Step-down experience

Ruby Vee, BSN · Jun 6, 2017

Hello!
I am a new grad with her BSN and have accepted a nursing job on a Pulmonary Advanced Care (ICU step-down) Unit at a large level 1 Trauma/teaching hospital. (I was also told this unit is similar to working in a small ICU) I am very excited and have a few questions!
-I see a lot of people asking about cardiac step-downs but hardly ever Pulmonary step-downs, I'm guessing these are not as common? Will working on this unit a year plus get me good expereince to go to any other nursing job after? What kinds do you think specifically would like to see this type of experience?
-What's the difference between starting off in a med-surg floor compared to starting off on a step down unit? Will step down be more valuable?
-I luckily snagged day shift. (I have worked as a PCA for over a year on night shift) I am excited that this will give me the opportunity to have a normal sleep schedule and ultimately a more normal social life. Do others agree with this? I know it will be more fast paced but I think I would rather the shift go by faster than to drag on. Will this be overly challenging? Or a good experience to learn on this shift?
-Any tips for a beginning Pulmonary step down nurse? Your experience? Recommendations? Plus any study tips for the NCLEX is appreciated too! ðŸ˜Š

I passed boards forty years ago when it was a two-day exam on paper with #2 pencils and took six weeks to get the results via snail mail. So no, no study tips -- except spend the day before your exam at the beach, the movies or somewhere fun.

For your hospital to have a separate pulmonary stepdown, it's probably a very large teaching hospital. Teaching hospitals are great, for the most part. You get to work with brand new interns and residents fresh out of medical school and you have the chance to influence their opinion of and interactions with nurses for the rest of their careers. It's an awesome responsibility that I hope you take seriously. We can save their butts (once you get some experience under your belt anyway) or we can make their lives miserable by nitpicking them all night long. Please make up your mind not to be the nurse that makes them miserable!

The patients will probably be sick still -- the larger the hospital, the more interesting (sick) patients you'll get at every level of care. I'm thinking you'll get some patients who are still ventilator dependent? Perhaps you know whether this is the case from your tour of the unit. If this is true, it would help you to read a little about ventilators so you understand the basic principles. You can also pick RT's brains when they're there to see to the equipment. A good RT is a veritable font of information and a good ally. "ICU FAQs" is a great resource. Some of their information won't apply to you, but some of it will. Feel free to just pick out the things you need.

http://http://www.icufaqs.org/

Working on a pulmonary stepdown will give you valuable experience for later on, once you're competent and confident and are ready to take the next step. You won't have the variety of patients that you would have on Med/Surg -- you're going to get mostly pulmonary patients. But they'll have co-morbidities so you'll learn some cardiac drugs, some diabetes drugs, some anti-hypertensive drugs, etc. More than that, you'll learn to suction (something that always scared me to death until I went to MICU and got a lot of practice), manage (and hopefully understand) CPAP, BiPAP, possibly ventilators, various respiratory treatments and drug interactions. You'll learn to talk to patients, visitors, physicians, ancillary services and how to give a focused report to the next shift. You'll learn some "skills", consolidate the skills you already have and get lots of practice. I think it's great experience, especially if you're already interested in the pulmonary system.

If you get the opportunity, take ACLS and learn what sorts of rhythm changes to expect with hypoxia. Learn to analyze blood gases so that you really understand what's going on. There's likely to be a lot going on during day shift, so you'll see a lot. If you get a chance to rotate to nights for a week or two, that would be a valuable experience. You should at least understand what goes on during the night shift, and night shift is just a bit slower so you have more time to look things up and get a good understanding of them.

I hope you score a seasoned preceptor who likes to teach, but even if you don't, you'll learn lots.

Smiley72 · Jun 7, 2017

Thank you so much for your response! I do believe we will get ventilated patients but more so the ones who have chronic need of it. I know we have to get our ACLS. I am very interested in units such as PACU, OR, and Endo...is this good experience for these areas?