The Ins and Outs of the Critical Care Nursing Field

Whenever the term critical care is mentioned – most people immediately think about severely sick patients in intensive care units or ICUs. They are not mistaken. Intensive Care Units and Critical Care specialized areas in the hospital that care for patients in need of intense and one on one attention. These are the areas where a critical care nurse Practices.

What is a Critical Care Nurse

A Critical Care Nurse or a CCN is a highly specialized nurse that has been trained to work in Intensive Care areas. They are nurses that care for patients who are severely ill and in need of individualized care. A CCN cares for patients of all diagnoses and gender. Patients may vary depending on this category. Critical care nurses also deal with complex technology that helps sustain patients.

The History

This type of nursing is a relatively new nursing specialty. It wasn’t until the 1950’s that the very first Intensive Care Units appeared in the Western world. These units were created to deal with gravely ill patients. They were considered to need a more intensive form of care compared to the patients in the regular wards. The notion of an intensive care unit quickly spread. Today, most hospitals are required to have these specialized areas and in turn specialized nurses and physicians to run them.

Back then, nurses assigned in CCUs and ICUs were not seen as different from regular ward RNs. It was only a few years later that CCN was considered as a specialized nursing field.

Roles of a CCN

Like any other registered nurse, the roles of the critical care nurse are very complex. These nurses have to deal with severely ill patients. They also need to be familiar with complex technologies that are continually present in a critical care setting. The critical care nurse also has to know basic and advance life support. Such skills may be called upon at any point during his/her service.

The critical care nurse must also be skilled in the art of diagnosis. He/she must be able to diagnose and identify a patient’s immediate needs. This part of nursing is important as it may be the difference between life and death for a patient. Nonetheless, the nurse must remember that despite being skilled at diagnosis, one must not overstep her boundaries and perform roles reserved for a physician alone.

Aside from dealing with patients and their needs, the CCN also has to deal with the patient’s family. The CCN often works as a counselor that helps the family get through the crisis at hand. He/she may have to deal with questions and concerns from the patient’s immediate family and significant others.

Qualifications and Requirements

IN THE PHILIPPINES – Locally, any registered nurse can become a critical care nurse. It is only a matter of area assignment. Most of the time, nurses who are assigned in critical care units are those who have shown promise in their previous areas of exposure. They are also the ones who have worked in similar areas such as medical/surgical or pediatric units.

ABROAD – Abroad, in the US specifically, there are no specialized requirement to be a critical care nurse other than an RN License. However, there are bodies of authority that certify CCNs.

Although, certification is not required, most CCNs abroad are choosing to go for it because it increases their credibility. Employers also often require their CCNs to be certified in the field. Certification is achieved post graduation. It is not something taught in school. Some schools may expose their students to ICUs, but this is not considered enough for certification. The RNs get their CCN certificates while they are on the job. It is also often sponsored by the employer.

Work Opportunities in the Philippine Nursing Scene

There are a lot of opportunities to become a critical care nurse in the Philippines. But, nurses have to understand that these critical care units are often hard to get into. These units only require a limited number of nurses. Most of the time there are only a total of 12 nurses that work in a typical ICU with 8-10 beds.

Those who do get into these areas are considered lucky because their position opens great opportunities to work abroad. In most settings, CCNs have a lesser work load compared to nurses in large wards. Patients in ICUs need more attention but the numbers are much smaller compared to wards. A typical government hospital ward may hold 50-70 patients and with only a nurse or two to manage it.

Work Abroad

There are a lot of work opportunities for a critical care nurse abroad. The CCN can work in any area where there is an intensive care unit. Certification is often an option provided by employers to deserving and promising nurses. The employers are often the ones who fund certification seminars and the likes.

With the present shortage in nursing manpower, hospitals are clamoring to get their hands on specialized nurses. These employers would often offer big sign-in bonuses just to get a nurse to work with them. The average salary of a critical care nurse in the US often ranges from USD50,000 – USD 75,000. It is estimated that nearly 70% of the critical care nurse population earn that much. Some earn slightly lower while others earn upwards of USD90,000 to USD100,000 annually

Critical Care Nursing Career Tips

Critical care nursing is the specialty within the nursing profession that ensures the delivery of optimal care to acutely and critically ill patients. Critically ill patients are patients who are at high risk for actual or potential life threatening health problems. These patients are highly vulnerable, unstable, and have complex healthcare needs that require vigilant and intense nursing care.

These types of nurses and nurse practitioners are essential in intensive care units (ICUs), including medical, surgical, pediatric and neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments, and recovery rooms. Critical care nurses are also part of medical evacuation and transport teams.

