About Critical Care Nursing

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ABOUT CRITICAL CARE NURSING

Definition of Critical Care Nursing

Critical care nursing is that specialty within nursing that deals specifically

with human responses to life-threatening problems. A critical care nurseis a licensed professional nurse who is responsible for ensuring that

acutely and critically ill patients and their families receive optimal care.

Definition of a Critically Ill Patient

Critically ill patients are defined as those patients who are at high risk for

actual or potential life-threatening health problems. The more critically ill

the patient is, the more likely he or she is to be highly vulnerable,

unstable and complex, thereby requiring intense and vigilant nursing

care.

Number of Critical Care Nurses in the United States

According to "The Registered Nurse Population" study conducted in March

2004 by the Department of Health and Human Services, there are

503,124 nurses in the U.S. who care for critically ill patients in a hospital

setting. Of these, 229,914 spend at least half their time in an intensive

care unit (ICU); 92,826 spend at least half their time in step-down or

transitional care units; 117,637 spend at least half their time in

emergency departments; and 62,747 spend at least half their time in

post-operative recovery. Critical care nurses account for an estimated37% of the total number of nurses who work in a hospital setting.

Where Critical Care Nurses Work

According to "The Registered Nurse Population" study, 56.2% of all

nurses work in a hospital setting, and critical care nurses work wherever

critically ill patients are found intensive care units, 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 healthcare, managed careorganizations, nursing schools, outpatient surgery centers and clinics.

What Critical Care Nurses Do

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


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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. AACN defines advocacy as

respecting and supporting the basic values, rights and beliefs of the

critically ill patient. In this role, critical care nurses:

Respect and support the right of the patient or the patient's designated

surrogate to autonomous informed decision making.

Intervene when the best interest of the patient is in question.

Help the patient obtain necessary care.

Respect the values, beliefs and rights of the patient.

Provide education and support to help the patient or the patient's

designated surrogate make decisions.

Represent the patient in accordance with the patient's choices.

Support the decisions of the patient or designated surrogate, or

transfer care to an equally qualified critical care nurse.

Intercede for patients who cannot speak for themselves in situations

that require immediate action.

Monitor and safeguard the quality of care the patient receives.

Act as a liaison between the patient, the patient's family and other

healthcare professionals.

The Roles of Critical Care NursesCritical care nurses work in a wide variety of settings, filling many roles

including 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 caring for patients who are

more ill than ever before. Managed care has also fueled a growing

demand for advanced practice nurses in the acute care setting. Advanced

practice nurses are those who have received advanced education at the

master's or doctoral level. In the critical care setting, they are mostfrequently clinical nurse specialists (CNS) or acute care nurse

practitioners (ACNP). A CNS is an expert clinician in a particular specialty

critical care in this case. The CNS is responsible for the identification,

intervention and management of clinical problems to improve care for

patients and families. They provide direct patient care, including

assessing, diagnosing, planning and prescribing pharmacological and


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nonpharmacological treatment of health problems. ACNPs in the critical

care setting focus on making clinical decisions related to complex patient

care. Their activities include risk appraisal, interpretation of diagnostic

tests and providing treatment, which may include prescribing medication.

Level of Education for Critical Care Nurses

To become a registered nurse (RN), an individual must 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. Requirements vary as

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 is provided by the employer.

Advanced practice nurses must earn a degree at the master's or doctoral

level.

Critical Care Nurse Certification

Although 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 because they have demonstrated

acquisition of a specific high level of knowledge in their specialty through

successful completion of a rigorous, psychometrically valid, job-related

examination. For example, a critical care nurse must care for critically ill

patients for a minimum of two years to be eligible for the CCRN

certification exam offered by AACN, one of many credentials theassociation offers.

Because of the availability of Medicare and managed care reimbursement

to clinical nurse specialists, a growing number of employers are requiring

advanced practice certification. Additionally, as state boards of nursing

attain statutory authority to issue advanced practice nursing licenses,

nurses are often being required to pass a nationally recognized

certification examination. Certified nurses validate their continuing

knowledge of current practices in acute/critical care nursing through a

renewal process that includes meeting continuing education and clinicalexperience requirements.

Nursing Shortage More Pronounced for Critical Care Nurses

The nursing shortage is especially acute in the specialty areas of nursing,

as noted in the skyrocketing number of requests for temporary and

traveling critical care nurses to fill staffing gaps in every part of the U.S.


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These requests are most pronounced for adult critical care units, pediatric

and neonatal ICUs and emergency departments. Recruitment advertising

for critical care nurses in AACN's publications continues to grow,

especially in the annual Career Guide. Hospitals are offering critical care

nurses ever more attractive incentives, including sign-on bonuses,relocation bonuses, and reimbursement for continuing education and

certification. In addition, many hospitals are launching critical care

orientation and internship programs, such as the Web-based Essentials of

Critical Care Orientation (ECCO) program, to attract and prepare

experienced and newly licensed nurses to work in critical care and the

Essentials of Nurse Manager Orientation program.

History of Critical Care Nursing

Although there have always been very ill and severely injured patients,

the concept of critical care is relatively modern. As advances have beenmade in medicine and technology, patient care has become more

complex. To provide appropriate care, nurses needed specialized

knowledge and skills, and the care delivery mechanisms needed to evolve

to support the patients' needs for continuous monitoring and treatment.

