period but still very prone to rhythm changes, bleeding, etc. We care for vascular patients and cardio thoracic patients and then also are getting all of the post cath lab patients, many of whom still have lines in that we DC on our floor. The beds don't even get cold before they fill it again and you have to catch up on ALL of that discharge charting. It's crazy. I have many many days where I just cannot keep up. We pull chest tubes, wires, IJs, and also do our own discharges. We do our own ABGs as well if a patient is deteriorating.

It's a ton. I have a love/hate relationship with the chaos lol.

[VANurse2010]

The acuity can be very high, but unlike an ICU, for example, where discharges are relatively rare - discharges to home or to facilities are common on step downs and can be extremely complex depending on the circumstances. This adds a HUGE extra element of chaos that usually isn't present on an ICU combined with an acuity that isn't present on the floor. Additionally, as was mentioned above, stepdowns are notorious for getting admissions before the bed's even cold from the previous patient. I worked on a PCU (albeit with extremely variable acuity) where it was nothing for me to have 9 or 10 patients (not at once) during the course of a day when discharges and admissions are taken into account. Often in an ICU one can make it though an entire shift with the same two patients.

[nursej22, MSN, RN]

I agree with VANurse, it's not so much the acuity as it is the turn over. We had a new record 2 days ago: patient arrived from the cardiac recovery unit and within 15 minutes his provider discharged him.

It is not unusual to start our shift with 2 admits or transfers in the first 30 minutes. One is playing catch-up for the next 3-5 hours, providing they are stable. And we never are full. As soon as census nears the max, we triage off to take more.

another record set 2 weeks ago: with a capacity of 29 beds we had 20 admits in 24 hours.

[Don2014]

In my experience, 3-4 patients is low and explains why no was running around. The unit I worked on (as a CNA) was 6 or 7, and some days were crazy!

[Nurse Kyles, BSN, RN]

I work on a PCU that has a max of 3:1. It is actually a split tele/PCU with 15 beds of each. The turn over is definitely the worst. I dread if a patient of mine has their PCU status dc'd meaning they are appropriate for the tele part of my floor. As soon as the supervisor finds out, they will move my patient and give me a new one. It ends up being very busy, especially since we have post op day 1 open heart surgery patients, post cath patients with sheaths etc. 3:1 doesn't sound like much until I have three open heart surgery patients that I have to walk QID with their 2-3 chest tubes each, take to xray for daily PA/LAT, draw all labs etc. Or maybe I have two of those and a post angiogram with a sheath, yep I'll get right on those Q15 minute checks :) We can't mix isolation patients with "heart" patients, so sometimes you get screwed and have three isolations because nurses with "hearts" can't take the isolation patients. Many times I might have one or more of these patients on a titratable drip as well. I love my job, but I definitely wouldn't say it's a cake walk.

[michlynn, BSN, RN]

I work on a cardiac/tele floor that has "Intermediate Unit" beds and it really just depends on how sick these patients are. If you have IU patients we are only supposed to have a 4/1 ratio but that typically doesn't happen and it usually ends up 6-7/1 on nights and 5/1 on days. Some days we literally do run our butts off titrating drips and various other issues and have no downtime and other days we have a lot so it really all depends on the situation and your patient population.