snsbelcher

I work in a progressive care unit (formally titled step down), and have been here for about a year and a half. In my opinion, the step down I'd ra totally different kind of busy than the icu. No, you're not going to be in the patient's room consistently monitoring cvp, or titrating they're drip, but you'll be responding to more call lights, coordinating with more physician's (depending on the service lines on your unit). You will still have some drips, but hopefully not as many. My unit seems to be a mixing bowl of patients. I see multitudes of different disease processes. It isn't just cardiac or surgical or whatever. You will probably learn so much, and do a little refreshing every shift. I would find out the three most common patient types for the unit, and the and review the drips and any protocols they run. I agree with the idea of shadowing at least one day, and hopefully they orient you well tootheunit. Good luck, and enjoy!

Administration isn't increasing their bottom line with these ratios. Actually, we had a 470% increase in hai's in May. We went from zero clabs, ssi's, and caudi's last year on our unit to 4 in one month! I have a hard time believing that it is more expensive to staff more nurses than it is to pay for these infections. My manager has also asked that we all do our own research, and bring ideas to the table, so I'm not concerned with being labeled as a trouble maker. Thanks for your replies though.

I work in a 30 bed Progressive care unit with 10 of our beds being licensed for ICU patients. Our administration has been proposing increasing our nurse to patient ratios from 1:3 to 1:4 or even 1:5 at night and on weekends. As of now, we are lucky to have 8 RN's and 2 CNA's on days and 7 RN's and 1 CNA that doubles as our clerk at night. We share an RT with 3 other 30 bed units at this time, and sometimes a physician can be more than 30 minutes away from the bedside due to ER needs and other floor needs. Our patient population's include but aren't limited to CHF exacerbation, COPD exacerbation, Acute SIRS patient's, Acute GI bleeds, HTN crisis with drip titration (Nitro, Nicardipine, Esmolo), patient's in acute NSTEMI pre and post cath, POD 1 open hearts, we are the overflow for the Neuro and Burn ICU, we get many surgical complications DOS or POD 1 patient's with o2 general requirements up to 60% FIO2 and to 100% for up to 8 hours or even continuous BIPAP, vascular emergencies on heparin or argatroban pre and post op,LTC vent patients (with stable trach), we see many drug and ETOH overdose patient's that "Bare close monitoring," acute and chronic liver and renal failure patients, and our bread and butter seem to be insulin drips (acute DKA and HHNKA). We also routinely have at least 1-2 cardizem or dopamine drips on the floor at any given time. All of our patient's are on Tele, but we do not have a monitor tech, so we are responsible for also being aware of the monitors at all times. Our charge Nurse position is being phased out, and even they are taking 3-4 patients every shift at this time. Has anyone seen any resent research regarding increased CAUTI, CLAB, SSI, VAPS, falls, readmissions, or sentinel events related to increasing patient ratios and increased acuity? I'd like to be able to review and discuss this literature with our administration to help support our adverse feelings about proceeding with the ratio increase.