What to Expect in Critical-Care Nursing: ICU Travel Nurses
Critical-care nursing, or intensive-care-unit (ICU) nursing, is a specialty that requires focus and stamina. ICU nurses need a solid foundation of experience to actively monitor and treat acutely ill patients with life-threatening conditions. And because of their specialized skills, ICU travel nurses are in high demand with health care employers across the country.
Total patient care part of ICU nursing
In many other nursing specialties, minor patient care such as taking vitals, turning, bathing or moving patients would be delegated to a patient care techician. ICU nurses, however, usually provide their patients with total care.
"Our patients can be physiologically unforgiving," explained Shirley Sherman, RN, MN, BC-RN, CCRN, clinical nurse director of critical care at Virginia Mason Medical Center in Seattle, Wash. "Critical-care nurses have to provide all of a patient's care because it doesn’t take much for them to be in trouble quickly. Critical care nurses need to be highly aware of everything that is going on.”
“When I worked on the floor,” Sherman continued, “I would take blood pressure and measure urine outputs and provide any other care the patients needed because that would help me know how they were responding."
Few patients but great responsibility for critical-care nurses
Because ICU patients require such constant attention, critical-care nurses are typically only caring for one or two patients at time. Sherman notes that caring for just two patients is enough to occupy your mind and your time for an entire shift.
"I’ve been a critical-care nurse since 1981 and the reason I’ve enjoyed critical care is that it has always challenged me," she reflected. “Even now, as the nurse director, I learn every day. My learning these days is less about the clinical aspects and more about leadership. What I can say about the specialty is that it requires continuous life-long learning and you don't get bored."
Sherman says that one of the challenges of working in the ICU is that most of the time the care provided is aggressive and assertive in the effort to save a patient's life, but critical-care nurses also need to be able to switch gears and provide comfort care and end-of-life care.
"Critical-care nurses can suffer from compassion fatigue," she stated. "It is difficult to give such attentive care to patients and work so hard to save their lives and then lose them. I always try to support my staff as they are supporting patients and families."
The days and nights in ICU nursing
The pace of critical-care nursing is busy, and differs little day to night.
"Here at Virginia Mason, our day starts at 7:00 in the morning with a huddle,” explained Sherman. “We talk about how things went in the prior shift and what is happening during our upcoming shift: how many surgeries we have, which patients will be moving in and out of the unit, clarify who is in charge and which patients each nurse will be working with. We then do a handoff with the night shift nurses at the bedside, face-to-face, and review orders.”
“We will be present during rounds,” she continued. “Then we have meds to give and activities to do with the patients, such as getting them up or accompanying them to tests. During the day we might also be doing patient teaching, family teaching or having a conference with the family for setting goals of care. All of this while taking vitals on one or two patients every 15 minutes or every hour, depending on the acuity of the patient."
Education and training for critical-care nurses
There are two certifications available within the critical-care nursing specialty. The first is the CCRN, certified critical-care registered nurse, provided by the American Association of Critical-Care Nurses. The certification requires initially passing a difficult exam and, every two years following, submitting proof that the nurse has completed certain accredited classes. The second certification is the CNRN, the certified neuroscience registered nurse. This certification is for nurses working with neurological, or brain-damaged, patients.
Sherman said that Virginia Mason will rarely hire new graduates as critical-care nurses.
"It is better to get a foundation with patients who aren’t so sick. Working on an acute care unit such as cardiac is excellent experience and allows a nurse to become familiar with some of the equipment and monitoring when the stakes aren't so high," she recommended.
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