The first intensive care units emerged in the 1950s to provide care to

very ill patients who needed one-to-one care from a nurse. From this

environment the specialty of critical care nursing emerged.

Future of Critical Care Nursing

Rapid advances in healthcare and technology have contributed to keeping

more people out of the hospital. However, patients in critical care units

are more ill than ever. Many patients who would have been cared for in a

critical care unit five years ago are now being cared for on medical floors

or at home. Many patients in today's critical care units would not have

survived in the past. It has been proposed that hospitals of the future will

be large critical care units, and other types of care will be provided in

alternative locations or at home. Critical care nurses will need to keep

pace with the latest information and develop skills to manage new

treatment methods and technologies. As issues relating to patient care

become increasingly complex and new technologies and treatments are

introduced, critical care nurses will need to become ever more

knowledgeable.

A. General information


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1. Critical care nursing deals with human responses to life-threatening problems and

includes the critically ill patient, the critical care nurse, and the critical care

environment.

2. It is the field of nursing with a focus on the care of the critically ill or unstable patients.

3. Care is provided to patients of all ages with alterations in physical or emotional health.4. The critical care nurse coordinates interventions aimed at resolving life-threatening

problems.

5. Critical care nurses can be found working in a wide variety of environments and

specialties, such as emergency departments and the intensive care units.

B. Critically Ill Patient

1. Critically ill patients are defined as those patients who are at high risk for actual or

potential life-threatening health problems.

2. The critically ill patient is at high risk for developing life-threatening problems and

requires constant, intensive, multidisciplinary assessment and intervention to restore

stability, prevent complications, and achieve and maintain optimal responses

3. The more critically ill the patient is, the more likely he or she is to be highly vulnerable,

unstable and complex, thereby requiring intense and vigilant nursing care.

C. History of Critical Care Nursing

1. Critical care began as a component of recovery rooms before expanding into coronary

care units in the 1960s

2.The American Association of Critical-Care Nurses (AACN)was organized in 1969

3. A competency-based examination was developed in 1975 to provide certification

in critical care nursing; certification is valid for 3 years; available for adult, neonatal, and

pediatric certification

4.The AACN developed Standards for Nursing Care of the Critically Ill in 1981 to explain the

role of the critical care nurse in ensuring quality care for critically ill patients and their

families

C. Critical care environment

1. Units may be specially designated as medical, surgical, coronary, pediatric, neonatal,

recovery, or postanesthesia or may encompass other areas in some institutions

2. Adequate resources (emergency equipment, supplies, and support systems) are

necessary for safe care

3. A management and administrative structure is required to ensure effective care through

all phases of the patients hospital stay, from emergency department to discharge

4. Legal, regulatory, social, economic, and political trends must be monitored to promote the

early recognition of problems and a timely response

5. Specialized electronic technology and techniques are used to monitor patient status
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continuously; these may create safety hazards for patients, such as possible exposure to

electric shock

D. Roles of the critical care nurse

1. Care provider: provides comprehensiveand at times highly technicaldirect care to the

patient and family in response to life-threatening health problems2. Educator: provides patient and family with education based on their learning needs and

the severity of the situation and allows the patient to assume more responsibility for meeting

health care needs as health condition stabilizes or improves

3. Manager: coordinates the care provided by various health care workers to achieve the

specific goal of providing optimal nursing care to critically ill patients

4. Advocate: protects the patients rights

E. Functions of the critical care nurse

1. Assesses and implements treatment for patient responses to life-threatening health

problems

2. Provides direct measures to resuscitate, if necessary

3. Uses independent, dependent, and interdependent interventions to restore stability,

prevent complications, and achieve and maintain optimal patient responses

4. Provides health education to the patient and family

5. Supervises patient care and ancillary personnel

6. Supports patient adaptation, restores health, and preserves the patients rights, including

the right to refuse treatment

F. Legal issues affecting the provision of critical care nursing

1. Negligence

2. MALPRACTICE

3. INFORMED CONSENT

4. Implied consent

5. Advanced directives, including DURABLE POWER OF ATTORNEY and living wills

G.Qualifications of aCritical Care Nurse

1. To become a registered nurse (RN), an individual must earn a diploma in nursing, an

associates degree in nursing (ADN) or a bachelors degree in nursing (BSN) and pass a

national licensing exam.

2. Requirements vary and are dictated by each states Board ofNursing. Manynursing

schoolsoffer students exposure to critical care, but most of a critical care nurses specialty

education and orientation is provided by the employer. Advanced practice nurses must earn

a degree at the masters or doctoral level.

3. Although 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 because
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they have demonstrated acquisition of a specific high level of knowledge in their specialty

through successful completion of a rigorous, psychometrically valid, job-related

examination.

4. Certification examinations test critical care knowledge primarily at the application/analysis

level, which indicates strong critical thinking abilities.5. A required number of clinical hours in the specialty are also an examination prerequisite.

Certified nurses validate their continuing knowledge of current practices in critical care

nursingthrough a renewal process every three years, which includes meeting extensive

continuing education and clinical experience requirements.

6. Certified critical care nurses (CCRN) must have been in critical care practice for a

minimum of two years to be eligible for the examination.

Documents

About Critical Care Nursing