Critical Care Nurse

Critical care nurses (CCNs) capably manage and coordinate the care of severely ill patients suffering from complicated medical or surgical illnesses. They possess high-level skills and balance multiple requirements as these patients are frequently intubated, on multiple IV drips, and have unstable cardiac or other organ failure risk. CCNs quickly identify when a patient decompensates and alert the rest of the critical care team. Critical care nurses also deliver emotional and psychological support to patients and their families.

Patients are often unconscious, but critical care nurses must always pay attention to easing their and their loved one’s fears. In addition, critical care nurses are responsible for their patient’s recovery from life-threatening injuries or illnesses. They are the true masters of delivering lifesaving care.

Intensive care units are often divided into different subunits, such as medical ICU, surgical ICU, pediatric ICU, and neonatal ICU. In some hospitals, there are additional divisions for cardiac care, trauma care, neurological treatment, and progressive or step-down units. Critical care nurses encompass all those who deliver care in any of these designations, and they can further specialize based on their interests.

Critical care nurses often receive advanced training to improve their skills. Some become advanced practice registered nurses (APRNs) or clinical nurse specialists (CNSs) who specialize in an area of interest within critical care.

Critical care nurses perform some of the same activities as other nurses, but they focus on the life-sustaining treatment and recovery of critically ill patients. CCNs typically care for one to two patients in the adult intensive care population and one to three patients in the pediatric or neonatal population.

General activities may include:

• Assess and monitor patients for changes in ventilation, cardiac and renal status

• Administer IV medications, dressing changes, catheter care, and prevent skin breakdown

• Manage cardiac monitors, ventilators, and other monitoring equipment

• Track and record patient progress, draw lab work, administer blood, maintain airways, provide wound care, and administer nutritional support

• Attend rounds with the care team, report on patient status, and assist physicians with patient treatments.

• Provide family and patient reassurance and teaching

• Provide comfort for end-of-life care

Critical care nurses must be specifically trained in their specialty area. For example, an adult care CCN does not work with pediatric or neonatal critical care patients.

CCNs need advanced assessment skills and IV drug knowledge of drugs that need frequent adjustments based on the patient’s status, such as dopamine as well as resuscitation medications. They have knowledge to run sophisticated equipment to manage ventilators, arterial lines, EKG monitors, intracranial pressure monitors, and multiple infusion pumps.

CCNs must be able to anticipate all their patients’ needs as patients are either too young or not able to verbalize desires, concerns, or discomforts.

Critical care nurses usually work in hospitals or in emergency transport but also in outpatient surgical centers.

Adult, pediatric, or neonatal settings all have different types of cases, as do surgical ICU or medical ICUs. Any patient with a life-threatening medical or surgical condition, regardless of age, is sent to an ICU.

American Nurses Credentialing Center (ANCC)

• CCRN (Adult, Pediatric or Neonatal)
• CCRN-K (Adult, Pediatric or Neonatal) for nurse supervisors
• CCRN-E (TeleICU, Acute/Critical Care)
• PCCN & PCCN-K (Adult) Progressive Care Certified Nurse
• CMC (Cardiac Medicine Certification)
• CSC (Cardiac Surgery Certification)

There are other certifications for CNSs and acute care nurse practitioners.

Critical care nurses must be BCLS and ACLS certified. They are highly encouraged to become critical care registered nurse (CCRN) certified after gaining experience in their specialty area.

There are several certifications offered by the AACN. Each is specifically geared towards either bedside nurses, advanced practice nurses, clinical specialists, educators, or managers.

The certifications are divided into adult, pediatric and neonatal care but also may be cardiac or gerontology focused.

A CCRN needs to have worked either:

• 1750 hours directly caring for acute or critically ill patients for the last two years, with 875 of the hours accrued in the year before applying.

• 2,000 hours directly caring for acute or critically ill patients for the last five years, with 144 of the hours accrued in the year before applying.

1. Complete an Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) degree: takes two-to-four-years based on the program

2. Pass the NCLEX-RN exam and apply for your RN license after graduation

3. Apply as a new grad or from another nursing discipline such as Med-Surg or the ED

4. Become certified as a CCRN after meeting the prerequisites and gaining work experience.

Critical care nurses must be BCLS certified but also need ACLS certification. Many places prefer you have at least one year of experience in Med/Surg or a similar setting to grow your skills.

Apply for work in your critical care interest area. These units often offer internships and residencies to learn needed skills:

• Adult Intensive care unit (ICU)
• Pediatric ICU
• Neonatal ICU

Other high acuity areas that are considered to be critical care: Emergency department, Step-down units, Cardiac care units, Telemetry units, or Progressive care units.

You can apply for your CCRN in (Adult, Pediatric or Neonatal) from the AACN after completing the required clinical hours in either two or five years.

You can also advance by getting an MSN or doctoral degree with a critical care focus as a Clinical Nurse Specialist (CNS) or an acute care nurse practitioner specializing in areas such as ED or ICU.

Critical care nurses typically make between $60,887- $103,872, with a median salary of $79,800, according to Salary.com.

The May 2021 Bureau of Labor and Statistics report shows which states have the highest and lowest wages for nurses. They do not list by nurse specialty, but critical care nurse salaries would likely follow suit. The highest-paid states are California, Hawaii, and Oregon. The lowest-paid states are South Dakota, Alabama, and Mississippi.

• American Association of Critical-Care Nurses (AACN)
• Society of Critical Care Medicine