Tele vs Step down vs CCU

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Can someone explain the difference between these units? I worked on a unit called tele and that meant Post CABG, pre and post cath, cardiac drips (nitro, diltiazem, etc.), pre and post any cardiac procedure performed at our hospital. We didn't take art lines so once those were out and they were stable they were ours. We regularly took patients from the ICU once they no longer required that level of care. Was that normal tele stuff or more like a CCU?

anewsns

437 Posts

Specializes in Neurosciences, stepdown, acute rehab, LTC. Has 8 years experience.
1 hour ago, zombie nurse said:

Can someone explain the difference between these units? I worked on a unit called tele and that meant Post CABG, pre and post cath, cardiac drips (nitro, diltiazem, etc.), pre and post any cardiac procedure performed at our hospital. We didn't take art lines so once those were out and they were stable they were ours. We regularly took patients from the ICU once they no longer required that level of care. Was that normal tele stuff or more like a CCU?

Sounds like a stepdown. Do you mean CCU as in critical care unit? 

Has 5 years experience.

I just showed my ignorance. I thought CCU was cardiac care unit. ?

What is CCU, PCU, vs ICU?  Is there just a cardiac unit in a bigger hospital?

Can you tell me what a general step down unit does?

 

Thanks!

Specializes in PACU, Stepdown, Trauma.

CCU is most commonly a coronary care unit - a unit that offers critical-care level cardiac-specific care. Progressive care unit generally refers to a step down unit—a high level of care but not ICU-level.  

The delineation between step down and tele depends on the hospital. Your unit sounds like a typical telemetry floor to me. A step down floor might be willing to take a patient on a BiPAP, whereas a tele floor wouldn't do that at the hospital I work at. The ratio for step down is 3-1 and the ratio for tele is 4/5-1.

Has 5 years experience.

Thank you for explaining that to me. ?

To clarify, our unit did take Bipap, we just weren't supposed to initiate it on our unit. We would send them to ICU to initiate it and then they came back after an appropriate amount of time. I have taken care of patients on  Bipap. We did art lines when I first started but the number of people trained dwindled so they stopped. I had one patient with an art line post cath that other nurses helped me manage and was supposed to be a training experience but as even they felt rusty they decided after that to stop accepting them on our unit. I was required to take the AACN ECCO program when I started on the unit as part of my training. I also helped our pulmonologist perform bedside thoracentesis, FWIW.

Anyway, is the difference based on managing things like bipap?

The reason I am asking is I am looking to travel and want to use my skills. I don't know what an appropriate level of care would be for me, though. Is not being able to manage an art line the thing that would exclude me from a CCU? Would a progressive care unit or step down nurse need to run an art line?

Thanks for answering my many questions!

Specializes in PACU, Stepdown, Trauma.

Honestly, I think hospitals have so many different names for similar units that your best bet is to be up front with what your previous experiences have been and look at the requirements for each particular position. A quick Google search shows lots of RN travel positions available for telemetry units, which sounds roughly like what your experience has been. 

To answer your question about BiPAP, we would initiate it on the step down floor that I worked on and maintain continuous SPO2 monitoring. We never had art lines or any sort of invasive monitoring. The difference between tele and step down is in acuity of care and frequency of monitoring required — like neuro checks. ICU would do q1 hour neuro checks, the step down floor I worked on would do q2 hour neuro checks and tele and med/surg would do q4 hour neuro checks.

To work on a CCU (which I've never worked on), my impression is you would need experience with multiple types of invasive monitoring, vents, pressors, balloon pumps, etc. There's a lot more going on than just art lines. I currently work in PACU, which is considered critical care, but I'm not familiar with caring for critical care patients in an ICU or CCU setting. 

Has 5 years experience.

That makes sense. I really appreciate your clarifying this for me. I would definitely not be safe on a CCU as I did not use any invasive monitoring. We were NIHSS certified and did frequent neuros. I like your suggestion to evaluate each offering against my experience. Also, a good recruiter should be able to help me  with this process, I would hope. Thanks again to both of you!

JBMmom, MSN, NP

4 Articles; 2,348 Posts

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 11 years experience.

As you pointed out you would not be qualified to work in a CCU without experience with invasive monitoring, vents, titratable vasoactive medications, etc. Even if you applied, during the interview process a potential employer will feel out your experience and determine whether a PCU or tele type assignment would be most appropriate. Just remember if you're traveling you will often get one shift of orientation only, just to show you where things are. You're expected to be able to step in and hit the ground running with patient care aspects, the orientation day is just to give you the lay of the land in your temporary unit. I would recommend traveling to units where you are confident. Travel assignments aren't necessarily the place to expand your skillset.  Good luck with your future plans!

Has 5 years experience.

Thanks! I absolutely have no wish to work above my experience. This post is to help me understand where my experience fits in. I have heard at some hospitals tele is med/Surg with a monitor. I am able to handle more than that as our m/s didn't take cardio active drips, for example. So I assume they don't anywhere else. I appreciate the help in figuring this out! ?