AboutCriticalCareNursing

DefinitionofCriticalCareNursing

Criticalcarenursingisthatspecialtywithinnursingthatdealsspecificallywithhumanresponsestolife
threateningproblems.Acriticalcarenurseisalicensedprofessionalnursewhoisresponsibleforensuring
thatacutelyandcriticallyillpatientsandtheirfamiliesreceiveoptimalcare.
DefinitionofaCriticallyIllPatient

Criticallyillpatientsaredefinedasthosepatientswhoareathighriskforactualorpotentiallifethreatening
healthproblems.Themorecriticallyillthepatientis,themorelikelyheorsheistobehighlyvulnerable,
unstableandcomplex,therebyrequiringintenseandvigilantnursingcare.
NumberofCriticalCareNursesintheUnitedStates
Accordingto"TheRegisteredNursePopulation"studyconductedinMarch2004bytheDepartmentof
HealthandHumanServices,thereare503,124nursesintheU.S.whocareforcriticallyillpatientsina
hospitalsetting.

Ofthese,229,914spendatleasthalftheirtimeinanintensivecareunit(ICU)92,826spendatleasthalf
theirtimeinstepdownortransitionalcareunits117,637spendatleasthalftheirtimeinemergency
departmentsand62,747spendatleasthalftheirtimeinpostoperativerecovery.Criticalcarenurses
accountforanestimated37%ofthetotalnumberofnurseswhoworkinahospitalsetting.
WhereCriticalCareNursesWork
Accordingto"TheRegisteredNursePopulation"study,56.2%ofallnursesworkinahospitalsetting,and
criticalcarenursesworkwherevercriticallyillpatientsarefoundintensivecareunits,pediatricICUs,
neonatalICUs,cardiaccareunits,cardiaccatheterlabs,telemetryunits,progressivecareunits,emergency
departmentsandrecoveryrooms.

Increasingly,criticalcarenursesworkinhomehealthcare,managedcareorganizations,nursingschools,
outpatientsurgerycentersandclinics.
WhatCriticalCareNursesDo

Criticalcarenursespracticeinsettingswherepatientsrequirecomplexassessment,highintensitytherapies
andinterventionsandcontinuousnursingvigilance.Criticalcarenursesrelyuponaspecializedbodyof
knowledge,skillsandexperiencetoprovidecaretopatientsandfamiliesandcreateenvironmentsthatare
healing,humaneandcaring.
Foremost,thecriticalcarenurseisapatientadvocate.AACNdefinesadvocacyasrespectingandsupporting
thebasicvalues,rightsandbeliefsofthecriticallyillpatient.Inthisrole,criticalcarenurses:
Respectandsupporttherightofthepatientorthepatient'sdesignatedsurrogatetoautonomous
informeddecisionmaking.
Intervenewhenthebestinterestofthepatientisinquestion.
Helpthepatientobtainnecessarycare.
Respectthevalues,beliefsandrightsofthepatient.
Provideeducationandsupporttohelpthepatientorthepatient'sdesignatedsurrogatemakedecisions.
Representthepatientinaccordancewiththepatient'schoices.
Supportthedecisionsofthepatientordesignatedsurrogate,ortransfercaretoanequallyqualified
criticalcarenurse.
Intercedeforpatientswhocannotspeakforthemselvesinsituationsthatrequireimmediateaction.
Monitorandsafeguardthequalityofcarethepatientreceives.
Actasaliaisonbetweenthepatient,thepatient'sfamilyandotherhealthcareprofessionals.
TheRolesofCriticalCareNurses

Criticalcarenursesworkinawidevarietyofsettings,fillingmanyrolesincludingbedsideclinicians,nurse
educators,nurseresearchers,nursemanagers,clinicalnursespecialistsandnursepractitioners.Withthe
onsetofmanagedcareandtheresultingmigrationofpatientstoalternativesettings,criticalcarenurses
arecaringforpatientswhoaremoreillthaneverbefore.
Managedcarehasalsofueledagrowingdemandforadvancedpracticenursesintheacutecaresetting.
Advancedpracticenursesarethosewhohavereceivedadvancededucationatthemaster'sordoctoral
level.Inthecriticalcaresetting,theyaremostfrequentlyclinicalnursespecialists(CNS)oracutecare
nursepractitioners(ACNP).
ACNSisanexpertclinicianinaparticularspecialtycriticalcareinthiscase.TheCNSisresponsiblefor
theidentification,interventionandmanagementofclinicalproblemstoimprovecareforpatientsand
families.Theyprovidedirectpatientcare,includingassessing,diagnosing,planningandprescribing
pharmacologicalandnonpharmacologicaltreatmentofhealthproblems.
ACNPsinthecriticalcaresettingfocusonmakingclinicaldecisionsrelatedtocomplexpatientcare.Their
activitiesincluderiskappraisal,interpretationofdiagnostictestsandprovidingtreatment,whichmay
includeprescribingmedication.
LevelofEducationforCriticalCareNurses

