Progressive Care Nursing - Interview with Linda Bay

[traumaRUs, MSN, APRN]

Progressive Care nursing is nursing of patients that don't meet ICU criteria but need a higher level of care than a medical-surgical unit. This type of nursing can be found in step down units, telemetry floors, and even the emergency department.

The American Association of Critical-Care Nurses (AACN) first coined the term "progressive care nursing" in 2001. As all areas of nursing have evolved, so has progressive care. AACN now offers certification for this specialty. There are core competencies that form the basis of education and training of progressive care nurses.

An Interview With Linda Bay, DNP, RN, ACNS-BC, PCCN-K, CCRN-K

Mary Watts, BSN, RN, allnurses.com's Content and Community Director recently interviewed Linda Bay, DNP, RN, ACNS-BC, PCCN-K, CCRN-K and discussed progressive care nursing. Dr. Bay is a Clinical Nurse Specialist at Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin. She recently presented on the topic Why Building a Strong Foundation to Care for the Progressive Care Patient is Important. Mary asked how Dr. Bay got involved in progressive care nursing and she stated, "I wanted to reinvent myself. I spent 10 years as an acute care CNS.” She added that she wanted to have a different type of impact on patient care.

Goal

They discussed that the goal of progressive care is to keep patients out of the ICU. Typical patients found in a progressive care unit include a patient with respiratory distress who needs a higher flow of oxygen or more intensive monitoring. These types of units also care for patients with sepsis who might need simple hemodynamic monitoring in an effort to avoid an ICU admission. It may seem like these units care for a wide variety of patients. However, in reality, they care for patients whose commonality is the need for a higher level of care than the usual medical-surgical unit.

Nurse/Patient Ratios

They also talked about nurse/patient ratios and Dr. Bay said, "this should always be what the patient needs. Hopefully, not more than one nurse to three patients.”

Mary then asked if the need for progressive care nursing was increasing. Dr. Bay agreed and stated that there are certain factors in our country that make progressive care a growing specialty:

• Older age of the patient
• More comorbidities
• Technology that is allowing patients to live longer with chronic illness
• Progressive care costs less than ICU level of care
• Adds another tier of care to the hospitalized patient

Next, they talked about the "identity crisis" that these types of units experience. Different hospital systems refer to these units by many different names:

• Progressive Care Units
• Step-Down Units
• Telemetry Units
• Direct Observation Unit
• Clinical Decision Unit
• Intermediate Care Unit

This results in confusion among patients, visitors, and even staff. When a nurse applies for a job at a particular hospital, it is helpful to have an understanding of the unit. On a related noted, Dr. Bay indicated that a Progressive Care Unit is a good place for new grads, "I believe nurses need these skills. Assessment is the key and this is a nice bridge to an ICU.”

[OUxPhys, BSN, RN]

As a current PCU nurse I can tell you most hospitals do not treat PCU's as a higher level of care, its used as a dumping ground. We are constantly getting inappropriate admissions. I now tell doctors that when they say they are sending someone to us for "closer monitoring" I tell them that our ratios are no different than the floor they are currently on.

As usual, staffing is always about money and numbers, never about acuity or patient needs.

Anyways, my first job was on a step-down at a very well known hospital and I loved it. Great co-workers and management. I saw some very sick people with some unique conditions. I agree 100% that if you aren't ready for ICU but don't want a typical M/S floor then a PCU/Step-down is a great place to start.

[2Ask]

22 hours ago, traumaRUs said:

Nurse/Patient Ratios

They also talked about nurse/patient ratios and Dr. Bay said, “this should always be what the patient needs. Hopefully, not more than one nurse to three patients.”

1:3 ratio is a nice ideal but is it reality?

The ratio can be 1:4 on a PCU even in California. The California ratio law apparently does not apply to PCU's but to a "stepdown unit". The large hospital where I work does not have a single "stepdown unit". It does have multiple PCU's and the PCU is staffed with the mandated telemetry ratio of 1:4 unless you have a vented patient, then you will have a 1:3 assignment.

Looking at job ads, I have seen PCU jobs in other states stating 1:5 ratios in the ad.

[OUxPhys, BSN, RN]

1 hour ago, 2Ask said:

1:3 ratio is a nice ideal but is it reality?

The ratio can be 1:4 on a PCU even in California. The California ratio law apparently does not apply to PCU's but to a "stepdown unit". The large hospital where I work does not have a single "stepdown unit". It does have multiple PCU's and the PCU is staffed with the mandated telemetry ratio of 1:4 unless you have a vented patient, then you will have a 1:3 assignment.

Looking at job ads, I have seen PCU jobs in other states stating 1:5 ratios in the ad.

And thats where hospitals get away with it. By calling it a “PCU” they dont have to do the recommendation for a step-down even though they are the exact same type of floor.

It’s all semantics.

[mindofmidwifery, ADN]

This is probably a dumb question but how does PCU and intermediate care differ from stepdown? And are PCU patients really in CDU areas? I thought the CDU was for more stable patients.

[OUxPhys, BSN, RN]

PCU and step-down are the same type of floor. The names are interchangeable. CDU I thought was for ER patients to be observed to see if they were to be admitted or not. If thats the case then yes they are usually stable.

[HelloWish, ADN, BSN]

I am fortunate, our IMCU is 3:1. I interviewed at a couple of other hospitals near me which do 4:1 and they even took on sicker patients than we do at my current hospital.

[OUxPhys, BSN, RN]

38 minutes ago, HelloWish said:

I am fortunate, our IMCU is 3:1. I interviewed at a couple of other hospitals near me which do 4:1 and they even took on sicker patients than we do at my current hospital.

That’s awesome! My old job was 4:1 sometimes 5:1 (day shift) and the patients there were much sicker than the place Im currently at. We usually have to fight to get 3:1 ratios for LVADs.