Critical-care nursing is that specialty
within nursing that deals specifically with human responses to life-threatening
problems. A critical-care nurse is a licensed professional nurse who is
responsible for ensuring that all critically ill patients and their families
receive optimal care.
Although very sick and complex patients
have always existed, the concept of critical care is relatively modern. As
advances have been made in medicine and technology, patient care has become much
more complex. To provide appropriate care, nurses needed specialized knowledge
and skills, while care delivery mechanisms also needed to evolve to support
patients’ needs for continuous monitoring and treatment. The first intensive
care units emerged in the 1950s as a means to provide care to very sick patients
who needed one-to-one care from a nurse. It was from this environment that the
specialty of critical-care nursing emerged.
According to the March 1996 report, “The
Registered Nurse Population,” by the U.S. Department of Health and Human
Services (DHHS), there are 273,850 nurses in the U.S. who care for
critically ill patients in the hospital setting. Critical-care nurses account
for an estimated 24 percent of the total number of nurses working in the
Critical-care nurses practice
in settings where patients require complex assessment, high intensity therapies
and interventions, and continuous nursing vigilance. Critical-care nurses rely
upon a specialized body of knowledge, skills, and experience to provide care to
patients and families and create environments that are healing, humane, and
caring. Foremost, the critical-care nurse is a patient advocate.
Critical-care nurses work
in a wide variety of settings, filling a variety of roles. They are bedside
clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse
specialists, and nurse practitioners. With the onset of managed care and the
resulting migration of patients to alternative settings, critical-care nurses
are now called upon to care for sicker patients more than ever before.
Managed care has also fueled a
growing demand for advanced practice nurses in the acute- and critical-care
setting. Advanced practice nurses have received advanced education at the
master’s or doctoral level. In the critical-care setting, they are most
frequently Clinical Nurse Specialists (CNS) and Acute-Care Nurse Practitioners (ACNPs).
They demonstrate a high level of independence and in many states, they are now
eligible for direct financial reimbursement, just like physicians.
A CNS is an expert clinician in
a particular specialty—critical care in this case. The CNS is responsible for
the identification and intervention of clinical problems and in the management
of those problems to improve care for patients and families. They provide direct
patient care, including assessing, diagnosing, planning and prescribing
pharmacologic and non-pharmacologic treatment of health problems.
ACNPs, in the critical-care
setting, focus on making clinical decisions related to complex patient care
problems encountered in the acute-care setting. Their activities include health
history and risk appraisal, interpretation of diagnostic tests and providing
treatment, which may include prescribing medication.
Critical-care nursing includes
the sub-specialties of adult, pediatric, and neonatal nursing practice.
According to the March 1996
DHHS report, 60 percent of all
nurses work in the hospital setting.
Within the hospital setting, critical-care nurses are found wherever
there are critically ill patients: intensive-care units (ICUs); pediatric ICUs,
neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units,
progressive care units, emergency departments, and recovery rooms. Increasingly,
critical-care nurses work in home health, managed care organizations, nursing
schools, outpatient surgery centers, clinics, and flight units.
Critical-care nurses must have
education and training beyond their basic preparation as a registered nurse (RN)
to meet the needs of patients and families who are experiencing critical
illness. Most critical-care nurses will complete a critical-care training course
or orientation that includes essential information on the care of the critically
certification is not mandatory for practice in a specialty like critical care,
many nurses choose to become certified. Some employers prefer to hire certified
nurses, as they tend to demonstrate a higher level of knowledge in their
specialty and often have more specialty practice experience. Certified
critical-care nurses (CCRNs) validate their knowledge by passing a rigorous test
and by meeting extensive continuing education and clinical experience
Critical-care nursing salaries
can vary by geographical location, practice setting, and the size of the
institution. Other factors that influence salary are educational level,
experience, and position. The growing nursing shortage is especially acute in
the specialty areas of nursing. Hospitals are offering critical-care nurses
ever-more attractive incentives including generous sign-on bonuses, relocation
bonuses, and reimbursement and other attractive benefits.
According to a recent
membership survey conducted by the American Association of Critical-Care Nurses,
50 percent of the total membership reported the following annual salary ranges:
$25,000 to 39,999
$40,000 to 54,999
$55,000 to 74,999
to a 2000 salary survey of 2,784 nurses by SpringNet.com, the average annual
salary for full-time nurses is $37,980.
The salaries of certified nurses were compared with those who aren't certified
and results found that some 23 percent of certified nurses earn more than
$50,000 per year. Only 11 percent
of nurses who aren't certified in a specialty earn more than $50,000.
To become a registered nurse,
one must either earn a diploma in nursing, an associate’s degree in nursing (ADN),
or a bachelor’s degree in nursing (BSN) and pass a national licensing exam.
The requirements vary from state to state and are dictated by each state’s
Board of Nursing. Many nursing schools offer students exposure to critical care,
but most of a critical-care nurse’s specialty education and orientation are
provided by his or her employer. Advanced practice nurses must earn an advanced
degree, either at the master’s or doctoral level.
American Association of Critical-Care Nurses
Aliso Viejo, CA 92656-1491
Web site: http://www.aacn.org
Society of Critical
8101 East Kaiser Boulevard, 3rd Floor
Anaheim, CA 92808-2259
Fax: (312) 601-4501
Web site: http://www.sccm.org
AACN Clinical Issues: Advanced Practice in Acute & Critical Care
American Journal of Critical Care(r)
Critical Care Nurse Journal