When I graduated nursing school, I chose to apply for a critical care internship. The program only accepted 12 new grads each term, so I never thought I would get the job. I did, and my first day working in ICU was the day I became a nurse. When people asked me what kind of nurse I was, I would proudly proclaim my intensive care roots. I thought that if I can take care of the sickest patients, then I can take care of anyone. This proved to hold validity. ICU nursing taught me critical fundamentals of nursing care, and set the foundations of lifelong compassionate service.
Life in the ICU gives you the opportunity to learn the assessment and intervention skills that truly save people’s lives. For example, one night, around the Christmas holidays, a young man was admitted to the family medicine unit for abdominal pain. His initial CT scan showed a large gallstone, but no occlusion at that time. Within hours of his observation, the stone moved, and he began the fight against SIRS, MODS and liver failure. His status began to decline and the rounding physician consulted the critical care team. Upon our arrival to his room, the young man was in late stages of ARDS. Not good. The critical care team rushed him to the unit and we worked all night to keep him alive. We were successful and, in the morning, his 12 year old son came to visit, in awe of the tubes, the machines and, most importantly, the team that had saved his father’s life. We stood there together, quiet, in the calm after the storm. It was one of the most poignant moments of my nursing career.
ICU nurses must learn to be two steps ahead of the gravely ill patients they care for. Failure to do so could lead to the patient’s clinical course derailing and crashing. That’s what intensive care is all about. I compare it to an elite athlete within their sport. Timing, training, precision, and performance are never questioned. In nursing, ICU nurses are those stellar clinical performers. ICU nurses are the ones that other nurses look toward when their patient’s condition begins to swirl the drain. At any given time, in any given place, within the walls of a hospital, life can be just as close as death, and someone has to be ready to take the reins. ICU nurses are trained to handle the most delicate situations in patient care. From in house cardiac arrests, to starting CVVH on an adult sized pediatric patient, to starting IVs for the floor nurse who is too busy to do so, ICU nurses are flexible, but ready to handle whatever is thrown at them. An ICU nurse makes up an integral part of a multi-disciplinary team. This team is comprised of nurses, techs, intensivists, respiratory therapists, and other care givers such as clinical nurse specialists. While most ICUs are medical/surgical focused, there are specialty ICUs such as surgical, trauma, pediatric, and cardiac.
In reality, patient acuity levels are growing by leaps and bounds. As with most specialties, a nurse must successfully pass the NCLEX-RN and possess an unencumbered nursing license in their
practicing state. Most intensive care units require RNs to have at least 1 year of general clinical experience. Because of the nature of the clinical setting, nurses must have BLS/CPR certification, ACLS, and other unit specific core competencies. The AACN (American Association of Critical Care Nurses) developed ECCO (Essentials of Critical Care Orientation) to help structure new graduate and nursing internships across the nation. Many facilities utilize this orientation process that could last well over 6 months for new ICU nurses. Nurses must also remain up to date with using medical devices and advanced care protocols. Aside from this, they must also know how to
treat the patient in the event that there is device failure (Hurricane Katrina helped paint this picture). All in all, adaptability is necessary for ICU nurses. The specialty certification in this care setting is the CCRN (Critical Care RN), which is awarded after passing the AACN’s CCRN exam. This exam is noted to be extremely difficult, but can offer credibility to nursing staff.
Medical advancement allows sicker patients to be sustained in the ICU settings. With the growth of palliative and supportive care, patients who previously frequented the ICU for care, are now cared for in tertiary settings or at home. This means the patients who are admitted to ICUs are significantly ill. According to the AACN website, managed care has also fueled a growing demand for advanced practice nurses in the critical care setting. Advanced practice nurses are those who have received advanced education at the master’s or doctoral level. In the critical care setting, they are most frequently clinical nurse specialists (CNS) or acute care nurse practitioners (ACNP).
According to “The Registered Nurse Population” study, 56.2% of all nurses work in a hospital setting, and critical care nurses work wherever critically ill patients are found — intensive care units, pediatric ICUs, neonatal ICUs, cardiac care units, cardiac cath labs, telemetry units, progressive care units, emergency departments and recovery rooms. This means that nurse who are experienced in ICU nursing care are at an advantage. Travel nursing can open the doors for many nursing opportunities across the country. Many facilities offer an attractive incentive package for travelers, particularly those who specialize in ICU nursing. If a nurse desires to search for growth in their career, they can explore possibilities in specialty trauma centers, burn units, research, teaching hospitals, or critical access facilities. The potential is exponential. A dear friend of mine decided to travel as an ICU nurse. She threw caution to the wind, and found a company that met her wants, not needs. She had the skills, so she could negotiate her assignment. She accepted an assignment in Hilo, Hawaii. That was 5 years ago, and now she is a permanent resident, happily married, and a novice surfer. I’m not guaranteeing this kind of fairy tale ending, but traveling can bring excitement and rewards so find out how to get started today!
By Jennifer Petrea, RN
Jennifer Petrea is a Registered Nurse from Concord, with clinical experience that includes critical care, ER, trauma, hospice & palliative care and case management. Jennifer is currently pursuing a Master’s Degree in Nursing and certification as a Clinical Nurse Leader. Jennifer also works as a freelance writer for various medical, health and fitness projects. Learn more about Jennifer on Google+