Tobecomearegisterednurse(RN),anindividualmustearnadiplomainnursing,anassociatedegreein
nursing(ADN)orabachelor'sdegreeinnursing(BSN)andpassanationallicensingexam.Requirements
varyasdictatedbyeachstate'sBoardofNursing.
Manynursingschoolsofferstudentsexposuretocriticalcare,butmostofacriticalcarenurse'sspecialty
educationandorientationisprovidedbytheemployer.Advancedpracticenursesmustearnadegreeatthe
master'sordoctorallevel.
CriticalCareNurseCertification

Althoughcertificationisnotmandatoryforpracticeinaspecialtylikecriticalcare,manynurseschooseto
becomecertified.Someemployersprefertohirecertifiednursesbecausetheyhavedemonstrated
acquisitionofaspecifichighlevelofknowledgeintheirspecialtythroughsuccessfulcompletionofa
rigorous,psychometricallyvalid,jobrelatedexamination.
Forexample,acriticalcarenursemustcareforcriticallyillpatientsforaminimumoftwoyearstobe
eligiblefortheCCRNcertificationexamofferedbyAACN,oneofmanycredentialstheassociationoffers.
BecauseoftheavailabilityofMedicareandmanagedcarereimbursementtoclinicalnursespecialists,a
growingnumberofemployersarerequiringadvancedpracticecertification.Additionally,asstateboardsof
nursingattainstatutoryauthoritytoissueadvancedpracticenursinglicenses,nursesareoftenbeing
requiredtopassanationallyrecognizedcertificationexamination.
Certifiednursesvalidatetheircontinuingknowledgeofcurrentpracticesinacute/criticalcarenursing
througharenewalprocessthatincludesmeetingcontinuingeducationandclinicalexperiencerequirements.
NursingShortageMorePronouncedforCriticalCareNurses

Thenursingshortageisespeciallyacuteinthespecialtyareasofnursing,asnotedintheskyrocketing
numberofrequestsfortemporaryandtravelingcriticalcarenursestofillstaffinggapsineverypartofthe
U.S.Theserequestsaremostpronouncedforadultcriticalcareunits,pediatricandneonatalICUsand
emergencydepartments.
RecruitmentadvertisingforcriticalcarenursesinAACN'spublicationscontinuestogrow,especiallyinthe
annualCareerGuide.Hospitalsareofferingcriticalcarenursesevermoreattractiveincentives,including
signonbonuses,relocationbonusesandreimbursementforcontinuingeducationandcertification.
Inaddition,manyhospitalsarelaunchingcriticalcareorientationandinternshipprograms,suchasthe
WebbasedEssentialsofCriticalCareOrientation(ECCO)program,toattractandprepareexperiencedand

newlylicensednursestoworkincriticalcareandtheEssentialsofNurseManagerOrientationprogram.
HistoryofCriticalCareNursing
Althoughtherehavealwaysbeenveryillandseverelyinjuredpatients,theconceptofcriticalcareis
relativelymodern.Asadvanceshavebeenmadeinmedicineandtechnology,patientcarehasbecomemore
complex.Toprovideappropriatecare,nursesneededspecializedknowledgeandskillsandthecaredelivery
mechanismsneededtoevolvetosupportthepatients'needsforcontinuousmonitoringandtreatment.

Thefirstintensivecareunitsemergedinthe1950stoprovidecaretoveryillpatientswhoneededoneto
onecarefromanurse.Fromthisenvironmentthespecialtyofcriticalcarenursingemerged.
FutureofCriticalCareNursing
Rapidadvancesinhealthcareandtechnologyhavecontributedtokeepingmorepeopleoutofthehospital.
However,patientsincriticalcareunitsaremoreillthanever.

Manypatientswhowouldhavebeencaredforinacriticalcareunitfiveyearsagoarenowbeingcaredfor
onmedicalfloorsorathome.Manypatientsintoday'scriticalcareunitswouldnothavesurvivedinthe
past.Ithasbeenproposedthathospitalsofthefuturewillbelargecriticalcareunits,andothertypesof
carewillbeprovidedinalternativelocationsorathome.
Criticalcarenurseswillneedtokeeppacewiththelatestinformationanddevelopskillstomanagenew
treatmentmethodsandtechnologies.Asissuesrelatingtopatientcarebecomeincreasinglycomplexand
newtechnologiesandtreatmentsareintroduced,criticalcarenurseswillneedtobecomeevermore
knowledgeable.