Critical care nursing

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Intensive Care Unit (ICU) nurse at the San Salvatore Hospital in Pesaro, during COVID-19 pandemic in Italy Covid-19 San Salvatore 03.jpg
Intensive Care Unit (ICU) nurse at the San Salvatore Hospital in Pesaro, during COVID-19 pandemic in Italy

Critical care nursing is the field of nursing with a focus on the utmost care of the critically ill or unstable patients following extensive injury, surgery or life threatening diseases. [1] Critical care nurses can be found working in a wide variety of environments and specialties, such as general intensive care units, medical intensive care units, surgical intensive care units, trauma intensive care units, coronary care units, cardiothoracic intensive care units, burns unit, paediatrics and some trauma center emergency departments. These specialists generally take care of critically ill patients who require mechanical ventilation by way of endotracheal intubation and/or titratable vasoactive intravenous medications.

Contents

Specific jobs and personal qualities

Critical care nurses are also known as ICU nurses. They treat patients who are acutely ill and unstable requiring more frequent nursing assessments and the utilization of life sustaining technology and drugs. Although many ICU patients have chronic health issues, patients are in the ICU for an acute pathology or an exacerbation of a chronic pathology. ICU nurses apply their specialized knowledge base to care for and maintain the life support of critically ill patients who are often on the verge of death. On a day-to-day basis a critical care nurse will commonly, "perform assessments of critical conditions, give intensive and intervention, advocate for their patients, and operate/maintain life support systems which include mechanical ventilation via endotracheal, tracheal, or nasotracheal intubation, and titration of continuous vasoactive intravenous medications in order to maintain a mean arterial pressure that ensures adequate organ and tissue perfusion." [2] Taking care of ICU patients is a very exhausting profession, and critical care nurses face many issues doing so. Critical care nurses tend to feel overwhelmed for various reasons experiencing strong feelings of stress and anxiety due to the workload they receive. Within such an intense work environment, critical care nurses become extremely engulfed in the workload that they sometimes are unable to take the mental breaks that they need. They are even forced to take shorter breaks at times. This interferes with their ability to properly meet the needs of certain patients. [3] Another common issue that critical care nurses deal with is alarm fatigue, which is a lack of energy due to the loud and obnoxious alarms in a critical setting. [4] This causes the nurses to feel irritated and can become very burdensome. Some nurses do not know how to prevent alarm fatigue, while others believe that the only way to deal with it, is to adapt to the alarms because the issue is usually ignored or overlooked. [4] Although critical care nurses face common issues of stress and anxiety, these strong feelings can be prevented if nurses strive to obtain healthy habits and positive interactions to take care of themselves. [5]

Training and education

Critical care nurses in the U.S. are trained in advanced cardiac life support (ACLS), and many earn certification in acute and critical care nursing (CCRN) through the American Association of Critical–Care Nurses. Due to the unstable nature of the patient population, LPN/LVNs are rarely utilized in a primary care role in the intensive care unit. However, with proper training and experience LPN/LVNs can play a significant role in providing exceptional bedside care for the critically ill patient. [6] To become a critical care nurse, one must first achieve an associate or bachelor's degree in nursing and pass the National Council Licensure Examination (NCLEX-RN). Once the exam is passed, then someone can start working as a regular registered nurse (RN). After getting hired into a critical care area, additional specialized training is usually given to the nurse. After 1750 hours of providing direct bedside care in a critical care area, a nurse can then sit for the CCRN exam. The American Association of Critical Care Nurses advisory board sets and maintains standards for critical care nurses. The certification offered by this board is known as CCRN. Depending on the hospital and State, the RN will be required to take a certain amount of continuing education hours to stay up to date with the current technologies and changing techniques. [7]

Registration is a regulatory term for the process that occurs between the individual nurse and the state in which the nurse practices. All nurses in the US are registered as nurses without a specialty. The CCRN is an example of a post registration specialty certification in critical care. There are also variants of critical care certification test that the AACN offers to allow nurses to certify in progressive care (PCCN), cardiac medicine (CMC) and cardiac surgery (CSC). In addition, Clinical Nurse Specialists can certify in adult, neonatal and pediatric acute and critical care (CCNS). In November 2007, the AACN Certification Corporation launched the ACNPC, an advanced practice certification examination for Acute Care Nurse Practitioners .[ citation needed ] None of these certifications confer any additional practice privileges, as nursing practice is regulated by the individual's state board of nursing. These certifications are not required to work in an intensive care unit, but are encouraged by employers, as the tests for these certifications tend to be difficult to pass and require an extensive knowledge of both pathophysiology and critical care medical and nursing practices. The certification, while difficult to obtain, is looked upon by many in the field as demonstrating expertise in the field of critical care nursing, and demonstrating the individual's nurse's desire to advance their knowledge base and skill set, thereby allowing them to better care for their patients.

