Complete Guide to an ICU Nursing Career

By Katelynne Shepard, Contributor

ICU nurses, often referred to as critical care nurses, are responsible for providing nursing care to patients in the intensive care units. Because of the level of care needed, most of these patients are in hospitals, and this is the primary work environment for ICU nurses. Critical care means being able to make split-second decisions and shift quickly when a patient's status changes. Going into ICU nursing can be an especially rewarding calling and one that comes with high pay and excellent job growth outlooks.

What do ICU nurses do?

A career in ICU nursing comes with many of the same duties and responsibilities as any other kind of nursing, including monitoring patients' vital signs, administering medications per doctors' orders and keeping thorough documentation. However, critical care means that every decision and task carries a little more weight, and you must be able to take full ownership of every part of your job.

Responsibilities

ICU nursing usually carries a lower patient-to-nurse ratio, which means you'll be able to be more focused on your specific patients. However, this doesn't mean that there's any less responsibility. Here are just some of the things critical care nurses must be able to do and do well.

Putting the patient first: ICU nurses are expected to take full responsibility for their patients, which means they are in charge of everything from observing the patient to performing bandage changes and bathing. While in less serious wards nurse assistants may take on some of these tasks, critical care patients often need a more specialized level of care even for basic duties because of their overall condition.

Being able to handle the patient's family: While visitors are usually a good thing in other parts of the hospital, critical care patients are often not in good enough shape to be interacting with visitors or may tire quickly when talking. In these cases, ICU nurses must be able to be advocates for their patients while still being tactful with family members who may not understand (or accept) how sick their loved one is. The patient's well-being is the number one factor, and if visitors are causing a decline in the patient's health, the nurse must be able to take control of the situation and ask them to leave. However, this doesn't mean being harsh. The best ICU nurses are also able to show compassion and comfort family members during this time, especially if the patient passes while in their care.

Having confidence in their abilities: Like emergency nursing, critical care patients can change status quickly, and when this happens, ICU nurses must be able to take control of the situation and start providing whatever care is required without being told what to do or how to do it.

Working as part of a team: ICU units are often described by the nurses who work there as families. You must be able to work well with the other nurses on the unit as well as the doctors. This is especially important for travel nurses who don't get the benefit of developing these relationships naturally and have to be able to show up and be accepted as part of the team from day one.

Duties

ICU nurses must carefully monitor their patients' conditions because even just a slight downturn in vital signs or constitution could be grounds for a change in the treatment plan. Other duties specific to critical care nursing include:

Treating and dressing wounds
Constantly assessing the patient's condition to see if a change in the care plan is necessary
Responding to life-threatening situations
Providing emergency and acute patient care
Monitoring medical equipment to ensure it's working properly
Physically observing the patient
Helping with medical procedures
Monitoring lab results and adjusting fluids and meds accordingly
Cleaning and adjusting equipment like PIC lines and trach tubes
Educating the family on the patient's condition and requirements of care
Ordering diagnostic tests

Assignments

While almost all ICU nurses work in hospital settings, there are some critical care nurses who work in doctors' offices and walk-in clinics. ICU nurses can also work in a variety of specialized departments such as the pediatric or neonatal ICU, as well as cardiac care units. Critical care nurses often work in or in conjunction with the emergency room and surgical departments. ICU nursing often comes with long shifts (even by nursing standards), and you end up working swing shifts or picking up extra shifts as needed, especially in travel nursing.

Rewards and benefits of a career in ICU nursing

In addition to the regular benefits of nursing, a career in the ICU lets you have a firsthand role in providing life-saving care for patients every day. It often comes with more independence as nurses are expected to take on full responsibility for their patients' care and be able to handle anything that may come up.

Critical care patients are entirely dependent on their nurses for care, and this often leads to a strong relationship between the patient and the nurse and a higher job satisfaction for the nurse. ICU nurses make such a difference in their patients' lives that it's not uncommon for patients to come back after they've recovered to say thank you, which can be incredibly fulfilling.

Many nurses also enjoy the challenge of having to care for very ill patients and the variety in patient care. In one shift, you may go from helping a motor vehicle accident patient to a elderly man who's suffered a cardiac event, and every day is different. With many critical care nurses only having a few patients per shift, it also allows for more concentrated patient care.

All of this adds up to a lot of responsibility and demand on your skills, but as a critical care nurse, you'll also be well compensated for it. According to the Bureau of Labor Statistics, registered nurses made an average of $71,730 per year as of 2018. However, Payscale reports salaries up to $96,000 for critical care nurses, and travel nurses can expect to get even more — especially once you add in the other perks like a housing allowance and bonus pay.

Potential cons of working as an ICU nurse

One of the main drawbacks of working as an ICU nurse is that just because of the critical nature of the patients you're working with, you'll likely see more negative outcomes than other sectors of nursing. This can be difficult to deal with, especially when you've been caring for a patient for a while, but knowing that you did all you could to provide the best level of care and keep them comfortable can help.

