Filling a need: Milwaukee VA Progressive Care Unit marks 10-year anniversary

“It sounds kind of cheesy, but the Progressive Care Unit is really progressive,” said Angie Kinter, acting division leader. “It’s progressive in care for Veterans. It’s progressive in how (the staff) treats one another, and it’s progressive in the ideas that it brings forward and its innovation.”

The PCU fills the gap between the critically ill patients served by the Intensive Care Unit and the typically stable patients cared for in the Medical/Surgical units.

Such units are rare in hospitals, but in 2013, the Milwaukee VA identified a need for the specialized unit.

“This was an opportunity to create a space that could truly meet high-level acuity patient care needs and fill the gap,” said PCU nurse manager Courtney Wilson, noting the patients best served by PCU are those who are stable, but could become unstable rapidly. 

'A lot of unknowns'

The unit launched in February 2014, and it was a slow ascent as the nurses learned new skills and the hospital adapted to this new unit.

“There were a lot of unknowns,” remembered nurse Terri Domacinovich, who has been with the PCU since the beginning.

She said the nurses traveled throughout the hospital, observing and working in different units and learning the specialty skills required.

When the PCU finally opened, it was only two beds at a time, she said. But the PCU immediately relieved stress on the ICU, and in time, the other units came to realize the PCU’s importance.

“We fill a need,” said PCU nurse Olivia Hanson, a former U.S. Army nurse who started in the PCU last year. “This is a space that I feel is really needed. 

“Med/surg nurses know if they have a patient that’s a bit unstable, they can send them to us, and that we have the capability to care for those Veterans. And I feel like we can prevent some ICU admissions.”

As the unit became more integrated into the hospital, confidence both inside and outside the unit grew. Nurses took ownership in their unique role and gladly embraced innovation and expanding their skills.

'A full-on MASH unit'

Then came March 2020, and everything changed with the COVID-19 pandemic.

Faced with a rise in very sick Veterans grappling with an unknown disease, the hospital pivoted the PCU and made it the COVID unit. For some, the change took place overnight.

“One day, I came to work and we were a full-on MASH unit,” said Michelle Kirkendoll, PCU assistant nurse manager who was a night shift nurse on the unit at the time. “There were taped-up walls and doors, people guarding the entrance, and there were all these instructions we had to follow.”

Large air handling units were moved into patient rooms to make them negative pressure sites. The donning and doffing of personal protective equipment became the norm. 

Nurses learned how to use CAPR helmets, and wearing a surgical mask became so commonplace that nurses felt odd when they didn’t have one on, Kirkendoll said.

But worse than all of that was the sickness of the patients. And the grim outcome for many of them.

“It was very heavy,” Wilson said. “We were dealing with a lot of death.”

At the same time, though, Wilson saw the resilience and fortitude of the PCU nurses, noting that nearly all of them chose to stay on rather than transfer to another unit.

“They ran with us toward the fire,” Wilson said. “It was exhausting and very challenging. But we did it, and we did it very well. It was difficult, but I’m happy to put that in my back pocket.”

“We worked great as a team,” Domacinovich said. “It was a struggle, for sure, but we bonded, learned and collaborated, and we came out strong.”

'Growth and innovation'

In February 2022, the PCU began to emerge from its “COVID unit” designation and got back to fulfilling its original role. Progress since then has been remarkable, Wilson said.

“I’m excited where the unit is at. I’m excited about where it is going,” she said. “The staff wants to have higher acuity patients. They want those challenges. We’re working to continue to move it forward. 

“The growth and innovation have been at an exponential level for where we were. It’s been like a rocket ship.”

And the nurses have embraced that rise. They cite teamwork as the best part of working on the unit.

“We’re really team-centered here,” said PCU nurse Heather Leonovicz. “That’s why I like it here so much. Everybody helps one another and looks out for each other’s patients. Everyone is here for the Veteran. Everybody wants to be here and help one another.”

Hansen, one of the newest members of the team, said she recognized that immediately when she signed on last year.

“Coming in as a Veteran, it is so awesome to be surrounded by people who care about Veterans and want the best for them,” she said. “The team dynamic is very similar to what it was like as an active-duty nurse. And I really love that. We’re always trying to be our best.”

Because of the great things the PCU does and continues to do, Wilson said it was important to recognize the 10-year anniversary of the unit.

“It shows the contribution PCU has provided for the facility,” she said. “It’s important to highlight growth and development … that has occurred and to recognize where we have come from since the pandemic. The momentum is exceptional.”

Kirkendoll agreed.

“Recognition is so important,” she said, saying the nurses are “such a cohesive unit. They do so much for each other to meet the needs of unit. They are a really resilient group, and they fight really hard for the Veterans. It’s good for the rest of the hospital to know we’re doing such great work.”