The latest medical technology and most critical patients converge in the intensive-care unit (ICU), where critical-care teams are ready to treat the most gravely ill patients -- those who might not have stood a chance of survival just 50 years ago.

Critical-care teams include a variety of specialists, including nurses, physicians, respiratory therapists, sonographers, radiology technicians, laboratory staff, pharmacists and other healthcare professionals who treat the most severely ill and injured patients. Critical-care nurses lead these teams. "A critical-care nurse is the choreographer of that patient's care for his entire stay in critical care," says Susan Odegaard Turner, founder of consultancy Turner Healthcare Associates.

Modern-day ICUs emerged in the '50s, and advances in medicine brought the capability to treat patients with more severe illnesses and injuries than ever before. These high-needs patients began to require one-to-one contact with doctors and nurses. Hospitals created ICUs to facilitate this care, which also produced the specialty of critical-care nursing.

The need for critical-care nurses has grown along with technological advances, with one study reporting vacancy rates in this specialty exceeding 14 percent nationwide. According to the American Association of Critical Care Nurses' Web site, "requests for temporary and traveling critical-care nurses to fill staffing gaps has skyrocketed in every part of the US over the past year."

Intense Environment

Turner started her nursing career in an ICU, pursuing a critical-care training program after graduation from nursing school. "I liked the fast pace, the high technology and the constant change of environment," she says. "You were doing something different every day. I liked the high-level acuity of the patients."

The continual advancements of medicine mean critical-care nurses will always see the most severe cases. Patients who would have been cared for in an ICU five years ago can now be treated on medical floors, while those being treated in the ICU may not have had a chance at survival in the past.

Ann Roberts is a registered nurse (RN) clinician IV in the coronary medical ICU at Virginia Commonwealth University Health System in Richmond, Virginia. "I love just about everything about my job," says Roberts, who has worked in intensive care for more than 20 years. "I like my patient population. I like the impact I can make for them. I like working in the university setting, because it's a teaching environment so you're always on the cutting edge of what's coming out."

Variety of Employment Options

Today, most critical-care nurses work in hospital settings in ICUs, cardiac-care units, cardiac catheter labs, telemetry units, progressive-care units, emergency departments and recovery rooms. But critical-care nurses also work in home healthcare, managed-care organizations, nursing schools, outpatient surgery centers and clinics.

Critical-care nurses are usually RNs who receive critical-care training from their employer after graduation. Some hospitals have new-graduate programs in critical care. Roberts says she knew she wanted to pursue this field before she graduated. "My school particularly prepared me to work in an intensive-care unit," she says. "I spent three days a week in an ICU preparing to take care of patients, so I didn't have a reality shock when I came out of school."

Roberts advises nursing students with an interest in critical care to get "clinical rotations that are in ICUs, that are more than just observational experiences."

After nurses have completed a prerequisite number of clinical hours and have been in critical-care practice for at least two years, they're eligible to take an examination and become a certified critical-care nurse (CCRN). This certification is not required to work in critical care and requires continual testing to be maintained.

"It's not something that you get for life, and you don't have to do it to work in critical care," Turner says. "It's a big professional kudo, because it's difficult to get."