With an ability to think quickly, act decisively and stay calm when lives are at stake, critical-care nurses are among the in-demand healthcare professionals who make life-or-death decisions about patient care every day.
Critical-care nurses treat patients at high risk for actual or potential life-threatening health problems and also tend to the emotional well-being of those patients' families. That's no small task, given the current current shortage of nurses in critical care -- a shortage that's expected to worsen as the level of patient acuity increases and the Baby Boomers age.
To help fill the current gap in this high-intensity specialty, hospitals are looking for temporary or traveling critical-care nurses, with requests up 45 percent in 2003, according to the American Association of Critical-Care Nurses (AACN).
Critical-Care Nurses on the Front Lines
Critical-care nurses draw on good communication skills, endless compassion and the ability to concentrate amid a patient crisis to succeed in their roles.
"Critical-care nurses are usually type-A personalities," says Michele Mazurek, RN, director of the surgical intensive-care and surgical open-heart units at Mount Sinai Hospital in Chicago. "You need to be extremely organized and methodical in your work. You need to be able to handle stress. You can't be easily swayed by the circumstances."
And since "critical-care nurses have a level of autonomy that most other nurses don't, you need to have confidence in your skills and be able to make quick decisions about patient care," says Jeanette Hermann, a nurse recruiter at Phoenix-based St. Joseph's Hospital and Medical Center, which is building a new wing that will add 144 new beds for critical and acute-care patients.
Critical-Care Settings, Certification
Critical-care nurses account for nearly 323,000 of the 1.36 million nurses working in hospitals, according to a 2004 Department of Health and Human Services study of the registered nurse population. Hospital settings in which critical-care nurses work include intensive-care, cardiac-care and transitional-care units; emergency rooms; and postoperative recovery units.
Outside hospitals, critical-care nurses are increasingly in demand in home healthcare, outpatient surgery centers and clinics. They can also become nurse educators, nurse researchers and nurse practitioners. Median critical-care nurse salaries are in line with the national median salary for nurses.
Critical-care nurses must be RNs. Training occurs on the job, because an intensive-care unit cannot be replicated in a training environment. Experience in this setting carries considerable weight in the job market. A nurse can demonstrate that experience by becoming a Certified Critical Care Nurse (CCRN). To earn this optional AACN designation, nurses must practice at least two years in critical care and pass a rigorous, valid, job-related examination that demonstrates strong critical-thinking abilities.
Beyond certification, critical-care nurses must make a lifelong commitment to learning, says Cathy Cooper, RN, MSN, a per-diem critical-care nurse and assistant professor in the department of nursing systems at the University of Wisconsin at Eau Claire. "It's challenging, because you have to stay abreast of new medications and technologies that save people's lives," she says.
Patient Ratios on the Rise?
Even though they deal with the challenges inherent in treating higher-acuity patients, critical-care nurses say a big plus is working with just one or two patients per shift vs. the six that's typical in medical/surgical units.
"In critical care, I feel like I can do a lot to help an individual patient," says Cooper, who practiced as a critical-care nurse for 15 years before pursuing a professorship.
However, the nursing shortage may mean critical-care nurses will be caring for more patients in the near future, a potentially troubling development given that increasingly ill patients demand more individual attention.
Critical-care nurses say that helping to save a life balances out the pain of losing one. However, Mazurek estimates that about 50 percent of the critical-care nurse's job is helping a patient die with dignity and helping his family enter into the grieving process.
To relieve stress, "critical-care nurses do silly things for one another," she says. "You find the nurses that you work with form very tight relationships. You go through more with strangers and team members than you do with your family and friends."