Progressive Care Nursing - Interview with Linda Bay

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.”