Progressive Care and Being PCCN Certified

People are often confused by the specialty of progressive care. Isn’t that what ICU is for?

No, not exactly.

Linda M. Bay, DNP, RN, ACNS-BC, PCCN-K, CCRN-K, Nurse Consultant, VA Office of Inspector General as well as a member of the national board of directors, American Association of Critical-Care Nurses (AACN) from 2012-2015, took time to not only explain what progressive care is, but also what PCCN certifications are and how they can help your career.

What is progressive care? What does a nurse in a progressive care unit do?

Progressive care is one of the fastest-growing nursing specialties, but remains one of the least understood. The term “progressive care” describes the increased level of care and vigilance required by acutely ill patients who are not in an ICU, but have complex health care needs. These patients are moderately stable with an elevated risk of instability and are found in settings such as step-down, intermediate care, progressive care, telemetry, and transitional care. Progressive care refers more to the acuity and care needs of the patient population than to a specific location within the hospital.

Many hospitalized patients require complex assessment and monitoring without the advanced therapies of intensive care. Progressive care nurses need to have highly developed assessment skills and the knowledge to monitor and anticipate their patients’ course. This is a specialized patient population with specialized needs. An experienced progressive care nurse can intervene and prevent a patient from needing intensive care-level services.

I think of progressive care nursing as a “gray” area. My experience in hospital settings and conversations with other nurses indicate that not everyone is familiar with that concept. When people ask me about progressive care, I ask them to consider the question, “How can we meet the needs of patients as they progress through acute or highly acute episodes and steer them clear of needing the intensity of a critical care unit?” 

To me, progressive care nursing means having enough knowledge of both critical care and acute care to be agile in our practices to accommodate what happens to patients in the middle.

When were the PCCN certifications established? What are they and why are they offered?

• PCCN:  AACN has recognized progressive care as a nursing specialty since 2004, when PCCN certification was established to validate the specialized knowledge and competencies needed to provide the best care to acutely ill adult patients in progressive care settings.

• PCCN-K:  In 2016, AACN Certification Corporation launched the PCCN-K credential for progressive care nurses who influence the care delivered to acutely ill adult patients, but do not primarily or exclusively provide direct care.

AACN Certification Corporation conducts periodic national studies of acute and critical care nursing practice to make sure that certification exams and test plans are grounded in actual practice. These surveys revealed a gap in the care needs of acutely ill patients outside of the ICU. The PCCN credential was created based on the increasing complexity of patients in other areas of the hospital, as well as the need to care for patients who were transferring out of ICUs much sicker than they had been historically.

Adding PCCN-K to the AACN family of nursing certifications reflects evolving roles and changing times in nursing and health care. A growing number of acute care nurses are shifting to positions where they influence patient outcomes by sharing their unique clinical knowledge and expertise rather than providing care directly—essentially becoming nursing “knowledge professionals.” Offering this credential enables a wider range of progressive care nurses to pursue or maintain certification

Today, nearly 20,000 nurses hold PCCN or PCCN-K credentials.

Some of the same types of patients I once cared for in the ICU are now cared for on progressive care units. The gap between acute care and critical care continues to narrow, and the sickest patients are now in hospitals as an inpatient. With hospitals working at full capacity, the need for the progressive care certification is even more important today because nurses need the knowledge to care for patients who are highly acute. 

How is PCCN-K different from PCCN? How can nurses determine which certification is most appropriate? 

PCCN is designed for nurses who directly care for acutely ill adult patients. These patients are often found in areas such as intermediate care, direct observation, stepdown, telemetry, and transitional care units.

PCCN-K is for RNs or APRNs who influence the care delivered to acutely ill adult patients but do not primarily or exclusively provide direct care. Nurses working in roles such as clinical educator, manager/supervisor, director, academic faculty, or nursing administrator may be eligible.

As a clinical nurse specialist, I worked directly with nurses, patients, and families, which enabled me to obtain PCCN certification. Now in my consultant role, I am doing indirect work, but I want to maintain expert knowledge of progressive care. So, I recently transitioned to the PCCN-K credential.

When nurses want to decide whether the direct care or knowledge professional certification is best for them, they should think about how they care for patients. Does the work they do put them at the point of care, with patients and families? Then PCCN is likely the appropriate credential. Does the work involve influence more than direct care (e.g. educating staff nurses, working with nurses and physicians, indirectly caring for patients)? Then PCCN-K is likely to be the right fit

Nurses who have questions on which credential is right for them should seek advice from the AACN certification experts before applying to take an exam. AACN specialists will help them identify which certification exam is right for them.

Why did you choose to become PCCN certified?

If I wanted our progressive care nurses to obtain the PCCN credential, I thought I first needed to “walk the walk.” PCCN certification gave me pride in knowing that my knowledge and expertise were validated. Knowing that I validated my knowledge gives me confidence. My motivation to remain certified is about being recognized for my expertise and my commitment to the profession by lifelong learning. I feel connected to others who are certified as well. For me, being certified says to the world “I know my stuff.”

Nurses who became certified gain a sense of pride—and more importantly, a sense of empowerment—because they have more knowledge. They became more comfortable with advanced cardiac life support, began asserting themselves more effectively with physicians, became more competent in caring for patients who became more critical, and confidently cared for patients right out of the ICU. I am quite proud of those nurses for their courage to get certified and their willingness to grow

How can certification help a nurse’s career?

Beyond promoting continued excellence in progressive care nursing and helping nurses stay up-to-date on the latest research and evidence-based practices, certification as a progressive care nurse acknowledges the valuable clinical specialty knowledge of these accomplished nurses.

When people see that a nurse has board certification and credentials, they see someone who has exceeded expectations. Certification validates knowledge, but getting and keeping those credentials shows a commitment to the profession.

Professional journals often have recruitment advertisements for “certified nurses,” and hospitals are pointing to their certified nurses as a showcase of nursing excellence. Some organizations even offer bonuses or raises for certification.

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