med-surg tele & step down unit... how are they different?

[curlygirl8]

Hey nurse friends,

My nursing experience for seven years has been on what my hospital called a med-surg/ tele unit. The hospital has only med-surg units and ICUs; no step down or progressive care unit.

On the med-surg/tele unit we took care of patients on IV gtts like Cardizem, Amiodarone, Nitro, Integrillin, Heparin, Lidocaine, low dose Dopamine. We had patients immediately pre & post caths with interventions and femoral sheaths, PPM & ICD implantation, pre & post CV and EPS, in with chest pain, MIs, post-op day one CABG and valve surgeries... among others.

I just took my first travel assignment & I picked a med-surg/tele unit, thinking it'd be a good fit. But at this hospital, all those patients pretty much go to the ICU. The nurse manager said when they renovate they're going to build a step down unit....

Would someone explain to me the differences? For my next assignment I may consider a step down unit, if I have the right experience. What type of care is provided there compared to that of med-surg? I'm not sure now where I best fit.

:redbeathe

[AnnaN5]

The unit you worked on seems more like a step-down unit then just a med/surg tele. It really depends on how the hospital names their floors. I work a cardiac unit that does drips, pre/post cath lab, sheath pulls, etc and we are considered a step-down unit, we also get patients straight out of intensive care.

[curlygirl8]

Thanks!

As a step down unit ,what other types of patients, procedures, care do you handle that a regular med-surg unit typically wouldn't?

For example, I've never done anything with a arterial line (besides removing femoral sheaths post cath). Would you in step down?

Thank you again! You're helping me figure out where I belong :-)

[CCL RN, RN]

Honestly? Sounds like you should work in an ICU. Especially if you were able to handle 4 of these pts…It's time.

Btw, The only other thing to do with an art sheath is transduce it.

[curlygirl8]

Thanks!

That's what I'm starting to think too. Scary thing is, I used to be assigned 5-6 of these patients on day shift. Granted, some weren't so acute, in with CHF management of something. But still, I'm starting to see how crazy unsafe that was.

One last thing (and it might sound silly or obvious, forgive me)... is step-down strictly cardiac by definition?

[CCL RN, RN]

Nope. Step down is just a place where they are stable but too sick for the floor. Typically the assignment is only 3-4.

I think you'd do quite well in ICU. When you interview, tell them all the stuff you told us here.