Is this step-down?

[cp24001]

With patients living longer and admitted with acuity levels that are higher than ever, I find that the nurse-patient ratio on my floor is overwhelming. I talk to nurses who have been out there for 20+ years and they agree...

Many of our patients are transferred from ICU and/or surgical, with much med-surg "overflow". Depending on patient status, some need to be transferred right back.

So my question is this...what qualifies a unit to be "step-down" vs. "med-surg" ? Is it acuity level, equipment required...?

Thanks for the input.

[martymoose, BSN, RN]

yes I'd say this is step-down. unfortunately this is how step down seems to be. It really sucks when the pts you just got for stepdown have to go right back, when they should have never left in the first polace. And because you are overflow- you get more patients to replace the one you just sent back. Nothing like doing double work. No wonder nurses are ragged at the end of their shifts.

oh to answer your question- stepdown is supposed to be based on the higher acuity of patient.Supposedly

[nursemike, ASN, RN]

My floor has both acute care and stepdown beds. Our ratios are 3:1 in stepdown, 6:1 on the rest of the floor. All stepdown beds have monitors, some "floor" patients have remote telemetry. But, yeah, the distinction sometimes seems pretty arbitrary. We've had resolved TIAs in stepdown all weekend, then discharged home Monday morning. We've had pts trached, PEG'ed, in iso, missing cranial bone in floor status. I once had a pt with a Hx of CA with orders for a heparin drip. I called to clarify the titration scale, and as an afterthought asked why the drip. She was having an MI. I dunno--that might have meritted a transfer to stepdown, although she was a very sweet patient and did just fine.

[cp24001]

thx for the replies...

We are 6:1 & sometimes 8:1.

Wound care, trach care, chest tubes, NG, PEG, rhythm surveillance, PCA, epidural, vent, heparin drip, restraints, isolation (more often than not)...

Safety? Who is losing here, the nurse or the patient? And why are the pt satisfaction scores down? Hmmmm....

It is nice to know I am not alone. thx.

[ChristineN, BSN, RN]

thx for the replies...

We are 6:1 & sometimes 8:1.

Wound care, trach care, chest tubes, NG, PEG, rhythm surveillance, PCA, epidural, vent, heparin drip, restraints, isolation (more often than not)...

Safety? Who is losing here, the nurse or the patient? And why are the pt satisfaction scores down? Hmmmm....

It is nice to know I am not alone. thx.

Those ratios are insane, and if you have vents you are 100% absolutely a step-down. That sounds scary.

[cp24001]

vents are few & far between, but I have seen my share.

One more...how is your acuity measured? Subjective charting by the nurse?

:angthts::sstrs::grn:

[martymoose, BSN, RN]

i guess by how many drips one is on, how unstable they are, how bad their rhythm is, what type of drips, etc. i was ( and hope to be returning ) to cardiac stepdown. on eves we would have 5:1 avg. but those 5 could include post plasty , post op paced/defib, heparin gtt, cardizem drip, and a confused patient- any of the combos could be isolation. isolation did not determine acuity, unless they were going septic. now when i would be charge, i would to balance the shift out- if some one had a pt that was practically 1:1( as in pt so labor intensive that the nurse literally cant get out of the room to see any other pts, we would divy up the rest of her assignment. most didnt complain, as they were glad to not have the high acuity pt. In years past that type of pt would be in the unit. sometimes we would have 3 day three MI's walkie talkies- stable. made for a nice assign. but far and few between.

hth