What Is Progressive Care Unit (PCU) Nursing? The Ultimate Guide
Are you wrapping up nursing school and exploring options for your first nursing job? With lower acuity patients than in an intensive care unit (ICU) and lower patient-to-nurse ratios than in a medical-surgical unit (Med/Surg), the progressive care unit is often considered an ideal setting for new nurses.
Read on to learn all there is to know about progressive care unit nursing: job description, salary, patient-to-nurse ratio, and more!
What Does PCU Stand for, and What Does It Mean in Medical Terms?
The abbreviation PCU stands for progressive care unit. PCUs offer high-quality, cost-effective, and safe care. Increasingly common in US hospitals, progressive care units offer an intermediate level of care between that offered in intensive care units and medical-surgical units. Sometimes, patients are admitted to a progressive care unit directly from an emergency room (ER). Others may be transferred from a Med/Surg unit because they require additional monitoring, equipment, or medication. The types of patients also vary significantly, but they all require a high intensity of nursing care or a high level of surveillance.
What Is a Progressive Care Unit in a Hospital?
Progressive care units may also be referred to as step-down units, intermediate care units, transitional care units, or telemetry units. Regardless of their name, these units help reduce the number of patients in ICUs without compromising the level of care these patients receive.
As step-down intermediate care units, progressive care units offer advanced care to patients with a range of critical conditions, such as the following:
- Cardiac conditions, such as heart attack and defibrillator or pacemaker implant
- Cancer or orthopedic surgery
- Severe pneumonia
- Sepsis or other serious infections
- Chronic wounds
Progressive care units are staffed by the following interdisciplinary team members:
- Nursing care partners
- Case managers
- Social workers
The average length of stay in these units varies, but patients usually don’t stay long. Most patients stay in a hospital PCU for a few days and are then transferred to a Med/Surg unit or are discharged home.
“PCU is progressive care unit, could also be known as ICU stepdown or intermediate care. My old PCU we saw chronic trach/vents, fresh trachs and PEGs (they'd spend a few days in ICU then come to us for education) and people requiring a closer eye without necessarily being critical.” – Reddit user Anaidea
What Is the Role of a Progressive Care Registered Nurse?
Progressive care registered nurses collect and assess patient data in active collaboration with the rest of the multidisciplinary team to guide the therapeutic care the team offers. Progressive care nurses perform all elements of a nursing assessment, which by definition include physical examination, psychosocial assessment, assessment of readiness to learn, functional assessment, and patient-/family-specific assessment scales. PCU nurses’ planning and delivery of care are guided by factors related to ethics, safety, and cost-effectiveness. PCU nurses must maintain up-to-date knowledge in nursing and use research findings in their practice.
What Does a Progressive Care Registered Nurse Do?
As part of their broad nursing role, progressive care nurses have many specific responsibilities. The following are some typical duties of a progressive care nurse:
- Assessing a patient’s behavioral and physiologic status through interviews, observation, physical examinations, and other available data
- Integrating nursing interventions into the multidisciplinary plan of care
- Incorporating discharge care planning into the multidisciplinary plan of care
- Implementing safe, competent, and efficient patient care
- Setting priorities by adapting to changing patient and unit situations
- Assuming responsibility for effectively managing the nursing care of individual patients
- Documenting the nursing process comprehensively
- Evaluating a patient’s responses to care based on the effectiveness of nursing interventions
- Identifying the learning needs of patients and their families and adapting standard information accordingly
PCU Patient-to-Nurse Ratio?
Patient-to-nurse ratios can vary from one PCU to another; however, this variation usually hovers between three to six patients per nurse, and the most common ratio is four patients per nurse.
“I'm 4:1 on a Medical PCU. I was offered a position at a pcu that's 6:1 straight out of school, though.” – Reddit user TheMastodan
“I work cardiac pcu on nights. Our ratio is 4:1 on days and 5:1 on nights.” – Reddit user ooopieceacandyy
How to Become a Progressive Care Nurse and How Long Does It Take?
PCU nurses are registered nurses who have either completed a two-year associate’s degree in nursing (ADN) or a four-year bachelor’s of science in nursing (BSN). That said, many hospital progressive care units prefer hiring RNs with BSNs. Although many hospitals hire newly graduated nurses, others require a minimum of six months or more of nursing work experience. An excellent way of acquiring nursing experience is to pick up per diem nursing shifts. Nurses can work per diem in addition to part-time or full-time jobs, or they can choose to work per diem full-time.
Additionally, PCU jobs require nurses to hold Basic Life Support (BLS) or other cardiopulmonary resuscitation (CPR) certifications. Although not required, PCUs usually prefer hiring nurses who also hold advanced certifications.
Progressive Care Nurse Certification?
The American Association of Critical-Care Nurses (AACN) offers two certification options for progressive care nurses:
- The Progressive Care Nursing – Adult (PCCN®) certification is designed for nurses providing direct care to critically ill adult patients regardless of their location. Nurses holding or interested in this certification may work in intermediate care, direct observation, stepdown, telemetry, transitional care, or emergency departments. The following are the eligibility requirements for this credential:
- Holding a valid RN license
- Practicing as an RN or an advanced practice registered nurse (APRN) for 1,750 hours in the direct care of critically ill adult patients over the previous two years, with 875 of those hours accrued in the previous year or practicing as an RN or APRN for 2,000 hours providing direct care to critically ill adult patients in the previous five years, with 144 of those hours accrued in the previous year
- The Progressive Care Knowledge Professional – Adult (PCCN-K®) is designed for nurses who influence the care of critically ill adult patients but do not provide direct care to them. These nurses generally work in the following roles: clinical educator, manager/supervisor, director, academic faculty, or nursing administrator. Eligibility criteria include the following:
- Holding a valid RN license
- Practicing as an RN or APRN for 1,040 hours over the past two years, with 260 of those hours accrued during the previous year
- *Practice hours include areas in which nurses apply knowledge in a way that influences patients, nurses and/or organizations to have a positive impact on the care delivered to critically ill adult patients and their families.
