Progressive Care Units (PCUs) are specialized medical units that provide care to patients who are more stable than those in intensive care units (ICUs) but still require more advanced medical care than in med-surg units.
They might also be known as “intermediate care units,” “step-down units,” or even “transitional care units” depending on the facility and the type of care the unit specializes in.
PCUs are becoming increasingly popular in hospitals and long-term care facilities due to their cost-effectiveness and the level of care they can provide to patients. PCUs are staffed by registered nurses, nurse practitioners, and other healthcare professionals who specialize in providing this type of care.
Most PCU nurses are specialized (for example, you might become a neonatal or pediatric PCU nurse). PCU nurses generally have fewer patients than on a med-surg floor, but they often have more than in an ICU.
Educational Requirements for PCU Nurses
PCU nurses must have an associate’s or bachelor’s degree in nursing. They must also be licensed as a registered nurse in the state where they work, which requires passing the NCLEX. In addition, PCU nurses usually need at least one year of experience in a hospital or long-term care facility.
You’ll also be required, as all nurses are, to have a Basic Life Support certification, but you may also be required to have an Advanced Cardiac Life Support certification, depending on where you work.
Because PCUs are so specialized, you’ll likely need other certifications specific to the focus of the unit you’re on. For example, you may be required to get a PCCN certification.
Types of Patients in a PCU
PCUs typically care for a variety of patients; however, the types of patients you’ll work with depend on the focus of the unit. There are PCUs for addiction, cardiovascular issues, physical rehabilitation, and more.
You may have to treat patients who have had a major surgery or procedure, such as a cardiac bypass or joint replacement, or patients who have chronic medical conditions, such as diabetes or heart failure. Other patients may be recovering from a serious illness or injury.
Because PCU patients require such a high level of care, you’ll be treating them around the clock, often giving them powerful medications that have to be carefully monitored. They will likely be in your unit much longer than patients in a med-surg unit would be, and they’ll often need help with basic hygiene.
Unfortunately, these patients are also more likely to experience severe complications, so you’ll need to be prepared to call in a rapid response team more often than on a general care unit, and you’ll also experience many more code blues. These patients also tend to have a higher risk of falling.
What to Expect in a PCU
While the lower nurse-to-patient ratio might sound great at first, you have to keep in mind the level of care they require. These are not patients who can be left alone for long — they require constant monitoring.
You’ll still likely have 3–4 patients on average, though some days you might only have 2, and those patients are likely to stay in the unit longer than on a med-surg unit—sometimes for up to a month or more.
This is good in some ways as you get to know your patients better and become more attuned to their needs. However, you’ll also have to sometimes deal with patients who become increasingly frustrated at having to stay day after day in the hospital, which can become an issue.
To put it simply, even though you have fewer patients, you’ll have at least as much work as on another unit, if not more.
Benefits and Drawbacks of Working in a PCU
Working in a PCU can be a rewarding and fulfilling experience because you get to see patients who have severe illnesses recover and regain their health.
Getting to know patients better because they’re on the unit for so long can also make your workdays better — you develop a rapport, and even an emotional bond, with your patients, which can be both rewarding in itself and make your work easier to do, especially if they have a good attitude about being in the hospital for a long time.
Working in a PCU can also be a great opportunity for career advancement. PCU nurses are able to gain experience in a specialized field and can use this experience to move into higher positions.
The big problem with working in a PCU is that, because your patients are so sick, you’ll end up with more patients who don’t make it or have to go to the ICU, which can be really painful, especially if you’ve developed a relationship with them.
For the same reason, it can be more stressful than other units. There’s so much more you have to monitor and pay attention to, and you have to constantly be on the lookout for changes in their condition.
Working with patients who can’t take care of their personal hygiene can also be draining, especially when you have 2 or 3 other patients who need just as much care. You have to be efficient and fast while still being caring and attentive, which is a difficult line to walk.
Overall, working in a PCU is different from any other unit, which means it comes with its own challenges and rewards. The only way to find out if it’s right for you is to try it
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