Returning to critical care, nervous, excited and with questions

[snowfreeze, BSN, RN]

I am a little nervous and really excited, I have decided that I have enough geriatric experience so am returning to hospital nursing. I want a critical care position and have been offered a telemetry step-down unit position. A few questions are 1. what is the usual patient:nurse ratio, when I left ICU it was 2:1 and sliding to 3:1, CCU was holding at 2:1, Trauma was usually according to acuity but 2:1 was common, Neuro was usually 3:1 or 4:1 depending on acuity, Telemetry 5:1 or 6:1 with lots of transfers and admissions. 2. are the patients really sicker on these units now or are they still the mostly walking talking going home in a week crowd? I am planning for my interview in two weeks, this will include a tour of the unit I will work on and a chance to ask lots of questions.

Please add things you feel I should check on during my couple hours at this facility.

I have been in geriatrics for 5 years now, all aspects in a 325 bed facility with 9 units and personal care, dementia, dementia behavior, LTC and subacute with ventilators working all units and supervising. I have been a nurse for 12 years with 6 years of critical care experience.

[papawjohn]

Hey Snowfreeze

This question is a good one and it's sat around for a while. I'll toss my 2cents worth in: In ICU the standard still is 2:1. Depending on acuity and staffing--'tripling' is not unheard of.

In Tele--where I've been at in the last few years, I have bad news. In one hospital, we'd have 4:1 with Pt's that really were indistiquishable from the CCU Pts I've had in 2:! staffing. Typical Pt was Positive MI, s/p CathLab with sheath in and we're going to pull the sheath and DC home in the AM. I was amazed--a 'drive thru heart attack'!!! In another, they were using LPNs quite a lot and dealt with the legal and competency issues by going to "team nursing". As an older RN (pulled from ICU) I was given report on 12 Pts and had a 'team' of 2 LPNs and a Pt Care Tech. There was also a monitor tech.

I didn't know how to take report on 12 pts!!! (It was on tape--so I kept re-playing it.) Horrible night.

Good Luck to ya. I admire your versatility. (Could never do LTC).

Papaw John