In the United States, most critical care nurses are registered nurses; because of the unpredictable nature of the patient population, licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) rarely assume the primary care role in caring for critically ill patients.

Registered nurses can obtain certification in critical care nursing through the American Association of Critical Care Nurses (AACCN), an advisory board that sets and maintains standards for critical care nurses. This certification, known as the CCRN, describes the holder as a certified critical care nurse for adult, pediatric and neonatal patient populations.

Several subspecialties of this type of nursing can be found in units composed of similarly aged patients. These subspecialties are in the following areas:

• Neonatal Intensive Care Unit, also called Nursery ICU or NICU. The NICU’s patients are primarily newborn and premature infants who are cared for until they reach the gestational age of one month. After this period, their care will be assumed by the Pediatric Intensive Care unit.
• Pediatric Intensive Care Unit, or PICU. Here, the patients are about one month to eighteen years of age.
• Adult Intensive Care, or ICU, takes care of patients who are beyond eighteen.

There may, however, be deviations from the above setup, such as sending newborns who get admitted in the Emergency Department to the PICU, rather than the NICU. There may be rare cases where an adult patient with congenital heart disease will be admitted to the PICU, as their current treatment is a continuation of treatment they had been receiving from their physicians since they were children.

Care subspecialties may also be based on the type of disorder, disease or primary injury of the patient population. For example, the Adult Intensive Care Unit may have a specialized unit for trauma patients called the Adult Trauma Intensive Care Unit.

There is a variety of equipment used in the critical setting with which intensive care nurses need to be thoroughly familiar. These include hemodynamic and cardiac monitoring systems, mechanical ventilator therapy, intro-aortic balloon pumps, ventricular assist devices, continuous renal replacement equipment, and other advanced life support devices. All of these are at the critical care nurse’s disposal when providing medical intervention to the critically ill.

With advances in healthcare and technology, medical conditions previously described as critical can now be treated outside the critical units. Nonetheless. critical care nurses continue to keep abreast with new treatment methods and technologies in this growing profession.

How to Become a Critical Care Nurse

A critical care nurse is a professional who deals with seriously ill patients in the intensive care unit. They do not only care for the patients, but also help doctors administer treatment and monitor the conditions of the patients. The service of critical care nurses is highly important and can mean the difference between success and failure of a medical endeavor. In some cases, they can also save the lives of patients. As such, a career in critical nursing can be very stressful and requires extraordinary commitment and genuine passion to help others. Although it is a challenging job, it can also bring great fulfillment. If you wish to become a nurse, it is advantageous to know exactly what the job entails.

Job Profile

The duties of a critical care nurse include caring for patients, checking and monitoring the vital signs of patients, administering appropriate medicines and helping doctors perform treatments. As a critical nurse, your job is more pressurizing than that of a regular nurse as a result of the critical nature of the illnesses of the patients under your care. When critical symptoms show, you must act in an efficient manner to ensure that the appropriate treatment will be administered as soon as possible. You also have to work with many different kinds of medical equipment, including life support systems.

What It Takes to Become a Critical Care Nurse

To become a successful nurse, you must be very attentive as you will be required to provide information regarding patients to the doctors. You are responsible for detecting symptoms in patients and must be constantly prepared for the unexpected as life-threatening symptoms may present at anytime. It is also important that you possess strong knowledge of medications and treatment methods, as well as their effects on patients. You will be required to work closely with doctors and must be prepared to work long hours when emergencies occur. Attention to detail, a strong will and calmness are some of the traits that you need to possess to excel in the field of critical care nursing.

Education Requirements

An education in nursing is a must for anyone who wishes to become a critical care nurse. There are many schools that offer excellent nursing courses and programs that are appropriate for a critical nursing career. If you want to learn the basics of nursing, you can opt for a diploma or Associate Degree in nursing. A Bachelor’s Degree or Master’s Degree in nursing will prepare you for greater career advancement, making you eligible for top critical care nursing positions in the best medical facilities. Typically, nursing programs cover areas of study such as human anatomy, illnesses, medications, and nursing procedures. After obtained the required nursing education, you must obtain an advanced practice certification or a cardiac care certification before you seek employment.

