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Step down ratios


One of the other posts got me wondering - what are your ratios if you work in a step down and what specialty (if any) does your step down have?

Currently my step down is four flex five. We're an oncology unit with an emphasis on surgical patients though we also hang chemo and have patients that go to radiation daily. We also deal with a lot of nephrotoxicity and cardiotoxicity issues due to the nature of chemo.


Specializes in CICU, Telemetry. Has 7 years experience.

I used to have 1:3 ratio 'ideally' in cardiac surgery stepdown, but would end up with 4-6 patients plenty often/most of the time.

Dealt with patients on telemetry, q2h interventions, chest tubes, epicardial pacemakers, amiodarone, diltiazem, heparin, insulin, dopamine, lidocaine, nitro, argatroban, milrinone, dobutamine and some other drips that don't come to mind at the moment.


Specializes in Trauma | Surgical ICU. Has 7 years experience.

In accordance to California nursing staffing ratio, step down unit ratio is 1:3 California RN Staffing Ratio Law

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

The term "step down" is used for a wide variety of patients, oncology units are typically considered a specialty unit, which is a bit different than a true step down which is usually 1:3. A specialty unit is one where patients require "technical support" using advanced monitoring, but do not require significant forms of life support (ventilator, ECMO, VAD, CRRT, frequently titrated vasoactives or inotropes). From what you've described, the California mandated ratio would be 1:4 which usually translates to 1:4 or 1:5 elsewhere.

I work a fulltime job and a prn job at two different hospitals in med/onco. At both places, it is typically a 4 to 6 ratio with 4 being more typical. On one of my floors, chemo is hung frequently, patients go to PET scans, and patients often go to radiation. My other job is at a smaller hospital and radiation is not typically done unless we have to send them to the clinic to get it.

Granted this isn't step down, but almost always i have four patients lately. At the larger hospital, the patients are usually a bit sicker, but ratio is the same.


Specializes in Stepdown . Telemetry. Has 8 years experience.

I am in CA on stepdown and we are 1:4 for a stepdown... The this title is defined by definition of the patients we get.

The hospital however has worked around this by maintaining title of "telemetry" since we also get the cardiac pts.

The entire floor agrees we need to be 3:1, even the manager. But its a coorporate trick.

The patients that are "stepdown" are the sepsis/shocky patients that are moderately unstable, you see icu in their near future...and usually by shifts end this is where they go...

Its a BS workaround in my opinion.


Specializes in Neurosurgery, Neurology.

I'm on a neurosurgery/neuro stepdown (with both "floor" and stepdown patients). We can have 2 floor patients and 2 stepdown, 3 floor and 1 stepdown, or 3 stepdown and 1 floor.

Here.I.Stand, BSN, RN

Specializes in SICU, trauma, neuro. Has 16 years experience.

My hospital's stepdown units are 1:3. One is more focused on cardiac -- post cath lab and transfers from the SICU postop, medical including those on our DKA protocol, and I want to say they take the occasional trauma pt if they have significant cardiac concerns. Another is more focused on trauma and stroke/other neuro pts, and occasionally a postop kidney transplant. The burn unit is one-stop nursing for thermal and chemical burns/inhalations, frostbite, SJS, necrotizing fasciitis, etc. Their ratios for stepdown beds is also 1:3.

1:4-5 sounds appropriate for floor. Especially with those DKA pts, with the q1 hr FSBGs and drip titrations and q4hr labs (and ensuing nearly constant K+ replacement.)

Julius Seizure

Specializes in Pediatric Critical Care.

peds cardiac surgery step-down - we take vented trach patients, drips that don't require frequent titration, etc.

We usually stay 1:2.

Technically I guess we can go 1:3, but it rarely happens. I've only experienced it twice that I can think of. One of the times that I had three patients it was because my patient was waiting for a bed to open up on the floor, so I had 3 patients for about four hours while I waited to transfer him.

Edited by Julius Seizure

1:4 usually. Its extremely hectic. We got very unstable patients generally cardiac, new stroke, sepsis or bleeds


Has 8 years experience.

1:4 is common and all the step down units at the L1 trauma center I worked at were 1:4. I've seen 1:3 as well. Anything higher than that is typically just called tele or med/surg with monitoring as the patient isn't truly a step down from the ICU, they are just needed cardiac monitoring. I think in general most inpatient nursing is heading towards ratios of 1:4 (or 1:5 max) because if you're sick enough to be in the hospital, generally the amount of attention you need is 1 nurse to 4 patients. To me a nurse to 7 or 8 or more patients means the patients probably don't need to be in the hospital. The level of complexity of charting, etc that is now present in hospital nursing really would make high ratios a nightmare. Can you imagine having to go through EPIC checklists and charting on 8 people?

When I worked step down in WA and ID ratios were 1:4. One unit was mostly cardiac, and the other unit was strictly cardiac. At times the ratio was a little higher if there were new grads who were struggling. We were always busy!

MrNurse(x2), ADN

Specializes in IMC, school nursing. Has 28 years experience.

My previous employ was on a post-OHS step down that also had intensive abdominal post op and telemetry. Our ratio was technically 1:3, but if you came in with 3, you were getting an admission. Night was 1:5. Do not miss that unit AT ALL. Now work SNF/LTC, able to be paid for being a nurse and my 1:15-30 ratio is livable, actually enjoyable.