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Quick Facts :
Critical Care Nurses
What Is a Critical Care Nurse?
According to the American Association of Critical Care Nurses (AACN), patients who are dangerously ill or suffering from life-threatening injuries that require advanced care can typically be found in these hospital departments:
- Intensive care unit (ICU)
- Emergency department
- Step-down unit
- Neonatal ICU
- Pediatric ICU
- Cardiac care units
- Cardiac catheter labs
- Telemetry units
- Progressive units
- Recovery rooms
The AACN goes on to report that critical care nurses comprise some 37 percent of the total number of nurses who work in hospitals. Typical work settings also include patients’ personal residences, outpatient surgery centers, private physicians’ offices, managed care centers, and nursing schools. In any employment setting, the critical care nurse must have the ability to perform complex patient assessments, implement intensive interventions and therapies, and monitor patients, all while remaining calm in desperate, sometimes life-threatening situations. Because a critically ill or injured patient’s condition can change quickly without warning, the critical care nurse must be capable of immediately changing a current care plan and providing emergency care as necessary.
Besides direct, hands-on care, the critical care nurse also performs the important role of acting as the patient’s advocate. In this position, advocacy means supporting and respecting the basic rights, values, and beliefs of a patient who is critically ill or injured. Performing as the patient’s representative, a critical care nurse finds additional resources for patients outside of the immediate care setting to assist in their recovery. Advocacy in this role, according to the AACN, means the critical care nurse is expected to:
- Respect the rights of the patient or his or her designated surrogate to make independent health care decisions, even when he or she disagrees with those decisions.
- Act as an intermediary in matters concerning the patient, his or her family, and other staff involved in the patient’s direct care or members of the care team.
- Intervene when other health care professionals or the family is not acting in the patient’s best interests.
- Continually monitor the quality of care provided to the patient.
- Assist the patient in obtaining necessary care when the critical care facility is unable to provide it.
- Act as a champion for patients who are unable to speak for themselves when the situation demands it.
- Educate and support the person acting as the patient’s spokesperson.
- Transfer care to other health care personnel as situations demand.
- Represent the patient’s wishes to other medical staff.
Working as a Critical Care Nurse: Typical Duties & Responsibilities
The critical care nurse works alongside other healthcare professionals, including doctors, surgeons, nurse practitioners, clinical nurse specialists, nurse researchers, nurse educators, and health care case managers. As a direct result of pressure applied by managed care insurance organizations, today’s hospitals have been forced to reduce costs, increasing the demand for additional critical care nurses in outpatient settings. When the nursing shortage hit, the specialty areas of nursing, including critical care, suffered more than nurses in more general positions, which makes skilled, experienced critical care nurses especially valuable in today’s job market.
While people have always suffered serious illness or injuries, the concept of one-on-one care from a nurse with specialty training is relatively new. In fact, the first ICU department was established in an American hospital in the 1950s. The critical care nurse position as we know it today arose in this environment. While the original role of the critical care nurse was in hospital ICU departments, it has expanded greatly over the past six decades.
In addition to acting as a patient advocate, a critical care nurse has these specific duties, among others:
- Cleaning and bandaging patient wounds.
- Tracking life support equipment such as heart monitors.
- Immediately responding to changes in the patient’s condition.
- Evaluating vital signs such as heart rate, respiratory rate, and body temperature.
- Administering medications through an intravenous tube, gastric tube, orally, by injection, or other methods, as determined by the patient’s condition.
- Infusing blood products and monitoring patients for reactions.
- Caring for the patient’s body immediately after death and arranging for transportation to a hospital, burial facility, or morgue.
- Identifying patient needs according to age and level of consciousness and creating a care plan to meet them.
- Diagnosing patient illnesses and injuries.
The critical care nurse works with patients and families who are experiencing extreme stress. An empathetic, compassionate nature and the ability to remain calm in life or death situations are necessary to perform effectively in this position. Additionally, the critical care nurse must learn not to take patient and family behaviors as personal attacks; instead, he or she should remain calm and dispassionate in all situations. The nurse must have the ability to make tough decisions, think quickly and calmly, and maintain a caring but objective attitude.
Steps to Become a Critical Care Nurse
A critical care nurse provides specialized care to patients in the intensive care units of a hospital that treat the most severely ill or injured patients, caring for the daily needs of those who are the most vulnerable. To perform effectively in this position, critical care professionals require specialized training.
While education and training are essential for this type of nursing career, it’s equally important that the critical care nurse has the right temperament. He or she must be cool-headed and confident, with the ability to endure physical and emotional stress. Indeed, the critical nurse also must have the ability to make vital decisions while under stress. Critical care nurses, also known as “ICU nurses,” must also possess excellent communication skills and be able to work with patients of all ages from a variety of backgrounds and cultures.
