Critical care nursing
Encyclopedia
Critical care nursing is the field of nursing
with a focus on the utmost care of the critically ill or unstable patients. Critical care nurses can be found working in a wide variety of environments and specialties, such as emergency department
s and the intensive care units.
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.
Nurses in the US who wish to obtain certification in critical care nursing can do so through a national advisory board, known as the American Association of Critical Care Nurses. This advisory board sets and maintains standards for critical care nurses. The certification offered by this board is known as CCRN. This does not stand for 'Critical Care Registered Nurse' as is popularly believed, but is merely a certification as a critical care nurse for adult, pediatric and neonatal populations.
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 Specialist
s 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 . 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 pump
s (IABP), ventricular assist device
s (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 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–-October 26, 2005, entitled Critical Care: The making of an ICU nurse.
(or NICU, also called Nursery ICU), Pediatric Intensive Care
(or PICU), and Adult Intensive Care (or ICU). The patient population of these units is generally based on the age of the patient.
Further specialties of care can be found based on the disorder, disease or primary injury of the patient population. 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.
Nursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
with a focus on the utmost care of the critically ill or unstable patients. Critical care nurses can be found working in a wide variety of environments and specialties, such as emergency department
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
s and the intensive care units.
Training and education
Most critical care nurses in the U.S. are registered nurses. Due to the unstable nature of the patient population the LPN/LVNsLicensed Practical Nurse
Licensed practical nurse is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians. The term licensed vocational nurses is used in...
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.
Nurses in the US who wish to obtain certification in critical care nursing can do so through a national advisory board, known as the American Association of Critical Care Nurses. This advisory board sets and maintains standards for critical care nurses. The certification offered by this board is known as CCRN. This does not stand for 'Critical Care Registered Nurse' as is popularly believed, but is merely a certification as a critical care nurse for adult, pediatric and neonatal populations.
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 Specialist
Clinical nurse specialist
A clinical nurse specialist is an advanced practice registered nurse, with graduate preparation from a program that prepares CNSs. According to the APRN Consensus Model for Regulation "The CNS serves a unique APRN role in integrating care across the continuum and through three spheres of...
s 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 . 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 pump
Intra-aortic balloon pump
The Intra-aortic balloon pump ' is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery...
s (IABP), ventricular assist device
Ventricular assist device
A Ventricular assist device, or VAD, is a mechanical circulatory device that is used to partially or completely replace the function of a failing heart...
s (LVAD and RVAD), continuous renal replacement equipment (CRRT/CVVHDF), extracorporeal membrane oxygenation
Extracorporeal membrane oxygenation
In intensive care medicine, extracorporeal membrane oxygenation is an extracorporeal technique of providing both cardiac and respiratory support oxygen to patients whose heart and lungs are so severely diseased or damaged that they can no longer serve their function...
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.
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
Massachusetts General Hospital
Massachusetts General Hospital is a teaching hospital and biomedical research facility in the West End neighborhood of Boston, Massachusetts...
invited reporter Scott Allen and
photographer Michelle McDonald from The Boston Globe
The Boston Globe
The Boston Globe is an American daily newspaper based in Boston, Massachusetts. The Boston Globe has been owned by The New York Times Company since 1993...
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–-October 26, 2005, entitled Critical Care: The making of an ICU nurse.
Subspecialities
Subspecialities of critical care nursing include such areas as Neonatal Intensive CareNeonatal intensive care unit
A Neonatal Intensive Care Unit —also called a Special Care Nursery, newborn intensive care unit, intensive care nursery , and special care baby unit —is an intensive care unit specializing in the care of ill or premature newborn infants.The problem of premature and congenitally ill infants is not a...
(or NICU, also called Nursery ICU), Pediatric Intensive Care
Pediatric intensive care unit
A pediatric intensive care unit , usually abbreviated to PICU , is an area within a hospital specializing in the care of critically ill infants, children, and teenagers....
(or PICU), and Adult Intensive Care (or ICU). The patient population of these units is generally based on the age of the patient.
Further specialties of care can be found based on the disorder, disease or primary injury of the patient population. 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.