What is the difference btw Step down unit and ICU?

  1. Hello! I am always hearing step-down unit and am afraid to ask anybody what it means. I thought it was ICU " a step down from med-surg" but I know that it sounds stuid.

    Can you tell me the difference, I graduate in May 2007 and I am trying to decide if ICU or "step-down" is the critical care unit I want to join.

    Thank you
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    About rn2bn07

    Joined: Jan '06; Posts: 183; Likes: 63
    Specialty: Cardiac Tele (1 year), new MICU RN


  3. by   AnnieOaklyRN
    ICU is for patients who are either unstable or have a high potential of becomming unstable. A lot of these patients require invasive monitoring through arterial lines, medications to support certain functions like BP, and ventilators to assist with breathing. A step down unit from ICU would be a telemetry unit where patients who need to be on a cardiac monitor and have frequent VS taken stay. The cardiac monitor is actually only a small box that the patient wheres so they have more freedom as they are not attached to a wall monitor like the ICU patients. These patients are stable, but may require monitory because they have some potential of becomming unstable. Many of these patients end up being heart patients.

    ICU is where the most critical patients go, telemetry (aka tele) is a step down from the ICU, and med surg is a step down from the telemetry unit. Just keep in mind not all patients stop at all those floors, some may go home from the tele floor, and how sick the patients are depends on the hospitals and its policys.

    Hope this helps

  4. by   smile123
    Quote from rn2bn07
    Hello! I am always hearing step-down unit and am afraid to ask anybody what it means. I thought it was ICU " a step down from med-surg" but I know that it sounds stupid.

    Can you tell me the difference, I graduate in May 2007 and I am trying to decide if ICU or "step-down" is the critical care unit I want to join.

    Thank you
    Hey, there's no stupid question. Just the one that one is afraid to ask!

    Before I got into nursing, I thought there was only the ICU and the med/surg general floor. Then I heard about stepdown or the intermediate unit. ICU patients are critically ill patients. Often they can be sedated or intubated, so you don't have much chance to interact with them. Intermediate or stepdown patients are generally on a monitor. They can talk and interact with you, but they aren't as well as the general med/surg patients or critically ill like ICU patients. The other difference is that in the ICU you may care for 1 or 2 patients, while in the stepdown, the ratio is 1:3 or 1:4 (depends on the hospital).

    If you have the chance, ask if you can shadow a nurse in the ICU and the step-down units. Then you can observe the level of care for each patient and decide. Good luck!
  5. by   dfk
    there's one hospital i know of in NYC that has a step down unit and their patients are sicker than some ICUs i've been to.. i guess it depends on where you are.. i wouldn't blanket the statement that all step downs are the same..
  6. by   Gigglesforall
    I have to agree that there isn't a single definition for a "step-down unit" because I work in a hospital where there is one 14-bed ICU and next door is a 16-unit "Intermediate Care Unit" where the ratio is 1:3, but often the patients are still as serious or worse, but often maybe the care is not going to be as aggressive, so there's more DNRs or nursing home patients, but still as heavy or more to take care of. Vitals are done q2, there's sometimes a. lines, insulin drips, and vasopressors, hopefully with less titration than in ICU, but not necessarily. If a pt. codes there, they often keep them instead of transferring, if it's doable with a 1:3 ratio. It's a lot of work...personally, ICU is a lot less stressful most of the time!!
  7. by   AfloydRN
    Depends on the capabilities of the step down unit. Ours take vents, a- lines, post carotid, post open heart( day 2) post AAA stents, post CVL patients etc... Ours is very progressive. We have taken Swans as well.
  8. by   JamesEDaddict
    Having worked on both units many times, I would say the biggest difference is not the type of medications on a drip but the rate and titration of those drips.
  9. by   turnforthenurse
    Stepdown capabilities vary from facility to facility. I can tell you the stepdown that I work on now is different from the stepdowns I have worked on as a NT. Those stepdowns (when I worked as a NT) took vents, but I never saw A-lines or swans (maybe they had them, just not while I was working lol). Patients would be on titratable drips.

    Where I work now - we do not take vents. We do not have A-lines or swans. Patients can be on drips; however, we are technically not supposed to titrate them. If they need to be titrated (and usually they do!) they need to be transferred to ICU. The only drip we are allowed to titrate is NTG for chest pain only, not for BP. The rationale is because my unit is more spread out than our ICU and the patient:nurse ratio is 4:1 whereas in ICU it is 2:1. For patients on a titratable drip, they need more monitoring. There have been times where I have titrated a cardizem drip (from 10 down to 5, because the patient's BP and HR wasn't tolerating it - nursing judgement call) but I did give the on-call cardiologist a buzz to explain the situation and to get an official order to have the dose changed down to 5 on the MAR.

    Think of stepdowns as a "stepdown" from ICU. You have ICUs where the most critical patients go, then a stepdown unit where the patient is still semi-critical - not well enough to go to a med-surg unit. They need more monitoring with telemetry. Then of course you have med-surg. As HappyParamedicRN said, not all patients go from ICU to a stepdown to med-surg or vice versa. it just depends on the condition of the patient.

    We still get very sick patients on my unit, too. We get a lot of cardiac/respiratory problems, but I've seen DKAers, HHNKSers, PE's, patients with tamponade, etc. Hope this helps!
  10. by   ObtundedRN
    Step-down does vary depending on the hospital.

    In my hospital, our ICUs are all the unstable with titrated vasopressors and sedation. They are 1:2
    Our Progressive care is more stable but critical. Policy states they can have titrated pressors and sedation like the ICU, but they really only do pressors at set rates by the MD, but can still do titrated sedation. Most of the patients have already been trached and are often still vent dependant. They are on all the same bedside cardiac monitors as the ICU, but A-lines, Swan lines, and pretty much any other invaisive hemodynamic monitoring go to the ICU. CVPs and ICP monitoring can be done in the Progressive unit. Patients requireing q2 or more frequent neuro checks, accuchecks, vitals, etc are by policy required to be in a minimum of at least Progressive care. Ratio is also 1:2 like the ICU. Our progressive unit has sicker patients then most other ICUs in our region. Our prog unit is actually pretty difficult and is considered part of our ICU division. ICU nurses hate floating to Prog because they know they are going to have to work way harder then they ever do in the ICU.

    Then we have our Step-down units. They have tele, and are used to getting people who come out of the ICU. They aren't sick enough to need ICU or Prog, but not well enough for a normal cardiac tele or med/surg. They are often medically stable, but have more frequent meds or time consuming dressing changes, full care or almost full care, etc. I think ratios are 1:4.

    Cardiac tele is mostly walkie talkie patients who are in need of just cardiac tele monitoring. Ratios are 1:5.

    Med/surg is probably pretty generic to other hospitals. The most stable of all hospitalized patients. Unmonitored. Ratios are 1:6.

    All of these descriptions vary greatly by hospital. Even other hospitals within our own hospital system are entirely different.
  11. by   formyinfo
    Thanks for the great posts everyone!! Very informative and clear explanations
  12. by   ohioSICUrn
    I work in a SICU stepdown, its funny really we play musical chairs with the SICU, the pts come/go back/come/go back as many as 4 times a week. Noone is stable, we just down have the invasive lines... oh not to mention the codes every night!
  13. by   not.done.yet
    MSICU stepdown here too. I never know where to post - seem to be in an in-between world.

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