Intensive care nurses are also required to be comfortable with a wide variety of technology and its uses in the critical care setting. This technology includes such equipment as hemodynamic and cardiac monitoring systems, mechanical ventilator therapy, intra-aortic balloon pumps (IABP), ventricular assist devices (LVAD and RVAD), continuous renal replacement equipment (CRRT/CVVHDF), extracorporeal membrane oxygenation circuits (ECMO) and many other advanced life support devices. The training for the use of this equipment is provided through a network of in-hospital inservices, manufacturer training, and many hours of education time with experienced operators. Annual continuing education is required by most states in the U.S. and by many employers to ensure that all skills are kept up to date. Many intensive care unit management teams will send their nurses to conferences to ensure that the staff is kept up to the current state of this rapidly changing technology.

In Australia there is no compulsory prerequisite for critical care nurses to have postgraduate qualifications. However, the Australian minimum standard recommends that critical care nurses should obtain postgraduate qualifications. [8] Critical care nurses must have a bachelor of nursing, be registered with the Nursing and Midwifery Board of Australia, and meet the NMBA’s standards in order to work as a critical care nurse in Australia. [9]

Employment areas

Critical care nurses work in a variety of different areas, with a diverse patient population. There are many critical care nurses working in hospitals in intensive care units, post-operative care and high dependency units. They also work on medical evacuation and transport teams.

In August 2004, to demonstrate the work of critical care nurses Massachusetts General Hospital invited reporter Scott Allen and photographer Michelle McDonald from The Boston Globe to take part in an 'immersion experience' in the surgical intensive care unit (SICU). The Globe staffers spent eight months shadowing an experienced nurse and a trainee nurse to learn about nursing practice first hand. The result was a four-part, front-page series that ran from October 23 to 26, 2005, entitled Critical Care: The making of an ICU nurse. [10]

The added psychological stress of nursing in critical care units has been well-documented, and it has been argued the stress experienced in ICU areas are unique in the profession. [11]

Patient interaction

According to Washington, no matter their specialty, all nurses must be able to build trusting relationships with their patients. When the nurses develop strong relationships between their patients they are able to obtain important information about them that may be helpful to diagnosing them. Also, family members that become involved in this relationship make it easier for the nurses to build these trusting relationships with the patients because the family members could ease any stress that could lead the patient to be timid. When a patient has a long-term illness, the good relationships built between the nurse and patient can improve the patient's quality of life. [12]

Subspecialities

Critical care nurses can specialize in several different areas based on either the patient’s age or the illness/injury that the patient has. Geriatric patients are considered to be people over the age of 65 and nurses that specialize in geriatrics work in an adult intensive care unit (ICU). Pediatric patients are children under the age of 18, a nurse that works with very sick children would work in a pediatric intensive care unit (PICU). Finally, a child is considered a neonatal patient from the time they are born to when they leave the hospital. If a child is born with a life-threatening illness the child would be transferred to a neonatal intensive care unit (NICU). [7]

Also, the location that the CCRN works can vary. Some places that they can work most commonly include hospitals: in regular or specialized intensive care units. Uncommonly they can work at some patients’ homes, in some flight centers and outpatient facilities. [7]

The specialty areas of the critical care nurses can also be based on the patient’s illness or injury. For example, a unit that is an adult intensive care unit, specialized in the care of trauma patients would be an adult trauma intensive care unit. The focus of the unit is generally on either an adult or a pediatric/neonatal population, as the treatment methods differ for the age ranges. Another example could include an intensive care unit solely to care for patients directly before and after a major or minor surgery. [13]

Statistics

Depending on the location, critical care nurses in Australia work approximately 31.7 hours a week. In South Australia critical are nurses are recorded to work approximately 28.2 hours a week. While in the Northern Territory critical care nurses have been documented to work 31.7 hours a week. [8]

