stepdown description

mattsmom81 · May 21, 2004

Stepdown units are the place patients transfer to from ICU when they don't quite qualify for ICU care anymore but their monitoring/care needs are too great for the high patient-nurse ratio on the general floors. Depending on the facility, you may get 2nd day postop valves and CABG's, you may manage all uncomplicated MI's directly from the ER too. Some stepdowns manage all vascular postprocedures like PTCA's ...recover them and pull sheaths, etc. Some manage stable ventilator patients who are not requiring 2:1 monitoring in ICU too. So...in your interview ask specifics of what is done, whether you will have a good orientation and preceptorship....and decide what is best for you. Stepdown acuities increase patient nurse ratio from 2:1 in ICU to 3-5 :1. Good luck and hope this helped. :)

beausud · May 21, 2004

hey, i have worked several stepdown floors, respiratory, neuro, med/surg. the way i can describe it would be, "stable ICU patients" your right it's a good place to be if you want to go to ER or the units. stepdown units depends on which hospitals you work at, also on which type of stepdown floor your are on. i've worked at one floor where the stepdown pt.'s didn't have to be hooked up to the monitor (cardiac). most places do have stepdown down pt.'s monitored, again this depends on the pt/hospital policy. stepdown pt.'s like i said are (in my opinion) stable ICU pt.s, they still need very close monitoring, VS q 2hrs, typically a stepdown RN would have max 3 patients, depending on their acuity; again this depends on the hospital. in a typical day on the respiratory stepdown (for example) i would get report from the nurse, quickly look over the orders, asses my pt. head to toe, make sure the vent settings are as ordered (if any), make sure IVF /TF are as ordered, making sure all is connected securely and to the right spot. check out all drains/foley etc.. i have a timetable for myself to do my assesments, my assesment is ongoing... i want to spread out my time w/ each pt., then i would move onto to my meds for each pt. , recheck the orders. try to take a break at 10 am.. again my assesment is always ongoing so whenever im in the room i do a quick pt. check. then hopefully have lunch at either at 1pm or 2pm. then redo the whole process. emphasis on assesment and check out the orders. next thing you know its 7pm and your pt needs to be cleaned up... hehe. do your best not to leave the oncoming RN in a bind. so now i take a deep breath and do it again the next day. dont forget to smile! -every RN has they're own way of doing things, thats my disclamier. good luck. you'll be fine, as long as you show that what you dont know, you will learn. in return the floor will get a good nurse. :)

PS: the way i do things on a med/surg stepdown floor doesn't differ greatly from the above mentioned. just replace the vent w/ another task, i.e. dressings etc.. ok, you'll do great!

i have an interview coming on monday for a med/surg or stepdown position. i have heard that stepdown is a good place to work if you want to eventually do ER, which i do. what i need to know is what kind of unit is stepdown and what do you do in a typical day?
Thanks

cursenurse · May 25, 2004

thank you so much for the info, i went to the interview and was told that i would receive a ccu oreintation. i was also told the orient. would last anywhere from 8-16 weeks depending on what i needed.

JohnnyGage · May 25, 2004

Sounds good. Just remember to tell them if you feel more orientation is needed! However, also remember that orientation is not to make you a "great" nurse, just a "competent" nurse. The "great" is up to you and your work ethic.