"You are now a stepdown nurse too"

Specialties Critical


  1. What would you do?

    • 11
      Find a new ICU job stat!
    • 7
      Grudgingly accept it...
    • 2
      Great! Stepdown is what I want too!
    • 1
      I am not ICU

21 members have participated

Specializes in ICU + Infection Prevention.

What would you, an ICU nurse, do if you were informed you now staff stepdown, so 3:1 no CNA, on regular basis?

You either accept it of you quit your job and find a new ons. There are many hospitals that IMCU is staffed by the ICU core staff.

I know the ICU nurses routinely float to the step-down tele unit where I work. They actually start in Tele before they can train in the ICU so for them it's not such a hard transition. Does your contract stipulate that you are an "ICU" nurse or is it more general?

Specializes in MICU - CCRN, IR, Vascular Surgery.

We can float to cardiac or surgical PCU and since we have no medical PCU they're mixed into my ICU. I personally prefer actual ICU patients, but to each their own.

Personally I would wonder if there was an implication that I wasn't quite up to speed to be in the ICU yet, and would probe my supervisor about what I need to do to step up my game.

That may very well not be the case with your situation, but that's where my silly brain would go with that.

Specializes in ICU + Infection Prevention.

This is unit wide. This isn't an individual reassignment. It isn't floating, but an expansion of stepdown and shrinking of ICU.

Specializes in Trauma Surgical ICU.

3:1 is great. Our step-down or PCU is 5-6:1 with the same charting and assessments as ICU !!!! At my last hospital 3-4:1 was max but the techs did all the baths,turns, toileting,FS and the charting/assessments were q4 and q4 vitals. So it was much more do-able..

I have worked step-down a few times and its not bad but its hard to change our "mindset" from critical to more stable.

Specializes in Surgery, Trauma, Medicine, Neuro ICU.

We get "floated" to tele/pcu sometimes but lately our patients have been so sick and there have been so many of them that we've been overflowing ICU patients into PACU so NOOOO ONE has been floated to tele in years I think. But technically...we float there if we are overstaffed and they are short staffed.

Specializes in Nursing Professional Development.

If the assignment is reasonable, accept it. Be a team player. Hospitals have to be flexible to deal with changing patient census and occasional fluctuations in staffing needs. To go between ICU and step-down is a reasonable thing for them to ask you to do. It's not like you suddenly being asked to take maternity patients or NICU patients or some other type of patient that you would not have the knowledge & skills to care for. If you refuse to be a little flexible in this situation, you will face political problems that are not worth having for this issue. This situation is not bad enough for you to take your stand here. Save your energy and political capital for bigger battles.

That is assuming that the assignment making / staffing levels are still within a safe range. If it is not safe, then express your concern in terms of the need for patient safety -- not in terms of what is best (or fair) to you. Advocate for the patient while showing your willingness to do your share to pitch in and help in this situation. That would be your best approach. If that doesn't work, then you may face the tough choice between leaving and staying. But don't jump to that choice prematurely. Try to make it work first.

Specializes in Neuro ICU and Med Surg.

Our ICU staff and CCU staff work both ICU step down, and CCU step down. Our step down ratio is 4-5:1. ICU and CCU are 1-2:1. Usually 2:1. Tele is 6-7:1 unless you have a patient on a drip you are 4:1.

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