Nurses in the ICU may also face higher risk of burnout due to the intense emotions and will need to practice excellent self-care. Critical care nurses learn to cope by talking with their coworkers who understand the pressures of the job and taking time away to regroup and focus on themselves. ICU nurses may need to take extra care when it comes to getting enough exercise and eating right to combat job-related stress.

While all nursing is physically demanding, a career in ICU can be even more so due to the fast-paced nature of the environment and how much time you spend on your feet. Having to turn and bathe patients who can't provide any care for themselves can be exhausting.

Outlook for ICU jobs

The overall outlook for jobs for registered nurses is very good, with job growth projected to be 15 percent from 2016 to 2026, according to the Bureau of Labor Statistics. This is categorized by the BLS as much faster than average for all occupations. This fast-paced growth is due in part to the aging population and an increased need for care, but when it comes to the ICU, critical care nurses are in even more demand because of the constantly changing technology.

Critical care relies heavily on the latest technology when it comes to diagnostics, procedures and medical equipment. The better the technology, the more patients nurses and doctors are able to save, which means very favorable job security for ICU nurses.

How to become an ICU nurse

Every ICU nurse starts as a registered nurse and must undergo the regular education and clinical requirements as well as pass the NCLEX-RN. After that, they can start working toward a career in the ICU by getting more hands-on experience and achieving certifications.

Education

To become a registered nurse, you have to complete a nursing program, which is usually either an associate's degree or a bachelor's degree in nursing. Some hospitals may also offer direct nursing programs, although this is rare. While you can take the NCLEX-RN with an associate's degree, most hospital ICUs require nurses to have a BSN. Once you have completed your degree and clinical experience, you go on to take and pass the NCLEX-RN, which shows that you have mastered the knowledge and skills required to be a successful nurse.

Nurses who want to go on to specialized areas — and boost their earning potential — may decide to pursue their master's degree in nursing or even a doctorate of nursing, which is considered the terminal degree for this field. Those with a master's degree can go onto to be ICU nurse practitioners, as well as nurse managers and nurse educators. This advanced training can also better prepare you for very specialized ICU work such as cardiac or neonatal care.

Training and work experience

ICU and critical care units don't usually employ entry-level nurses, so you'll likely end up working in another ward to gain the experience you need before working with very ill patients. However, you can take full advantage of this time by trying to get rotations in the emergency room, trauma ward and even the surgical department, all of which provide valuable skills and training for nurses wanting to go into critical care. Learning to administer IV meds as well as handle catheters, feeding tubs, vents, trach tubes and advanced wound care can help boost your resume and make you a more desirable candidate when an ICU job opens up.

Certifications

Unlike some other nursing specialties, certifications play a big role in critical care nursing, and the American Association of Critical Care Nursing provides the opportunity for nurses to get certified in the following areas:

CCRN (adult, pediatrics and neonatal): Acute and critical care nursing for those working directly with patients

CCRN-K (adult, pediatric and neonatal): Acute and critical care knowledge for those taking a managerial role in ICU nursing

CCRN-E: A focus in acute and critical care telehealth and e-medicine

PCCN: Progressive care nursing for those in direct patient care

PCCN-K: Progressive care knowledge for those in managerial roles

CMC: Acute and critical cardiac medicine care

CSC: Acute and critical care for cardiac surgery patients

ACNPC-AG: For graduate-level nurses providing acute and critical care to gerontology patients

ACCNS (adult/gerontology, pediatric and neonatal): Acute and critical wellness care for graduate-level nurses

What travel nurses need to know about ICU nursing

Travel nurses face a unique challenge when it comes to ICU nursing because they must be able to hit the ground running in an entirely new environment. While the nursing care provided may be the same, different facilities keep supplies and equipment in different places and may have different policies and procedures when it comes to calling a code or other critical care events. As a travel ICU nurse, you must be able to orient yourself to the facility and other nurses and doctors quickly and be ready to react and provide emergency care on a moment's notice. However, being a travel ICU nurse is also extremely rewarding — both when it comes to your job and your finances — and can be an excellent way to hone your skills and get more experience while potentially saving lives.

If the fast-paced environment of ICU nursing seems like a good fit for you, it may be time to take the next official step and start pursuing the critical care specialty as a career.

References

Suegnèt Scholtz, Elsabe W. Nel, Marie Poggenpoel, and Chris P. H. Myburgh. The Culture of Nurses in a Critical Care Unit

HCI College. Job Description For Critical Care Nursing.

Jiao Jiao (Melissa) Zhang. A Day in the Life of a Trauma ICU Nurse.

FORTIS. Career Choice: Typical Day for an ICU Nurse.

Bureau of Labor Statistics. Registered Nurses.

Payscale. Average Nurse, Intensive Care Unit (ICU) Hourly Pay.

Johnson and Johnson. Critical Care Nurse.

American Association of Critical Care Nurses. Get Certified.