RN Registered Nurses take care of people who are sick, injured, convalescent or disabled. They care for patients by assessing, planning, intervention, implementation and evaluation, under general supervision, and in accordance with established practices and philosophy. Registered Nurses work with other professionals to ensure patient care is delivered effectively to achieve desired patient outcomes. The RN must effectively interact with the patient and family members while maintaining the standard of professional nursing. There are many travel assignments and jobs available for the Registered Nurse as the Bureau of Labor Statistics notes that nursing is one of the top 10 occupations with the largest job growth. Where would you like to visit? Work in a great environment and enjoy free time seeing places you have always wanted to visit. Many great opportunities await the Registered Nurse in today’s market!
Progressive Care Unit Registered Nurses provide care for patients who require close monitoring and frequent assessment but are not unstable enough to require ICU care. The PCU RN will monitor critical vital signs and detect any changes, enabling intervention in a life-threatening or emergency situation. Many patients in this setting my receive complex medications that may require titration based on the vital signs of the patient. The PCU RN is also sometimes referred to as Step Down Nurse and the Progressive Care Unit can also be known as Cardiac Stepdown, Neuro Stepdown, Medical Stepdown, Surgical Stepdown and ER holding. The PCU RN has a unique job of caring for patients as they transition from the ICU. PCU nursing is increasingly important as more hospitals deal with limited ICU beds and are looking for the best way to care for the patient that is progressing and/or doing better. Progressive care describes the care delivered to patients whose needs are less acute. The patient is moderately stable with less complexity and requires moderate resources and intermittent nursing vigilance or they are stable but under risk of becoming unstable again and requiring increased intensity of vigilance and care. A decreased risk of a life-threatening event, decreased need for invasive monitoring, increased stability and an increased ability to participate in their own care are characteristics of the progressive care patient.
Progressive Care Unit Registered Nursing has expanded beyond the cardiac telemetry that marked its beginnings and PCU now encompasses a lot of the same therapies and technologies once limited to critical care units. In order to meet the changing needs of the patient, RN’s caring for progressive care patients must demonstrate skills influenced by ever changing technology.
The PCU RN should demonstrate the following basic competencies:
- Basic and advanced life support
- Dysrhythmia monitoring techniques, interpretation and treatment
- Medication dosage calculation, patient monitoring for medication effects, continuous medication infusion administration (non-titrated vasoactive agents, anti-arrhythmic agents, platelet inhibitors and/or insulin)
- Patient monitoring using standardized procedures for pre-, intra, and post procedures (TEE, cardiac catheterization with PCI, cardioversion, bronchoscopy, EGD, PEG placement, chest tube insertion)
- Recognition of the symptoms and signs of cardiopulmonary emergencies and the initiation of standardized interventions to stabilize the patient awaiting transfer to critical care.
- Hemodynamic monitoring including equipment setup and troubleshooting, monitoring and recognition of signs and symptoms of patient instability.
- Interpretation of ABGs and communication of the findings
- Assessment of the ventilated patient to assure delivery of the prescribed treatment and proper patient response
- Recognition of indications for and management of the patient requiring non-invasive 02 delivery systems including oral airways, bipap and nasal CPAP
- Assessment and understanding of long term mechanical ventilation and weaning
- Assessment, monitoring and managing of patients who require renal therapeutic interventions such as hemodialysis, peritoneal dialysis, continuous bladder irrigation, stents and urostomies
- Recognition of the indications for and complications of enteral and parental nutrition
- Recognition of and evaluation of the family’s needs for more involvement in the care to aid in transition from hospital to home
- The PCU RN should have the following characteristics: advocacy, clinical judgment, caring practices, systems thinking, response to diversity, collaboration, clinical inquiry and also be a teacher to educate the patients and their families.