Career Opportunities and Salary

Critical care nurses are in high demand nowadays and you can be assured that you win a great position once you have graduated from nursing school. Most critical care nurses work in hospitals, but there are some who work in nursing schools, outpatient surgery centers, clinics, nursing schools and private homes. With enough experience serving as a critical care nurse, you can get promoted to become a nurse practitioner, or you can even opt to become a professor in a nursing school. The average salary for a critical care nurse is $65,000 a year which may change based on the individuals drive and experience

Categorising Critically Ill Patients by Critical Care Nurses

Critical care nursing is the delivery of specialised care to critically ill patients or patients with the potential to become critically ill – that is, those who have or are susceptible to life-threatening illnesses or injuries. Such patients may be unstable, have complex needs and require intensive and vigilant critical care nursing. The Department of Health categorises acute hospital patient care into levels from 0 to 3:

Level 0 is normal acute ward care.
Level 1 is acute ward care with the input of critical care specialists, e.g. outreach. This may be required because of recent discharge from a critical care unit or because the patient’s condition or therapy/equipment used in their care means increased intervention is needed.
Level 2 is high dependency care for patients requiring an increased level of monitoring owing to their condition or potential for deterioration or patients with single organ failure/support. Nurse to patient ratios for this level of care are usually one nurse to two patients.
Level 3 is intensive care for patients with two or more organ failure/support or requiring mechanical ventilation. Nurse to patient ratios for this level of care are usually one nurse to one patient.

Illnesses and injuries commonly seen in patients on critical care units, either separate level 2 and 3 facilities or combined units, include:

traumatic injuries from such events as road traffic accidents, falls and assaults
cardiovascular disorders, such as heart failure and acute coronary syndromes (unstable angina and myocardial infarction [MI])
elective surgeries, such as abdominal aortic aneurysm repair and carotid endarterectomy
emergency surgeries, such as bowel perforation and neurosurgery
neurological disorders, such as hypoxic brain damage and subarachnoid haemorrhage
respiratory disorders, such as acute respiratory failure and pulmonary embolism
GI and hepatic disorders, such as acute pancreatitis, acute upper GI bleeding and acute liver failure
renal disorders, such as acute and chronic renal failure
cancers, such as lung, oesophageal and gastric cancer
shock caused by hypovolaemia, sepsis and cardiogenic events (such as after MI)

Meet the critical care nurse

They are responsible for making sure that critically ill patients and members of their families receive close attention and the best care possible.

What do you do?

Fill many roles in the hospital setting, such as staff nurses, sisters, charge nurses, nurse-educators, nurse-managers, clinical nurse specialists, advanced nurse practitioners (ANPs), nurse consultants and outreach nurses.

Where do you work?

Wherever critically ill patients are found, including:

adult, paediatric and neonatal intensive care units (ICUs) and high dependency units (HDUs), or combined critical care units caring for both level 2 and level 3 patients
coronary care units
cardiothoracic/neurosurgical/burns/liver units
accident and emergency departments
postanaesthesia/postoperative care units
general wards as part of an ‘outreach’ team (providing care to patients and education to staff caring for patients with complex care needs, potential to deteriorate or recently discharged from a critical care unit).

Why Critical Care is So Important

Critical care is an area of medicine that deals with the life-support and care of patients that are critically ill. Normally if you hear doctors refer to a patient as being in critical care, they are basically saying that the patient is in intensive care. The medicines that are administered in critical care are also intensive care medicines. This kind of service was established in different hospitals to ensure that you and the ones you love will be well taken cared of in times of emergency. The critical care service may not seem that important to you now until you are in a position where you or a member of your family is in desperate need of this service. Nevertheless, being aware that this service is available to you will make you feel a lot more comfortable, if you were to find yourself in an unfortunate emergency health situation.

It is very important that medical critical care services be available for 24 hours every day, as there are many people, probably thousands that may require this service on a day to day basis. It is highly recommended that you have a medical care service on call, if you are looking after members of your family that are diagnosed with diseases which make them susceptible to strokes, heart attacks or any other disease that is life threatening. In addition, in the case of pregnant women, these services can provide the much needed help if a delicate emergency delivery of the baby were to take place. This kind of service would also ensure that the necessary health care is given if any complications were to be developed at the time, or during delivery.

Critical care service would also be the best chance you have at getting emergency health care, if you were to develop or experience any severe medical complications in your body. This is because this service would ensure that intensive care is given to you by the medical staff as quickly as possible. In addition, there is no other medical service available that would be able to let you recover as quickly and safely as the service provided by critical care.

However, in order to be considered for the critical care services, your injury or illness, must meet the definition of a critically ill or injured individual. A person who is critically ill or injured is in a state that will harm one or more than one, of their vital organ systems, for example the respiratory system. The harm being done in this case to your vital organ system, must also be considered to be life threatening or a situation that will definitely result in your condition getting worse. If your injury or illness, meets the conditions above, then the critical care service would be administered to you.

If it so happens that you have to go to the critical care unit one day, there will be a team of doctors who will administer the necessary critical care service. They will perform critical services that will involve very complex decisions to control, assess, and support the operations of your vital organ system, and your organ system failure will be treated. These doctors will also carry out the necessary measures to ensure that your situation does not deteriorate any further, thus saving your life or the life of a member of your family.