Med-Surg Nursing vs Progressive Care Nursing (ICU Step-Down)

Med-Surg Nursing vs Progressive Care Nursing (ICU Step-Down)
Many of you will be graduating this semester, and you may have the opportunity to work on either a med-surg unit or a progressive care unit. Having worked in both of these areas, I thought I’d share some of the differences that you can expect. So what are some of the practical differences between med-surg nursing and progressive care nursing (also called ICU step-down unit)?

Progressive Care Nursing (ICU Step-Down)
The patients in the progressive care unit tend to have complex, chronic diseases, and they require complex nursing skills (high acuity). The next step for patients in this area is the ICU.
Most patients will be unable to get out of bed and will often be so sick that you’ll have to do most things for them, such as assist them to the bathroom, brush their teeth, etc.

PCU patients require constant monitoring. They will need around-the-clock care. This includes procedures, treatments, powerful medications that you’ll have to titrate, lab draws, central lines, and so forth.
The PCU rooms will have more complex monitoring devices and specialized nursing equipment installed.
The patient’s length of stay tends to be longer in the PCU. For example, many of my patients would be there for days, weeks, or even a month or so.
The patient-to-nurse ratio is smaller than med-surg nursing. I’d typically have about 3-4 patients in the PCU. That may not sound like many, but again, these patients require an extensive amount of monitoring and complex nursing care.
You will typically experience far more code blues and rapid responses in this area of nursing.
Medical-Surgical Nursing
In med-surg nursing, most patients will be able to get up, take themselves to the bathroom, feed themselves, and so forth. In nursing, we often call these the “walkie-talkie” patients. Some patients will need total care, but most won’t be as serious as your progressive care patients.
The length of stay for med-surg patients will typically be short, and they will often be discharged within 24 hours or so. The whole unit can have new patients the next day. In fact, there were many times in which I’d admit and discharge multiple patients within the same room during a nursing shift.

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Med-surge patient-to-nurse ratio can be more like 7-11 patients for each nurse, but this can vary depending on the way your employer staffs nurses on your unit.
Med-surg patients tend to experience fewer code blues, as they typically aren’t as chronically sick as your average PCU patient. Nevertheless, you can still experience this in med-surg, too.
Med-surg rooms will typically contain less equipment.
If the patient starts deteriorating on the med-surg unit, they will go to progressive care (unless they meet ICU criteria).
Which Did I Enjoy Most: Med-Surg or Progressive Care Nursing?
Regardless of which area of nursing you choose, both areas will provide you with excellent experience. You’ll learn how to think critically, and you’ll have plenty of opportunities to practice and develop various nursing skills. So either area is an excellent opportunity for new nurses, and I enjoyed my time in both areas.

If I had to pick just one area that I liked most, I guess I’d pick the progressive care unit. Here’s why. On the progressive care floor, I felt as if I had a better opportunity to get to know my patients. And because most patients are very sick, you get to see how your patient progresses over time. It is very rewarding to see someone come in on the brink of death, yet they gradually regain their health.

In addition, the monitors are already set up in progressive care, so I felt like I had an instant read on my patients’ vital signs, whereas med-surg typically didn’t have all of the extra monitors up and running.

Nevertheless, both areas can be very rewarding. Both areas have their own unique challenges, and I definitely grew from my experiences in both areas. Which area of nursing do you prefer? Click on the YouTube video above to leave a comment.