Stepdown ICU?

Daytonite, BSN, RN · Sep 7, 2005

You will need to learn to read telemetry, so within the first 6 months you will most likely have to take an EKG class so you can learn to identify the different heart rhythms. The hospital will most likely have certain protocols for some of the arrhythmias that you will have to treat. For instance, the unit I worked on we treated short runs of ventricular tachycardia and bradycardia. We had to be able to recognize them on the monitors, assess the patient physically and administer the lidocaine or atropine per the hospital protocol and then notify the physician. Some stepdowns today require their RN staff to have ACLS certification. It depends on the sophistication of the unit you work on. You need to have good physical assessment skills. We occassionally had patients on Dopamine drips, but it was not for the maintenance of blood pressure; it was for renal perfusion. We all had to take the dynamic monitoring class the ICU nurses took so we knew what wedge pressures and cardiac output assessments were because we were expected to float into ICU. However, we still never took any wedge pressures or did any cardiac outputs even when we worked in the ICU. My stepdown got a lot of patients who were either eventually headed toward the ICU or coming out of the ICU. We had a great many patients on ventilators and who had trachs or were intubated. So, we had to know about blood gasses and how to deal with the ventilators. Had to do a lot of suctioning and trach care. Had to know what to do if a patient pulled out their trach or endotracheal tube. We often got patients with chest tubes either due to chest surgery, trauma, or lung cancer; so, you need to know how to maintain them, problem shoot them and what to do if the patient pulls them out. We got a lot of post-op surgical patients who had had very extensive surgical procedures and needed close monitoring; so we had patients with every imaginable tube coming out of every natural and man-made orifice you can think of, a lot of them connected to suction. We also got a fair number of admissions in the middle of the night from the ER when the physicians wanted the patients put on telemetry for monitoring purposes; we spent time at the beginning of each shift discussing with the nursing supervisor who were possible candidates to come off telemetry for another patient needing it. It was our responsiblity, then, to call physicians for an order to D/C telemetry so an admission could have it. Many of our frequent flyers were COPD'ers, so you have to know how to assess respiratory status and act quickly. You cannot be squeamish about looking at or cleaning up sputum. We probably had more code blues than the regular med-surg units. We assisted physicians in chest tube placements, trach replacements, and central line placements. We were often the nurses who got floated into ICU while other med/surg nurses then got floated to our stepdown unit to replace us. The ICU nurses hated being floated to stepdown because they weren't used to having more than 2 patients at a time. :rotfl:

It was the best unit I ever worked on. We were a unit of LPNs and RNs, no CNAs other than one who kept our supplies stocked. Each RN had an LPN to work with for 9 patients. When we were not busy with our own patients we helped the other teams (we had 29 beds). We did a lot of basic nursing care like bed baths, turning and repositioning, and cleaning up wet or dirty beds. We did a lot of IVs and IV meds. You have to get along and work together as a team or it can become the worst unit you'll have ever worked on. The workload is a bit heavier and more intensive than regular med/surg units because you will be monitoring not only the patients, but labwork as well, notifying doctors of abnormal results, and working with a very wide variety of tubes and gadgets. There was never much time to sit down.

megan mahal · Sep 7, 2005

Thank you soooooooooooooo much for your information. it really helped me a a lot to visualize myself working in a stepdown ICU. i will have an interview with the manager for the new grad rn program....any tips/suggestions you may want to share? anybody....?? what will it take for the nursing manager to get me in the program? i do not have US clinical experience to offer ( i am a foreign grad).....what i can offer at the moment is theoretical knowledge and a new rn who is eager, enthuastic to work and a hard worker... would that be enough to get in a new graduate rn program for stepdown ICU? if not, how can i make myself "shine" during the interview? whether i get in or not....i just want to give it my best! :)

Daytonite, BSN, RN · Sep 8, 2005

I would imagine that your enthusiasm to learn new things would be important. They will probably want to see that you are a go-getter and are one of those people who can't sit down (because you won't on a stepdown unit). I can tell you that when I was interviewed for the position on the stepdown unit, the head nurse took me on a tour of the unit and deliberately took me into a couple of rooms of patients who were on ventilators and were comatose to see how I reacted. I learned later that she did this with anyone she was interviewing for a position on her staff. Stepdowns are not for the squeamish. I am not kidding when I warn you to be prepared for seeing all kinds of goo imaginable coming from peoples wounds. If you can't handle the suctioning and the sputum look to another unit to work. I always scoff when people say they can't stand blood. There are worse things than blood. In our bizarre sense of humor on stepdown we never considered anyone part of the staff until a trach patient hockered up a wad of sputum on them (not on purpose, of course!). Getting hockered on or knee deep in diarrhea or vomitus was cause for a party for the honoree. :balloons:

AMARTIN1 · Sep 8, 2005

Thank you soooooooooooooo much for your information. it really helped me a a lot to visualize myself working in a stepdown ICU. i will have an interview with the manager for the new grad rn program....any tips/suggestions you may want to share? anybody....?? what will it take for the nursing manager to get me in the program? i do not have US clinical experience to offer ( i am a foreign grad).....what i can offer at the moment is theoretical knowledge and a new rn who is eager, enthuastic to work and a hard worker... would that be enough to get in a new graduate rn program for stepdown ICU? if not, how can i make myself "shine" during the interview? whether i get in or not....i just want to give it my best! :)

Hi and welcome to the US!!! I currently work in a stepdown unit and daytonite is right, it is alot of work. I am also in an internship and you need to have sharp assessment skills and a great memory :rotfl: (your brain: all the pt's vital information will become your best friend.) On our unit, we deal with everything from stable vent's, to psych, to pregnant diabetics on insulin drips, to cardiac drips. You have to be multi tasked and quick on your feet. Oh and sit on your feet, I can't remember when i last did that :)!! If you are enthusiastic and willing to learn, you will make it. A strong med-surg knowledge base will help, but you will learn so much on your floor. I feel it's the best decision i have made in my early nursing career. Don't expect to know everything and learn from constructive critiscism. My preceptor has been my best resource and has protected me from potential problems along the way. I wish you lots of luck and hope you get the job, it is so worth it. Even if you don't get this one, remember my advice. I've had several small breakdowns :uhoh3: but I wouldn't change it for the world. Oh! and remember to write down anything and everything you need to know or need to report to a MD or next shift, especially labs. These pts' have so many different specialists and they have so many parameters and orders it is unreal.

I overestimated how much my brain could actual memorize, must be my age setting in :rotfl: God Bless....AMARTIN1...Let us know how it goes

megan mahal · Sep 8, 2005

thank u for all your replies...........i will let u know what happens. wish me luck...........megan

megan mahal · Sep 8, 2005

i currently started working in a LTC as my first work "hospital" experience but would like to try an acute setting hospital. they say that i should get an LTC experience for 6 - 12 months before i take the plunge to work in a high stress working environment like an acute hospital. is that true? but i think and feel otherwise.........LTC job is a "routine" job. i do not have the US clinical experience since i am a foreign grad...will that be a hindrance to get my feet wet working in a stepdown ICU unit or even med surg? any advise...