Tasmania has the largest percentage of nurses working part time with 71.8%, while the Northern Territory has the lowest with 18.4%. [8]

Salary

Critical care nurses are specialty nurses; because of this, they require more in depth and specialized training than regular RNs do. Therefore, their salaries are usually higher compared to basic RN’s because of the more intense work that they do day to day. The national average salary for a CCRN is around $78,110. However, in the top percentile salaries can reach $106,630. It all depends on the job and where they are working [14]

Critical care nurses in Australia do not need to have extra training than regular RNs do unless they have completed a postgraduate qualification. Therefore, their salaries are usually similar. Pay levels in nursing are bases on the position/level and experience. The average salary are approximately $55,617 for level 1.1, $57,841 for level 1.2, $60,155 for level 1.3, $62,561 for level 1.4, $65,063 for level 1.5, $67,666 for level 1.6, $70,373 for level 1.7, $73,187 for level 1.8, $75,488 for level 2.1, $77,028 for level 2.2, $78,600 for level 2.3 and $80,204 for level 2.4. Australian nurses receive shift loading/penalties and superannuation (approximately 10%). [15]

Related Research Articles

Intensive care medicine Medical care subspecialty, treating critically ill

Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians or intensivists.

Anesthesiology Medical specialty concerned with anesthesia and perioperative care

Anesthesiology, anaesthesiology, or anaesthesia is the medical specialty concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialized in anesthesiology is called an anesthesiologist or anaesthetist, depending on the country.

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A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as known as specialized nurseries or intensive care, has been around since the 1960s.

Pediatric nursing is part of the nursing profession, specifically revolving around the care of neonates and children up to adolescence. The word, pediatrics, comes from the Greek words 'paedia' (child) and 'iatrike' (physician). 'Paediatrics' is the British/Australian spelling, while 'pediatrics' is the American spelling.

Nurse practitioner Mid-level medical provider

A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe treatment plans. NP training covers basic disease prevention, coordination of care, and health promotion, but does not provide the depth of expertise needed to recognize more complex conditions.

Cardiac nursing is a nursing specialty that works with patients who suffer from various conditions of the cardiovascular system. Cardiac nurses help treat conditions such as unstable angina, cardiomyopathy, coronary artery disease, congestive heart failure, myocardial infarction and cardiac dysrhythmia under the direction of a cardiologist.

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Emergency nursing

Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients who require prompt medical attention to avoid long-term disability or death. In addition to addressing "true emergencies," emergency nurses increasingly care for people who are unwilling or unable to get primary medical care elsewhere and come to emergency departments for help. In fact, only a small percentage of emergency department (ED) patients have emergency conditions such as a stroke, heart attack or major trauma. Emergency nurses also tend to patients with acute alcohol and/or drug intoxication, psychiatric and behavioral problems and those who have been raped.

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Neonatal nursing

Neonatal nursing is a sub-specialty of nursing care for newborn infants up to 28 days after birth. The term neonatal comes from neo, "new", and natal, "pertaining to birth or origin". Neonatal nursing requires a high degree of skill, dedication and emotional strength as they care for newborn infants with a range of problems. These problems vary between prematurity, birth defects, infection, cardiac malformations and surgical issues. Neonatal nurses are a vital part of the neonatal care team and are required to know basic newborn resuscitation, be able to control the newborn's temperature and know how to initiate cardiopulmonary and pulse oximetry monitoring. Most neonatal nurses care for infants from the time of birth until they are discharged from the hospital.

Flight nurse Specialist in rescue/evacuation patient care

A flight nurse is a registered nurse who specialises in the field of providing comprehensive pre-hospital, emergency critical care, and hospital care to a vast scope of patients. The care of these patients is generally during aeromedical evacuation or rescue operations aboard helicopters, propeller aircraft or jet aircraft. On board a rescue aircraft you would find a flight nurse accompanied by flight medics and respiratory practitioners, as well as the option of a flight physician for comprehensive emergency and critical transport teams. The inclusion of a flight physician is more commonly seen in pediatric and neonatal transport teams. A critical care flight nurse must be able to deal with all age groups with broad critical emergencies. With no physicians on site the nurses scope of practice is expanded. The critical care experience is transferred over to a flight nurse with impacting factors such as altitude and changes in pressure, gravitational forces, and weather. Some patients may experience exacerbation's because of factors related to the cabin environment including hypoxia, limited mobility, gas expansion, and risk of injury related to turbulence and resources with definitive care are limited. Aeromedical evacuation crews coordinate with other organizations to plan for the safe and timely care and evacuation of patients. Crews must be prepared for patients suffering from trauma and mental health illnesses.

