Step down units: what's your ratio?

ixchel · Dec 4, 2014

.......Bueller???? ?

Greenclip · Dec 5, 2014

It's 1:3. We also have intermediate care units which are 1:4. Usually patients go from ICU to stepdown or to intermediate depending on their acuity, then to the floor. We have separate units for cardiac and med-surg stepdown, BUT for the intermediate care units, medical and surgical are separated.

We used to have dedicated trauma, neuro, medical and surgical stepdowns. Now, however, they aren't labeled as such but we send those patients to certain parts of the med-surg stepdown unit.

ixchel · Dec 5, 2014

Thank you for your response ?

Here.I.Stand, BSN, RN · Dec 6, 2014

Ours is also 1:3. We have one for medical/cardiac and one for surigcal/neuro/trauma. Burn stepdown pts are housed in the burn unit with all burn pts, ICU through floor.

unicoRNurse · Dec 6, 2014

1:4. General, but lots of cardiac (we recover cardiac cath with intervention), and there are also 4 dialysis beds.

OneDuckyRN · Dec 7, 2014

I work on a medical stepdown with a heavy focus on respiratory care, meaning that outside of ICU, we have the only ventilator patients in the hospital. I work nights, and our ratio is 1:4, which is not to be exceeded if one of the 4 is a vent patient. Occasionally it goes to 1:5 (way too much, in my opinion). Day ratio is 1:3, with one person getting 4 patients. Usually, about 90% of our patients are also on telemetry. Our charge nurses also take patients - days gets 2 pts, nights gets 3. The charge patients are usually independent or require minimal assist.

On a semi-related note, our unit is officially called Medical Intermediate Care, but we are a stepdown unit. For the facilities that differentiate between stepdown and intermediate, what is the difference? Curious minds want to know...

icuRNmaggie, BSN, RN · Dec 7, 2014

IMC ( intermediate care unit) or stepdown ratios are 3:1

These patients are stable on the vent or even if not mechanical ventilation, they can not have more than 2 IV gtts.

They are critically ill and require a lot of monitoring and care.

Nurse_Lily, RN · Dec 20, 2014

I work in a PCU (Progressive Care Unit) and the ratio is 1:3 and sometimes, you will cover a 4th patient that's being taken care of by an LVN. It is med/surg, only our Trauma stepdown is a specialty. Otherwise, we get any patient that comes in, Can be neuro, cardiac, medicine, neuro surg, renal, etc.

ixchel · Dec 21, 2014

Thank you for your responses!

The reason I ask is this.... I'm on a step down unit that is in a smaller hospital, so no segregation of patient types. We get everyone. Staffing is short lately, so we regularly have 5:1. Being new, this feels brutal in that I'm still a little slow to get things done, so I'm slammed the whole shift. By the time I have to give report, I spend half of it apologizing because my shift has been spent running around, not learning about the labs, imaging, disposition, history, or other things that I know are relevant. Worse than that - what's going to happen when one of my patients codes and the MD is firing questions at me that I can't answer because I didn't have time to actually read through the basics in the chart???

So I started this thread curious to know what is typical of step down ratios. The unit recently officially went from 5:1 to 4:1. This was an official change that the floor nurses pushed for because frankly, 5:1 was leading to too many safety issues and adverse outcomes. But now that staffing is an issue hospital-wide, it's been assumed that since the unit used to be 5:1, we can handle going back to it, so we're the first unit to get pulled from.

I'm exhausted. I get staffing needs phone calls every day, but I don't want to answer because I'm still so worn out from previous shifts. It doesn't help realizing that it's somewhat normal that ratios be 3:1 in other facilities. I've reached the point that on a typical shift with stable patients, 4 feels pretty easy to me. We get down time. It's mind blowing how much more work having only one more patient can be.

What about when we have a patient go unstable, though? I had this happen this week and I couldn't leave the room to do anything for the rest of my group. This is why 3:1 makes sense. I can't imagine that ever happening, though. It's hard and rare enough we get 4 anymore.

Is there research on this anywhere? I'd love to put some research behind my plea to stop pulling from us when we actually have 4:1 staffing available. It makes sense to me that simply preventing adverse outcomes (thereby lower costs, higher income) would be incentive enough. If Medicare rewards higher patient satisfaction scores, shouldn't we be working toward that with adequate staffing? I'd be happy with 4:1. I don't even need 3:1. Just give me 4!

*sigh* I know.... I'm preaching to the choir.

JeanOfAllTraits · Dec 22, 2014

Our intermediate care is 2:1 if there is super heavy or unstable and needing the ICU ASAP before we code otherwise it's 3:1. I've never seen ratio go above that, but my hospital is fantastic about ratios even though we're not union. Our IMC is 100% tele with a handful of stable trachea vents, some new from this admit some old trachs, some on PS/Bipap. They don't wean vent/PS setting but will do switching between vent and trace dome during the day. They take anybody who is needing Bipap apart from at night for OSA. It's a heavy and busy unit, sometimes 2 total cares with another IMC patient, but the team works very well together. The hardest thing is when the ICUs are full and we can't move patients to a higher level of care until we're at a rapid response or code situation.

Nurse_Lily, RN · Dec 23, 2014

Whoa. 4:1? We would never go to that. We are union and a county hospital. Is there anyone you can complain to? It seems like patient safety could be at risk with such a high ratio.