As a nurse working in a critical care setting, you may have to answer important questions about a patient’s condition and communicate information to them and their loved ones. In addition to understanding the patient’s plan of care, you’ll also need to know where in the hospital they’ll be staying and what that can mean in regard to their condition – especially if you’re working with patients in the PCU and ICU.
The progressive care unit (PCU) and intensive care unit (ICU) are dedicated hospital wings for patients who need specialized care and ongoing medical attention. While they do share some similarities, they’re by no means the same. Here’s the difference between the PCU and ICU.
What Is PCU?
PCU stands for “progressive care unit.” Patients on PCU floors require more monitoring and assessment than patients on regular hospital floors, but their conditions are stable enough to avoid the ICU (intensive care unit). Oftentimes, PCU’s are used for monitoring patients during or after cardiac events. These patients are either admitted directly to the PCU by way of the emergency department, operating room, or from the Cardiac Cath Lab. Patients may also be moved to the PCU from ICU as their condition stabilizes.
Progressive care, allows hospitals to reserve ICU beds for those patients who truly need critical care. Nurses in these units must monitor patient conditions carefully, as they may be at increased risk for complications. However, with proper care, many PCU patients can be discharged to a med/surg unit, skilled nursing facility, or even directly home depending on the circumstances.
What Is ICU?
The ICU treats patients who are in critical condition and require intensive medical care and/or life support. To put it simply, the most severe and complicated medical patients are cared for here. The ICU will support patients through traumatic injuries, heart attacks, strokes, and severe respiratory/circulation issues, to name a few.
The ICU is considered one of the most critically functioning operational environments in a hospital. Most, if not all, ICUs include specialized, technical, and monitoring equipment for critically ill patients, including heart monitors, artificial ventilators, dialysis machines, and intravenous infusions which may or may not include vasopressors (a class of drugs used to treat shock and restore blood flow to vital organs). Vasopressors are most often only used in the ICU. The size of the hospital will play a role in determining exactly how the ICU is set up. In hospitals that serve a large, diverse population, you may see several ICUs which can include cardiothoracic, Neurological, and Neonatal ICUs.
Staffing levels
PCUs have a higher nurse-to-patient ratio (around one nurse for every three to five patients) because these patients require more nursing care than is typically available in general hospital units. The additional PCU staff includes nursing assistants, patient care technicians, and unit clerks.
Patients in the ICU, on the other hand, require constant monitoring. As a result, the ICU typically has a higher ratio of doctors and nurses to patients than almost any other unit in the hospital. Many hospitals have a 2:1 nursing ratio for ICU patients. What also sets the ICU apart from other units throughout the hospital is the ICU’s teams.
ICU teams are multidisciplinary with highly-skilled intensive care nurses, doctors, and specialists — including patient care technicians, physical therapists, pharmacists, dieticians, respiratory therapists, and critical care coordinators — trained to provide critical care for patients with multiple medical, surgical, and trauma conditions. All team members are expected to collectively work together to provide the patient with the best care possible.
Certifications for Nurses Working in Critical Care Units
Because the staff for the PCU operates somewhere between the basic level of care and the highly-specialized level of care required in the ICU, the AACN formed the Progressive Care Task Force in 2000 to ensure the PCU staff is sufficiently trained for the level of care patients need. With the exception of proficiency with invasive technologies, the Task Force ultimately requires the PCU staff to have the same level of education as the ICU staff.
As a result of this unique combination of knowledge requirements for nurses working in the PCU, the AACN Certification Corporation created the following certifications:
- PCCN: This certification was created in 2004 to validate the specialized knowledge and competencies needed to provide the best care to acutely ill adult patients in the PCU. The PCCN addresses the increasing complexity of treatment plans needed for patients in other areas of the hospital as well as the care needed for patients who are transferring out of the ICU much sicker than they have ever been before.
- PCCN-K: The AACN Certification Corporation developed the PCCN-K credential in 2016 as a result of the shift in the PCU nurse’s role. Rather than providing care directly to patients, progressive care nurses are looked to as nursing knowledge professionals responsible for sharing their clinical expertise and influencing the care delivered to acutely-ill patients.
According to the AACN, PCCN certification keeps you up to date on the latest care practices and reinforces the special knowledge and experiences required for progressive care nursing. The Association also grants other credentials related to critical care, including CCRN, CCRN-K, and CCRN-E.
The Bureau of Labor Statistics projects that the overall demand for registered nurses expected to grow by 12% by 2028, and critical care nurses are playing an important role in this growth. A study conducted by the University of Pittsburgh found that nurses who were critical care-certified had reported higher levels of perceived knowledge and value of specific evidence-based practices used with patients receiving mechanical ventilation than their non-certified colleagues. CCRNs also reported higher levels of role clarity and self-efficacy.
The study concluded that RNs with specialty certification may ultimately speed the process of bringing the latest research-backed practices into everyday clinical settings, which ensures that patients in PCUs and ICUs receive the highest quality of care.
Type of Care in PCU vs ICU
Although there seems to be a wide variety of medical conditions that could land patients in either of these units, it’s important to note that nurses working in either setting must demonstrate high levels of nursing care competencies and critical thinking skills. Some of the specific types of care are offered in both settings.
Patients in the PCU are admitted for the following:
- Pulmonary problems
- Cardiac conditions
- Post-surgical treatment
Patients also receive treatment and care in the PCU for myocardial infractions, new pacemakers and defibrillators, strokes, and assistance with managing potent drug regimens that require close monitoring.
The ICU uses a multidisciplinary approach, and the nurses employed in the ICU provide the highest acuity of care. The patients seen here are the most critical in the hospital. Unless the patient is an emergency admission, patients typically need a referral from their doctor or specialist to be transferred to the ICU from other floors of the hospital.
A patient may be admitted to the ICU if they experience:
- Respiratory failure
- Severe burns
- Organ transplants
- Cardiothoracic surgery
- Complex spinal surgery
- Major trauma
While there are similarities between the PCU and ICU, the major differences lie in the types of care and treatment plans for patients, the staffing level requirements, and the clinical knowledge and expertise required in each unit. Both units handle some of the most delicate and complex medical conditions, and as such, the PCU and ICU are responsible for delivering the most specialized and critical care to patients.
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Sources:
https://healthywa.wa.gov.au/Articles/F_I/Intensive-care-units-ICUs
https://www.aacn.org/certification
https://www.ccm.pitt.edu/?q=content/upmc-study-supports-value-certified-nurses
