Progressive care units are increasingly common in hospitals in the United States. These units are often used to bridge the gap between intensive care units and medical-surgical units, with the goal of providing cost-effective, high-quality, safe care. Although progressive care units today may seem to provide care for a wide variety of patients, these patients do share certain typical features: they require a high intensity of nursing care and/or a high level of surveillance. Nurses working in progressive care units all must have certain basic competencies. Those core competencies have been identified and should form the basis for education and training of progressive care nurses.

This qualitative study describes the staff nurses' perspective of change in the care delivery model and skill mix in an intermediate care unit. Data were collected in interviews in focus groups with the registered nurses affected by the change. Two major themes emerged: (1) autonomy and control and (2) interdependence. The nurses emphasized an increased satisfaction (self and patient) with this model. This study confirmed that autonomy, control, connection with the patient, and peer and interdisciplinary support and respect are important for the staff nurse. These findings reinforced the value of involving the staff members in change and the importance of giving voice to their perspective through qualitative research.

Nurses play a vital role in patient care by providing continuous surveillance and are the frontline for early detection including prompt intervention should a patient's condition deteriorate. Inconsistent RRS activation has been associated with negative patient outcomes. Exploring nurses' perceived barriers to RRS activation may contribute to interventions that lead to nurses appropriately activating the RRS and potentially decreasing adverse patient outcomes.