ICU nurses often face a harsh reality. Many will not be able to restore their patients to good health; in fact, the patient may die while in the ICU unit. Over the course of their career, critical care nurses may experience patient death many times, which can take a toll on the nurse’s own mental health. This type of emotional stress can be draining and heartbreaking, but the right person for the job may find working as a critical care nurse a very rewarding career. This nurse often finds fulfillment in playing an important role in the lives of the patients with the greatest needs.
1. Earn Your Bachelor of Science in Nursing (BSN)
The first step toward becoming a critical care nurse is to earn a bachelor of science in nursing (BSN). While working toward the BSN degree, students study the principles of nursing and develop critical-thinking skills and problem-solving skills as they learn. During the course of study for a standard BSN degree, a student will learn anatomy, nutrition, microbiology, public health, health assessment, physiology, and evidence-based practice.
Acquiring this type of degree helps students learn how to function in a standard nursing role, which provides the foundation for more specialized training. Students who participate in a BSN program learn both evidence- and theoretical-based nursing practice. Many BSN programs require that students participate in clinical observations, which provides a glimpse of the day-to-day activities and stressors encountered in real-life care situations. Clinical experience helps students enter the field with a fully developed understanding of their profession.
2. Pass the National Council Licensure Examination (NCLEX-RN)
Once a nurse has graduated from a BSN program, he or she must pass the NCLEX-RN exam, a requirement for any nurse who wishes to receive licensure and work in the United States. The NCLEX-RN is a computer-generated exam created by a non-profit organization, the National Council of State Boards of Nursing (NCSBN). This organization works with nursing and regulatory boards to help maintain standards in nursing and promote the profession in every state.
The NCLEX-RN exam is designed to cover the processes that make up the foundations of nursing practice. The test is divided into four categories and six sub categories that span a range of topics, all of which help measure nursing competency.
- Physiological Adaptation
- Reduction of Risk Potential
- Safe and Effective Care Environment
- Physiological Integrity
- Psychosocial Integrity
- Pharmacological and Parenteral Therapies
- Reduction of Risk Potential
- Basic Care and Comfort
- Management of Care
- Health Promotion and Maintenance
After taking and passing the exam, a registered nurse must work for a minimum of two years. Nurses who wish to eventually become critical care nurses should work with populations such as families, geriatrics, adults, and children.
3. Earn a Master’s Degree from an Accredited MSN Program
To advance from this level, nurses should earn a master’s degree from an accredited MSN program with an emphasis in critical care or ICU nursing. While studying for the master’s degree, critical care nurses take additional theoretical- and evidence-based classes, building on the foundations of nursing learned while earning their BSN degree. This intensive education helps critical care nurses perform as professionals immediately upon graduation.
MSN Program Goals & Objectives
While earning the MSN degree, potential critical care nurses receive instruction in the classroom and complete clinical hours, both of which help provide the medical knowledge and skills the nurse needs to treat critically ill patients.
Additionally, critical care nurses learn how to take a leadership role in their positions. They learn how to meld theoretical learning with the real-life scenarios encountered in hospital settings.
Essential Skills & Knowledge
Master’s students are taught critical-thinking, problem-solving, and communication skills, training that helps critical care nurses prepare for the types of problems they will encounter on the job and during future interactions with their patients, families, and doctors. In addition, ICU nurses are taught to anticipate the emotional and physical challenges that accompany their profession, so they’ll be better prepared to think in a cool, objective manner in the midst of stressful situations.
Because the master’s degree is more advanced than a BSN, it provides instruction in the scientific thinking behind nursing theory and practice. This makes it possible for critical care nurses to make the type of immediate decisions required to help save patients’ lives. Students also learn how to interpret and evaluate journal articles and medical literature relevant to their profession, so they can continue their education after obtaining their degree.
MSN Coursework, Content, and Training
Typical MSN coursework, content, and training include a variety of courses focused on science, health, ethics, policy, professional dynamics, nursing research, pharmacology, acute care, public health, physiology, and more. Critical care nurses, more than other types of nurses, must possess a broad understanding of a range of health care topics. This helps ensure that they are prepared to meet the needs of their patients in critical situations.
4. Get Certified as a Critical Care Nurse by the American Association of Critical Care Nurses (AACN)
The CCRN certification from the AACN Certification Corporation establishes a baseline of knowledge for nursing critically ill or injured patients. Nurses who want to advance their career, demonstrate their knowledge, and improve their skills can obtain this certification.