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Pediatric intensive care unit Area within a hospital specializing in the care of critically ill infants, children, and teenagers

A pediatric intensive care unit, usually abbreviated to PICU, is an area within a hospital specializing in the care of critically ill infants, children, teenagers, and young adults aged 0-21. A PICU is typically directed by one or more pediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in pediatric intensive care. The unit may also have nurse practitioners, physician assistants, physiotherapists, social workers, child life specialists, and clerks on staff, although this varies widely depending on geographic location. The ratio of professionals to patients is generally higher than in other areas of the hospital, reflecting the acuity of PICU patients and the risk of life-threatening complications. Complex technology and equipment is often in use, particularly mechanical ventilators and patient monitoring systems. Consequently, PICUs have a larger operating budget than many other departments within the hospital.

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Obstetrical nursing, also called perinatal nursing, is a nursing specialty that works with patients who are attempting to become pregnant, are currently pregnant, or have recently delivered. Obstetrical nurses help provide prenatal care and testing, care of patients experiencing pregnancy complications, care during labor and delivery, and care of patients following delivery. Obstetrical nurses work closely with obstetricians, midwives, and nurse practitioners. They also provide supervision of patient care technicians and surgical technologists.

A Critical Care Transport Nurse is a Registered Nurse specialized in care in the pre-hospital setting. These are mostly air-medical personnel or critical care transport providers with specialized training and experience in pre-hospital care. Such nurses are required by their employers to seek additional certifications beyond basic nursing licensure and are often required to have three years (minimum) of full-time experience in emergency and/or intensive care. Certifications requirements vary but often include advanced cardiac life support (ACLS), basic life support (BLS), pediatric advanced life support (PALS), neonatal resuscitation program (NRP), trauma nursing core course (TNCC), and Advanced Trauma Life Support (ATLS), in addition to Pre-Hospital Trauma Life Support (PHTLS). Standards also include being board certified in Emergency Nursing (CEN), Critical Care Nursing (CCRN), and Ground Transport (CTRN) or Flight Nursing (CFRN) respectively. In some regions these nurses are authorized to operate base station phones for medical command. Some states allow them to operate entirely under standing orders while on a ground ambulance or air medical unit. Training also includes specific education relevant to the state and its protocols, and often requires the nurse to train with paramedics for a period of time as well as taking an additional exam administered by their medical director before being allowed to operate on a ground ambulance or air medical unit. Many of these nurses hold certifications as Emergency Medical Technicians or Paramedics, and in some states are required to, but it is not the standard of practice.

A pediatric nurse practitioner (PNP) is a nurse practitioner that specializes in care to newborns, infants, toddlers, pre-schoolers, school-aged children, adolescents, and young adults. Nurse practitioners have an in-depth knowledge and experience in pediatric healthcare including well childcare, and prevention/management of common pediatric acute illnesses and chronic conditions. This care is provided to support optimal health of children within the context of their family, community, and environmental setting. In order to be a pediatric nurse practitioner one must be compassionate, resourceful, good at communicating and have good attention to detail. In the past couple decades, the job of a nurse practitioner has nearly doubled in the United States. Pediatric nurse practitioner numbers have stayed relatively the same. It is expected that the demand for the PNP's will start to increase in our society. This demand comes from children with chronic illnesses which are surviving and having diseases. PNP’s are mostly taking over offices over the physicians, but still work side by side.

Neonatal nurse practitioner

A neonatal nurse practitioner (NNP) is an advanced practice registered nurse (APRN) with at least 2 years experience as a bedside registered nurse in a level III NICU, who is prepared to practice across the continuum, providing primary, acute, chronic, and critical care to neonates, infants, and toddlers through age 2. Primarily working in neonatal intensive care unit (NICU) settings, NNPs select and perform clinically indicated advanced diagnostic and therapeutic invasive procedures. In the United States, a board certified neonatal nurse practitioner (NNP-BC) is an APRN who has acquired Graduate education at the master’s or doctoral level and has a board certification in neonatology. The National Association of Neonatal Nurse Practitioners (NANNP) is the national association that represents neonatal nurse practitioners in the United States. Certification is governed by the National Certification Corporation for Obstetrics, Gynecologic and Neonatal Nursing Specialties (NCC).