How Much Does a Progressive Care Nurse Make?
Registered nurses working in general medical and surgical hospitals earn, on average, $85,020 annually. That said, average registered nurse salaries vary significantly depending on their level of education, work experience, certifications, and other factors, such as state and city of residence.
What Is Progressive Care Nursing Like?
The most common description of progressive care nursing is that it is a mix of ICU and Med/Surg nursing both in terms of acuity and patient-to-nurse ratio. The following are descriptions of progressive care nursing shared by PCU nurses:
“Basically, it's a revolving door. You're the buffer between ICU and the wards. Sometimes our patients are super soft med-surg patients the docs don't want to transfer, other times they probably belong in ICU, but ICU is at crash so we take them. The difference between PCU and the wards at my hospital is we are considered critical care…I personally feel PCU is easier than working a medical surgical ward as long as you have the skills. As a new grad, you'll learn a lot.” – Reddit user mogris
“...the workload can vary night to night. I can have four or five patients that are really med/surg acuity patients, but there aren’t any beds to transfer to. No IV meds, no meds they require monitoring, sometimes not even tele. Other nights I can have five patients that each have 3 titratable drips running, are on bipap, and are getting vital signs hourly. Those are the nights that my time management skills are really put to the the test.” – Reddit user ooopieceacandyy
Is Progressive Care Nursing Hard?
As is the case with all nursing specialties, progressive care nursing has its challenges. The following testimonials of nurses with PCU experience illustrate some of those challenges:
“Honestly, I found it the worst of both worlds (the call lights of med-surg and frequently the patients had one toe into needing to be in the ICU) but I learned A LOT” – Reddit user Anaidea
“Intermediate care. In my experience, it’s not wonderful. It’s literally a revolving door of patients being transferred/admitted in and transferred out to the floor of the ICU. You have more patients than in critical care, but the acuity is all over the place. You could have three high acuity patients or a mix, which makes it difficult. Lots of patients have a lot of needs because they’re not as critical as ICU patients so they’re on the call bell every ten seconds. I wasn’t a huge fan of it and am thankful I’m in ICU.” – Reddit user meowqueen
Why Choose Progressive Care Nursing?
Despite challenges, working in a progressive care unit also has many advantages. The following are reasons PCU nurses have appreciated working in progressive care:
“I really loved my experience there though. We had some patients that were more critical than others and I got to experience a wide variety of patients from NSTEMI's, strokes (lots of strokes), end stage COPD, liver failure, renal failure, sepsis, etc. Lots of things. It was very educational. Patients were anywhere between critical and needing lots of intervention all the way to typical walkie talkie awaiting their trip to the cath lab. You'll learn a lot.” – Reddit user NanaOsaki06
“I do think it makes a nurse learn a good bed side manner and how to deal with patients/families in distress, while also honing your critical thinking skills. It is more than just passing meds and doing procedures, I have to think "what could go wrong?" and look for trends in vitals and labs incase a patient starts to decompensate. It is great training for a new nurse. I have stayed for as long as I have because I love the people I work with and I like to be able to interact with my patients (most of the time).” – Reddit user Nursenocturnus
What Makes a Good Progressive Care Nurse: Tips for New Nurses?
In addition to completing a nursing program and obtaining nursing work experience and certifications, a new nurse starting or hoping to start in a PCU should try to develop personally and professionally in the following areas:
- Initiating multidisciplinary collaboration to improve healthcare outcomes
- Communicating effectively with patients, family members, and other staff members
- Supporting and enhancing the patient’s and family’s responsibility and self-determination in healthcare decision-making
- Preparing patients and family members to assume self-care on discharge
- Developing, maintaining, and terminating therapeutic relationships with patients and their families
- Showing sensitivity to diverse personal values
- Participating in activities aimed at broadening ethical decision-making skills
- Incorporating patients’ cultural, spiritual, and other belief systems in their care plans
- Performing self-assessments
- Recognizing elements in personal performance requiring development and seeking opportunities to improve
- Demonstrating knowledge of research findings related to progressive care
- Identifying recurring clinical practice issues and contributing to the development of specific plans to address these issues
It must be noted that this knowledge and these abilities develop over time. New nurses should not see the previous recommendations as prerequisites for working in a PCU but as long-term goals. Overall, PCUs are great places to begin a nursing career.
“All in all, it's a good place to start. If you're like me and get bored easily, you'll move on in a year or two after you've gotten all you can out of it. Enjoy it and use the time in the preceptorship to make mistakes and learn from them. Ask questions and be willing to go work with other nurses that will have you to learn skills. It's a good all-around place to learn.” – Reddit user Olipyr
“I’m a new grad and can confirm it’s a great place to start. I learn so much every shift it’s amazing. I thought I wanted to be an ED nurse, that was until I got ED as my final rotation in nursing school. After seeing what ED nurses do I decided it wasnt the best option for me. I didn’t feel I had enough nursing knowledge to draw off of and be safe. I’ve heard the burn out rate of new grads who go ED/ICU for their first floors is pretty high and I can understand why.” – Reddit user dancingwildsalmon
Final Thoughts on Progressive Care Nursing
Does progressive care seem like a good place to start your nursing career? Keep in mind that working in a progressive care unit does not have to be a long-term commitment. It can simply be a place to acquire nursing work experience, allowing you to apply to other units or healthcare facilities down the road.
There are so many healthcare settings and nursing specialties to choose from that there is no reason to settle for an unfulfilling or overly stressful job. Continue exploring your options here!