Many different areas of specialization exist, including:
- CCRN (Adult, Pediatric or Neonatal) ‒ Nurses provide direct care to critically ill patients
- CCRN-K (Adult, Pediatric or Neonatal) ‒ Nurses influence care but do not provide direct care for patients
- CCRN-E (Adult) ‒ Nurses work with ill patients from a remote location
- PCCN-K (Adult) ‒ Nurses influence care but do not provide direct care for patients
- CMC (Adult) ‒ Nurses provide care to critically ill cardiac patients
- CSC (Adult) ‒ Nurses provide care to critically ill cardiac surgery patients
- ACNPC-AG (Adult-Gero) ‒ Nurses provide care to meet the needs of very sick adult-gerontology patients
Critical care nurses have their choice of these specializations and others. The nurse must acquire knowledge, training, and experience with the population of focus to become certified. This certification is good for three years and must be renewed periodically.
The AACN certifications are provided by a national board-accredited organization, which means board certification is awarded to those candidates who meet national requirements. In addition to AACN board certifications, critical care nurses can obtain other types of certifications from different organizations. If you seek certification from another organization, check credentialing requirements before pursuing the endorsement. Requirements for renewal may differ from those stipulated by the AACN.
Employers usually require that their critical care nursing staff maintain continuing education to retain their position. Continuing education helps nurses perform effectively in the workplace, stay up-to-date with the most current teachings in the field, and master the latest technology. Continuing education also helps nurses perform as leaders in the workplace and raises the bar to ensure excellent patient care at each facility.
5. Search for Jobs and Enter the Workforce
Once you graduate from a master’s program, it’s time to find a job. Critical care nurses occupy an important niche in the nursing profession, and they are in high demand. Facilities all over the country, especially hospitals, hire critical care nurses to serve their patients. In addition to hospitals, critical care nurses may find work in nursing care facilities, home health care services, outpatient care centers, and physicians’ offices.
Many critical care nurses begin looking for work even before they graduate from their master’s program. Research before graduation helps candidates learn about the job market in their area, which helps them when it’s time to seek a position. Networking before graduation also helps the candidate find a position by not only helping them learn of open jobs but to secure a reference that will them get the position. As a result, nurse candidates are encouraged to maintain good relationships with peers, mentors, critical care staff, and administration.
Critical care nurses gain an edge over other candidates by practicing their interviewing skills prior to the meeting. With a friend’s help, role-play the interview process, anticipating potential question along with the best answers. Before the interview, the nurse candidate should research the facility to learn its values, history, and other important details. Nurses who prepare in this manner typically gain an edge during the interview process over other candidates.
Nurses should remember the most important skills required of a nurse in an ICU facility. Providing examples of real-life scenarios in which the candidate kept calm and poised and confident during an emergency, established relationships with patients, and made critical decisions decisively and quickly ‒ all show future employers the value of the candidate in a clinical setting.
Finding the right position can take some time. However, because critical care nurses fulfill an important role in the hospitals and facilities that handle patient emergencies, it’s true that not every candidate is right for the role. However, with hard work, careful preparation, and a thorough education, the potential critical care nurse should quickly find a rewarding position.
Critical Care Nurse Salary & Employment Outlook
According to the job posting and career website Indeed.com, the median annual salary for a critical care nurse is $68,462. The exact salary earned by a health care professional in this position depends on the level of education, years of experience, size of the hospital or healthcare facility, and numerous other factors. Indeed.com reports the following salaries for critical care nurses at various points on the pay spectrum:
- 10th percentile; $55,531 annual salary
- 25th percentile; $61,693 annual salary
- 75th percentile; $74,492 annual salary
- 90th percentile; $79,791 annual salary
For full-time positions, the reported hourly salary ranges from $27 to $38. Alternate job titles for the critical care nurse include: “intensive care unit nurse”; “registered nurse – intensive care unit”; “nurse”; “staff nurse – ICU”; “RN – intensive care unit” and “acute care nurse.”
Although it does not state a specific projected growth rate for the critical care nurse professional, the United States Bureau of Labor Statistics (BLS) indicates a 16 percent increase in demand for all nurses. This figure covers all the years through 2024. However, it’s safe to assume that the need for nurses with ICU experience will be even greater in the future.
As mentioned, critically ill and injured people are no longer confined only to hospitals. They need help at home, in community-based programs, at physical therapy facilities, and in a variety of other settings. People who would not have survived even a generation ago often are released from hospitals with complex medical needs that must be managed, sometimes for the remainder of their lives. This demand requires critical care nurses with specialized training and experience to meet the needs.
The nationwide increase in diabetes and other chronic health conditions is another reason behind the expected increase in demand for nurses with critical care experience. Although the critical care nursing position is often stressful and the pace chaotic, professionals who thrive in this role enjoy the satisfaction of helping others improve their quality of life.