Critical Care Nursing

I spent many of my years as a nurse working in Intensive/Critical Care Units (ICU/CCU). There are specializations within critical care, such as Neuro, Ortho, Open Heart, Burns, Medical/Surgical… Each with their own requirements - their own positives and negatives. The thing they all have in common is life versus death. That’s right, I said life and death.

The patients in an ICU are sick. The sickest of the sick. If the nurse isn’t paying attention, they can lose a patient in a matter of minutes. And I don’t mean the patient walked away and got lost. I am talking about death here. The loss of life.

When hearing an ICU RN has only two patients, people often think they have it easy. Afterall a Med-Surg nurse can have six or more patients depending on the state in which they work. The major difference is the acuity of the patient - which means how much work does this one patient require from the nurse in order to stay alive and actually, hopefully, heal and recover. The patient in critical care is more fragile – more apt to suddenly circle the drain of death.

It is not uncommon for one patient in the ICU to have five or more drips (medications and fluids) running simultaneously. A doctor once walked into my patient’s room, looked at everything, and asked how I keep it all straight. That one patient had so many pumps and other needed equipment it was hard to move around the head of the bed. That is the life of the nurse in critical care. When you have a patient in multiple organ system failure, you have to pay attention to every single body system – all the time.

ICU nursing isn’t for the lazy. No nursing specialty is for the lazy. If you want an easy life/work experience, do not go into nursing. It isn’t for you. Trust me. On the flip side if you thrive on challenges, hard work, and making a difference, critical care nursing may be your niche.

My plan after graduating from nursing school was to become a nurse anesthetist in 5 years. Well, that didn’t happen due to major life changes. However, knowing where I wanted to be in the future allowed me to make the best choices for myself at the start of my career.

I began my nursing journey on a large and very busy telemetry floor with floats to both the GI lab and the step-down unit. The step-down unit was one step less acute than critical care, but they still took care of stable ventilated patients. The GI lab gave me conscious sedation training from the beginning. Vents and sedation are needed skill sets for the ICU nurse.

 I also knew as a new grad RN, I needed experience from the medical/surgical units and multi-tasking skills best learned off the ICU. I have given this advice to every nursing student I have ever precepted. Start on a Med-Surg/Tele floor no matter the end goal. It is where you will learn vital information about procedures, tests, and the daunting multi-tasking of multiple patients all wanting help at the same moment. You will have to learn prioritization and triage so that you treat the most important issue first. No matter what your final destination is within nursing, these skills are required and best learned at the beginning of your career.

So, what is required to become a successful ICU/CCU RN? Obviously, you need knowledge and technical skills (Telemetry, Ventilators, Medications, Procedures, Sedation, Medical Equipment, ACLS, TNCC, PALs…). It may sound odd, but you also need to work well both autonomously and within a team. Ultimately, you are responsible for your patient while they are under your care. Nobody else is going to follow along behind you and ensure you do your job. And if you don’t do your job well, a patient may die. This is why you need to work well by yourself. However when a patient codes, it is the critical care team that responds. All hands-on-deck which includes someone monitoring all of the other patients in the unit while staff work to bring someone back from the edge of death.

In addition, the ICU nurse needs to be quick. Quick at assessments. Quick to critically think it all through and know what steps need to happen to save your patient. You must be able to assess ever-changing conditions and have the needed knowledge to understand and act swiftly and appropriately.

For this reason, I strongly urge that new grad nurses do not go directly into a critical care unit. The first year after graduating from nursing school is a huge learning curve full of experiences you will need before you are in a constant state of fighting off death in the ICU. The more experience you have before you go into ICU the easier it will be to remain calm during a crisis. An essential skill for critical care.

Now if I haven’t scared you away from being a critical care nurse, let me tell you about the positive side to the ICU. You can visibly see when your actions have improved the health and mental well-being of a patient. You get to spend more time with your patients and their loved ones as you are in your patient’s room frequently. You are able to establish bonds with them more easily due to spending that quality time with them. We all know one of the major strategies to prevent legal suits is communication and establishing a rapport with the patient and/or family (aside from performing all care correctly), so the importance of this benefit cannot be understated.

Also, some of my dearest friends were made in critical care units. As I stated previously, ICU nurses are team oriented, so you tend to form good relationships with one another. For me, the most gratifying aspect of working in any critical care area was saving lives – making a difference.

My goal and prayer every day I worked in bedside nursing was to catch abnormalities before they led to a code – before the patient’s heart stopped beating. I wanted to heal my patients. I wanted to see them walk out of the hospital. I wanted to make a difference. And I did.

Critical Care nursing is brutal, exhausting physically and mentally, and stressful. Lives literally depend on you. But it is also very rewarding emotionally and spiritually.  If you thrive under stressful circumstances and desire to make a difference, then critical care may be your nursing niche.