What is Progressive Care Nursing Like? Glad You Asked!
Written by Molly Kuyper - BSN, RN
I started on my Progressive Care Unit (PCU) as a new grad. As any new grad will attest to, I felt like a fish out of water on my unit.
There was so much to learn, but I was so excited to learn it ALL, and I felt ready for situations that would make the adrenaline pump. I was hungry for experiences and eager to develop my critical thinking skills. I wanted to see everything; I had endless questions, and after three years realize the questions don't stop just because orientation ends.
As a nurse, you know - at least conceptually - about dedicated units. The PCU I work on is not a dedicated unit. We see a little of everything.
Neuro
We have patients with
post-surgical crani's
pituitary adenoma resections
stroke patients needing NIHSS assessments,
DI
seizures
Renal
complicated kidney transplants
AKI
We take patients in afib RVR, COPD, and HF exacerbations, patients with chest pain who need a workup, patients whose BP or HR need vasoactive drips for intervention, and sepsis.
In the span of one shift, I can maintain a patient on an insulin drip in DKA, discharge an end-of-life patient to home hospice and then receive a flap patient from PACU. The real whiplash can come from taking care of a CIWA who is on the road towards ESLD and then receiving a liver transplant from the ICU that just got extubated earlier that shift.
We will take patients who rapid to our floor for a higher level of care, like those vasoactive drips, HFNC or Bipap, and hourly assessments and monitoring.
We take the patients needing more invasive monitoring that doesn't yet meet the criteria for ICU-this can include septic patients needing an a-line for more accurate BP monitoring.
Frequently we receive patients who may have stable vitals but need more face-to-face time with the nurse. For instance, a patient with altered mental status and SI patient or a patient requiring restraints may need a 1:1 assignment. These shifts can be draining. I sadly see many cancer patients who come in with neutropenic fever or patients needing debulking surgeries for their cancer. I see a lot of patients with GI bleeds or post whipple.
My floor can be a destination for a rapid patient or a pit stop for a patient needing to go down to the ICU. In contrast, it can be a jumping-off point for a patient improving by leaps and bounds who can discharge soon or be transferred to med/Surg.
The PCU is constant movement! There are our frequent fliers, readmissions, and those who are taking time to decide on their plan of care. These patients have been given a terminal diagnosis. They are finding out there is only so much more we can do. They and their family are processing the futility of treatment. They are on our floor because their vitals keep them off of a med/Surg floor, but their code status or prognosis excludes them from the ICU.
They will either continue to pursue any and every treatment, go down to the ICU or come to a decision to go the hospice route.
These are the hardest patients for me to take on our unit. The time of decision-making is taxing on the other nurses and me mentally. Are the treatments we are providing causing pain? Are we missing out on some palliative comfort care orders by not having a clear plan? How would I even work through these decisions if I was in their situation?
These situations aren't filled with the adrenaline like the others; it is tedious and hard and emotionally draining. I cannot begin to understand how the patient and their family feel.
The variety keeps me learning. We can go weeks or months without seeing one patient type makes for a unit built on teamwork and constant communication, and serving one another. I ALWAYS feel supported by my teammates and leadership. When a new admit, rapid, or transfer arrives, multiple nurses show up to your room and help you get your patient settled. There are resources for every patient type that we see, and people always willing to review materials and procedures with. When I have a patient dying, my nurse family comes around me and asks me what I need. I get to work with all specialties, the doctors that come on our floor respect our role and expertise. I get to be a part of the plan of care for a patient. I get to bring comfort to families in the midst of complex transitions.
I once heard of the PCU being referred to as the ugly stepchild of the hospital. I didn't understand what they meant until about a year in. Doctors don't want their patients coming to our floor since some see it as an indicator the patient isn't progressing as they planned. They certainly don't like losing their patient to critical care when we continue to page them, stating we cannot meet their needs on our unit. Yet, in the midst of it all, our crew loves what we do, and I feel confident stating we are excellent at what we do.
I've noticed that when a nurse is ready to leave our floor, they usually choose one of three avenues:
ICU - They feel prepared to transition to the ICU for even more learning,
Float Pool - since our floor gives so much diverse experience already,
Leaving bedside to go outpatient or procedural areas.
I am sure one day I will pursue one of these other avenues because I am a nurse, and we all know how we always seem to be ready for our next adventure, but for now, PCU, you are my ever-exciting home! If you like to always be learning, always be moving, and continuously assess your critically ill patient needs, this is the home for you.
For more perspective from local nurses, keep up with the EARN blog. EARN has a vision to precisely match RNs and NPs with the positions and organizations that fit your skills and personality. The right fit means everything.
👩⚕️Hi, I'm Molly; as an experienced BSN, RN in AZ, I'm excited to be a part of building a better way for RNs and NPs to be precisely matched with nursing positions that really fit them. I’m fueled by amazing coffee, being a new momma, and new adventures 🌎