Are you a nurse interested in learning more about progressive care units? Not all hospitals have progressive care units, and those that do may vary. This may cause some discrepancies in acuity and workload in some locations. In fact, some nurses may prefer to work in facilities offering progressive care units, as the acuity and workload seem to be more manageable than acute care units.
What is a Cardiac Progressive Care Unit?
Progressive care units help bridge the gap between acute and critical care patients. This allows for safe and more cost-effective care. Step-down, intermediate, PCU, and transitional care are other words used for progressive care. Patients in progressive units are often too sick for an acute care unit but might not meet criteria for critical care either. These patients are generally stable, but are at risk for deterioration.
Each progressive care unit will have their own specifications on acuity, admission criteria, and staffing requirements.
One example of facility-specific criteria is the use of the medication Cardene. One hospital may allow nurses to titrate this drip on an acute care unit, whereas another will only allow this medication to be titrated in progressive or critical care units. The importance of this lies in knowing the type of drug, what it does, and what is required to give it. Nurses are expected to monitor the patient's vital signs at regular intervals while this medication is being administered. A nurse with only 3 patients may manage this easier and safer than a nurse who has 5 or 6 patients.
In some locations, you may hear the term “telemetry” mentioned as a level of care or type of unit. This will also be dependent on your healthcare facility. Telemetry is a monitoring method that allows nursing staff to watch a patient's heart rhythm and QRS pattern in real-time. This will usually allow for the monitoring of the patient's heart rate and oxygen saturation as well. Telemetry is a resource well-loved by nurses as it allows for rapid detection of a patient's clinical status.
You may see telemetry as a level of care with a dedicated unit, or an intervention. Hospitals that have telemetry units will be monitoring patients at all times. If only used as an intervention, then the level of care will still be acute or progressive, with or without telemetry.
A cardiac progressive care unit consists of a cardiac-specific patient population. Most (if not all) of the patients will be admitted with conditions affecting their heart and vascular system. Depending on experience, nurses may require additional training to work in this unit.
What types of cases or patients may you see in the Cardiac Progressive Care Unit?
As mentioned, each healthcare facility will have its own progressive care specifications. Many postoperative cardiac patients will spend a few days in a cardiac critical care unit and then transition to progressive care. Examples include patients who have recently had a major cardiac surgery, such as a Coronary Artery Bypass Graft (CABG), an Left ventricular assist device (LVAD) insertion, or a transplant (at facilities who perform these surgeries). For generalized purposes, other types of patients who are cared for in a cardiac progressive unit may be:
- Patients who have recently experienced a life-threatening condition but are now able to transition out of critical care. Some examples may include a heart attack, heart failure, cardiogenic shock, and more.
- Patients with chronic heart and lung conditions that require them to be dependent on certain intravenous medications which require extra monitoring, such as milrinone or dobutamine.
- Patients who have pulmonary hypertension.
- Patients with decompensated heart failure, requiring an LVAD.
- Patients who require closer monitoring post cardiac catheterization lab intervention.
- Patients who are experiencing cardiac arrhythmias or hypertension, requiring medicated drips, such as Cardene, or others.
While nursing school may cover some of these conditions and medications, they are usually not able to cover all in depth. Hence, the need for specialized education for nurses hired into these units.
How does the Cardiac Progressive Care Unit differ from standard Progressive Care Units?
One of the primary factors that differentiate a cardiac progressive care unit from other progressive units is that the nurses are trained to care for patients with cardiac-specific disease processes. Depending on your facility, there may be other units that are specific to a certain service or cohort, such as general medicine or neurology.
A nurse working in a neurological progressive unit may care for stroke patients, whereas a nurse in a medicine unit may care for a diabetes population, to name a few. Be sure to familiarize yourself with what is offered in your facility. Other things to consider about progressive care:
- Most progressive units have similar nurse-to-patient ratios (1:3 or 1:4). Acute care unit ratios can be 1:5 or 1:6 (more in some areas where staff and resources are slim).
- Though the specialty may differ, most progressive nurses will require extra training that is specific to their patient population. This may result in a slightly longer orientation period.
- Gaining experience in a progressive unit may allow nurses to care for a wider population of patients .
What does a Cardiac Progressive Care Unit nurse do?
As mentioned, each facility may differ, but here are a few basics about the kind of nursing care seen in progressive units:
- Nurses in progressive units are expected to understand how to care for patients with a higher acuity level and with more complex health conditions.
- Nurses must have impeccable assessment skills to help detect early signs of deterioration.
- Progressive care nurses will need to perform assessments often. Even though the patients are no longer considered critical, their condition can change at any time.
Pro tip: practice your assessment skills often; no shortcuts!
- With more frequent assessments, comes more documentation. Remember: If you didn’t chart it, it wasn’t done.
- Time management and prioritization are good skills to have, as progressive care nurses will have patients with a variety of medically complex needs, such as wound care.
- Nurses may have to calculate medication dosages for continuous intravenous (IV) medications.
- Knowledge in managing complex devices, such as LVADs is something a cardiac progressive care nurse will need to know.
- In most facilities, nurses will be required to stay current with telemetry competencies, as well advanced cardiovascular life support (ACLS).
What kind of experience should a nurse have to work in a progressive care unit?
Assuming a nurse has graduated from a nursing program and passes the NCLEX, they can apply to work in any kind of nursing unit they want. Nurses can be hired into specialty units directly out of nursing school now (this wasn’t always as easy). Some may choose to begin their nursing career in another type of unit and later transition into a progressive unit. Nurses may find that getting experience on a general floor or in another area allows them to develop the skills they will need to care for more medically complex patients.
How does a nurse become a cardiac progressive nurse?
Nurses can choose to apply to a cardiac progressive unit during any time in their career. The specificity of a cardiac progressive unit may require the nurse to take some additional training courses to ensure competence, which may be offered at your facility. Additionally, much of the cardiac-specific content may be taught during orientation on the unit.
If you are a travel nurse, you can speak with your recruiter about which facilities offer cardiac progressive units. If you are not a travel nurse, then when interviewing for positions, be sure to ask about the types of units and levels of care offered where you are applying.
At the end of your nursing program, students should treat their clinical rotations like interviews, as this may allow the student to impress staff on the unit. This could result in a job offer before graduation.
With some experience, you also have the option to become a certified progressive care nurse; though this requires a passing score on a certification exam. Pro tip: Many employers offer reimbursement for certification exams. Becoming a certified progressive nurse is not required, though it offers nurses the opportunity to highlight their expertise.
Final Thoughts
Though not all healthcare facilities offer progressive care units, their appeal is within the acuity and better ratios than acute care. In hospitals without progressive care units, the acuity and the nurse:patient ratios are higher on the acute units. If you are a nurse interested in a progressive unit, be sure to ask pertinent questions as you are interviewing and/or researching travel assignments.
If you are interested in learning more about cardiac nursing as a specialty, check out the resources provided by Trusted Health here. Trusted Health also offers nurses the opportunity to earn CEU’s; check them out here! Lastly, if you are a brand new nurse and not quite sure where to start, reference the new graduate guide-it is FULL of great information!
References:
- American Association of Critical-Care Nurses:PCCN
- Heart Health: Left ventricular assist devices (LVADS)
- StatPearls: Dobutamine
- StatPearls: Milrinone
- The wonderful world of progressive care
- Use and Outcomes of Telemetry Monitoring on a Medicine Service
- What to know about Cardene (Nicardipine)
- WHO Classification of Pulmonary Hypertension
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