Patients with complex, life-threatening conditions. Families under pressure. Multidisciplinary teams working together-and everyone is depending on the critical care nurse to provide accurate, up-to-the-minute information and clinical expertise with compassionate care. In critical care, emotions are high, and the stakes are higher.
During my nursing school clinical rotation in the ICU, I was inspired when I witnessed my preceptor discuss pathophysiology or present patient assessment findings to the team. I knew I wanted to be at the forefront of evidence-based nursing practice, where I could apply new research, protocols and procedures, and technology and tools.
What we do. In critical care nursing, the patient is often experiencing a life-threatening emergency requiring medical support of organ function. This requires the close monitoring and intervention of a critical care nurse who has received specialized training above and beyond that required for nursing licensure. While staffing ratios can vary, a critical care nurse will typically have fewer patients so they can provide closer monitoring of those who are unstable and critically ill. Although some might assume that fewer patients per nurse in the ICU might mean a lighter workload, this is not the case.
Critical care nurses work with constantly evolving technology and must collaborate and communicate skillfully with a large interdisciplinary care team. We alert the team to changes in a patient's condition and participate in care planning, which requires a thorough understanding of science, pathophysiology, treatment plans, and goals.
Critical care nurses are also the most constant caregiving presence for patients and their families during their hospital stay, providing customized health care education as well as therapeutic communication and support. We have long known that allowing families to bear witness to complex and challenging medical situations with appropriate support from qualified care team members results in greater satisfaction with our efforts, regardless of the outcome.
Career goals. Because of the intersection of critical care nursing and advances in medical technology and life-preserving medical treatments, critical care nurses must be engaged in continuing education that advances their knowledge and skills in their specialty area. The American Association of Critical-Care Nurses (AACN; http://www.aacn.org) supports patient health and safety through specialty nursing certification. It offers critical care RN (CCRN) certification options for RNs or advanced practice RNs who provide direct care to acutely or critically ill adult, pediatric, or neonatal patients. There are other CCRN certification options for critical care nurses who influence care but do not provide direct care, as well as for those who work with acute and critically ill patients from remote telehealth hubs.
Challenges. Critically ill patients are at high risk for sepsis, health care-associated infections, hemodynamic instability, and other complications. We are constantly on the lookout for changes in our patients' conditions that require us to rapidly address potential issues. We are trained to operate equipment that monitors and supports organ function, such as continuous cardiac telemetry monitors and ventilators. Each of these devices has alarms that must be managed so they don't go off unnecessarily, leading to clinician alarm fatigue and delayed alarm response times.
Staffing is another challenge. Staff shortages in ICUs were already a challenge before the pandemic, and the sustained crisis has led to even more nurses leaving the specialty and, in many cases, the profession.
Connecting with colleagues. The AACN is the largest specialty organization in the world, representing over 125,000 progressive and critical care nurses. The AACN offers resources, education, and support to enhance its members' careers. It is also a leader in advancing evidence-based guidelines that allow nurses to deliver optimal patient care. Becoming a member of the AACN enables nurses to connect through local chapters, online community forums, and annual conferences such as the National Teaching Institute. Thanks to the learning and support I've gained from the AACN, I feel the most gratitude and professional satisfaction when I'm supporting patients during the most challenging days of their lives.