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What’s in a name?

In a recent NURSING SPECTRUM survey, 70% of nurses reported that their facilities did not use the term ‘’progressive care’’ to refer to telemetry, step-down, or intermediate care units. PCUs vary in name, management, and patient population, and their size typically ranges from two beds to 80 or more.

Although facilities like Eisenhower Medical Center in Rancho Mirage, Calif., don't identify units or nurses as progressive care, Chief Nursing Officer Louise White, RN, says, ‘’The work the nurses do fits in with AACN's description of progressive care.’’At Eisenhower, progressive care nurses work in the telemetry, vascular, and the postinterventional units. ‘’They care for patients formerly admitted to ICU, but who now go to a step-down unit to receive highly trained nursing care according to patients' needs,’’ she says.

According to the AACN, patients' care needs and required interventions define progressive care, rather than the location and name of the hospital unit in which they receive that care.³ ‘’The AACN Task Force struggled with the name 'progressive care,'’’ says Salipante, a task force member. ‘’We see the term as positive. Our patients are on the critical care continuum and [make] progress through it.’’

The bottom line

Progressive care makes financial sense. ‘’Hospitals are cost constrained,’’ Quintero says. ‘’Since costs drop by about 50% with each decrease in a level of patient care, progressive care offers a significant savings over critical care.’’ Quintero maintains that patient outcomes are improved when a patient is cared for at the most appropriate level of care. Discharging patients from the ICU to the PCU instead of to a general floor lower mortality rates because patients receive the appropriate care level for their acuity.⁴

Moving patients to PCUs offers a morale boost for patients, says Maggie White of Methodist Dallas. ‘’Patients who progress to a step-down unit see themselves as getting better, a real boon psychologically,’’ she says. ‘’Next step is discharge home.’’ And because rules for visitation are less restrictive than in ICUs, families have more opportunities to be with patients and participate in their care.

‘’Because of progressive care, patients get home quicker,’’ Dooney says. ‘’Within patients’ short stay, nurses educate them as they focus on health and wellness. Nurses connect patients with rehabilitation and home care visits that will keep them healthy and at home.’’

Progressive care also might enhance permanence among staff in telemetry units, Eisenhower Medical Center's Louise White says. ‘’Typically, mobile units are considered places to gain knowledge, stepping-stones to work in critical care,’’ she says.

Moving toward the mainstream

‘’The story of progressive care is one of inclusion into the mainstream, recognition, and acceptance,’’ says Quintero, who encourages progressive care nurses to be active spokespeople about the care they provide. ‘’Read the latest articles about progressive care and share them with your administration. Invite the local AACN chapter leaders to present at your facility. Acquire a voice at your hospital. We need to champion progressive care to help it grow,’’ Quintero says. And that will make all the difference.

Lorraine Steefel, RN, MSN, CTN, is a senior staff writer for Nursing Spectrum. To comment on this story, send e-mail to editorsc@nurseweek.com.

References

1. Edwards DF. The synergy model: linking patient needs to nurse competencies. Crit Care Nurse. 1999;19:88-97.

2. AACN. Progressive Care Fact Sheet. 2002. Available at https://www.aacn.org/AACN/pubpolcy.nsf/0/d887e5cacc 4d972488256d7a007bfba5?OpenDocument. Accessed August 11, 2004.

3. Berke W, Ecklund M. Keep pace with step-down care. Nurs Manage. 2002;33(2):26-29.

4. Meyer MN. Avoid PCU bottlenecks with proper admission and discharge. Nurs Manage. 2002;33:31-35.