An acute care nurse practitioner (ACNP) is a registered nurse who has completed an accredited graduate-level educational program that prepares them as a nurse practitioner. This program includes supervised clinical practice to acquire advanced knowledge, skills, and abilities. This education and training qualifies them to independently: (1) perform comprehensive health assessments; (2) order and interpret the full spectrum of diagnostic tests and procedures; (3) use a differential diagnosis to reach a medical diagnosis; and (4) order, provide, and evaluate the outcomes of interventions. The purpose of the ACNP is to provide advanced nursing care across the continuum of health care services to meet the specialized physiologic and psychological needs of patients with acute, critical, and/or complex chronic health conditions. This care is continuous and comprehensive and may be provided in any setting where the patient may be found. The ACNP is a licensed independent practitioner and may autonomously provide care. Whenever appropriate, the ACNP considers formal consultation and/or collaboration involving patients, caregivers, nurses, physicians, and other members of the interprofessional team.

References

  1. ↑ "Australia's Future Health Workforce - Nurses" (PDF). www.health.gov.au. Commonwealth and all State and Territory Health Ministers. 2014. Archived from the original (PDF) on 2018-05-13. Retrieved 2016-10-25.
  2. ↑ "Critical Care Nurse." DiscoverNursing.com. Johnson & Johnson Services, 3 Jan. 2013. Web. 17 Nov. 2013.
  3. ↑ Hayes, Bronwyn; Douglas, Clint; Bonner, Ann (July 2015). "Work environment, job satisfaction, stress and burnout among haemodialysis nurses". Journal of Nursing Management. 23 (5): 588–598. doi:10.1111/jonm.12184. hdl: 10072/400102 . PMID   24372699.
  4. 1 2 Lewandowska, Katarzyna; Weisbrot, Magdalena; Cieloszyk, Aleksandra; Mędrzycka-Dąbrowska, Wioletta; Krupa, Sabina; Ozga, Dorota (November 2020). "Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment—A Systematic Review". International Journal of Environmental Research and Public Health. 17 (22): 8409. doi: 10.3390/ijerph17228409 . ISSN   1661-7827. PMC   7697990 . PMID   33202907.
  5. ↑ Lim, Sungju; Han, Kihye; Cho, Hyeonmi; Baek, Hyang (May 2019). "Shift‐work nurses' work environments and health‐promoting behaviours in relation to sleep disturbance: A cross‐sectional secondary data analysis". Journal of Clinical Nursing. 28 (9–10): 1538–1545. doi:10.1111/jocn.14769. ISSN   0962-1067. PMID   30589981.
  6. ↑ "RN Programs, Schools, Jobs and Salary". cnanursing.net. Retrieved 22 April 2018.
  7. 1 2 3 Critical Care Nurse
  8. 1 2 3 "Nursing labour force 2001". www.aihw.gov.au. Australian Institute of Health and Welfare’s National Health Labour Force Series. 2003.
  9. ↑ "Registration & Endorsement". www.nursingmidwiferyboard.gov.au. Nursing and Midwifery Board of Australia.
  10. ↑ Allen, Scott (October 23, 2005), "Critical Care: The Making of an ICU Nurse.", The Boston Globe, Boston, MA
  11. ↑ Hay, MD, Donald; Oken, MD, Donald (March–April 1972). "The Psychological Stresses of Intensive Care Unit Nursing" (PDF). Psychosomatic Medicine. 34 (2): 109–118. doi:10.1097/00006842-197203000-00004. PMID   5017099 . Retrieved 2012-02-22.
  12. ↑ GT, Washington. "Trust: A Critical Element in Critical Care Nursing." NCBI. U.S. National Library of Medicine, 1990. Web. 19 Nov. 2013.
  13. ↑ Villanova University
  14. ↑ Parker, Mike. "The Salary of a CCRN." Work. Hearst Communications, n.d. Web. 07 Nov. 2013.
  15. ↑ "Health Australian Nursing Federation Registered Nurses Midwives Enrolled (Mental Health) Enrolled Nurses Industrial Agreement 2013" (PDF). www.health.wa.gov.au. Western Australian Industrial Relations Commission. 2014.
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