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.. 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 cares for patients as they transition from the ICU. Progressive care describes the care delivered to patients whose needs are less acute.. 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. 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.