Critical care involves complex assessment and intervention performed by highly skilled medical professionals who are able to function effectively under intense circumstances to save lives. Working with physicians and other medical professionals, critical care nurses care for critically ill or injured patients within the intensive care unit.
The American Association of Critical Care Nurses (AACN) notes that the term “critical care” is not included in the APRN Consensus Model, slated for adoption by many state Boards of Nursing in 2015. The AACN and the AACN Certification Corporation believe that “critical care” is inseparable from “acute care.” As such, all clinical nurse specialists under the APRN Consensus Model must be educated, evaluated, and regulated through the same acute care competencies as acute care nurse practitioners. Although the AACN’s position on the singularity of acute and critical care is accepted by many state Boards, the view that acute and critical care be maintained as distinct disciplines is still widely held among many within the medical community.
Although the term “critical care” is often interchanged with “acute care,” and both acute care nurses and critical care nurses serve patients with the most life-threatening conditions, critical care is best defined as care provided in the various ICUs and related units:
- Cardiothoracic ICU
- Oncology ICU
- Neurocare ICU
- Pediatric ICU
- Neonatal ICU
- Cardiac Catheter Labs
- Telemetry Units
Critical care nurses may also find employment in settings such as post-operative recovery rooms, emergency departments, progressive care units, and outpatient surgery centers.
A number of specialties and patient population foci are represented within ICUs, allowing advanced practice nurses to further specialize within the broader critical care specialty:
Although the duties and responsibilities of critical care nurses differ depending on their role in the ICU, in most situations they will be involved in the following:
- Assessment, implementation and coordination of complex care and interventions
- Supporting a compassionate and therapeutic environment for critically ill patients
- Providing comfort and preventing suffering
- Collaborating with patients, their families, their healthcare providers, and healthcare professionals
- Acting as patient advocates
- Arranging and overseeing continuous monitoring and nursing vigilance
- Prescribing pharmacologic and non-pharmacologic treatments
- Interpreting diagnostic tests
Education and Degree Options
Critical care nurses are advanced practice registered nurses, usually designated under the clinical nurse specialist (CNS) role. Licensure in the CNS advanced practice role, in all state’s that recognize the role, requires an unencumbered RN license, an advanced degree (master’s, post-master’s certificate, or doctorate) conferred through an accredited institution, and national certification. Most critical care nurses choose to pursue a master’s in nursing with a critical care or acute care track, as this satisfies educational requirements for certification eligibility as maintained by the major national certifying bodies.
In these programs, the advanced practice nursing core courses of advanced pathophysiology, advanced pharmacology, and advanced physical assessment, will be specific to the critical care specialty. These and other courses commonly found in MSN critical care nursing programs include:
- Management of acutely injured patients
- Applied Technology in Critical Care
- Pathophysiology of Critical Illness
- Critical Care Nursing Practice
- Research Methods for Health Practitioners
- Critical Care Nursing: Pharmacology for the Acutely Ill
- Critical Care and Emergency Nursing Assessment
Upon completion of a graduate degree, post-graduate degree, or doctorate degree with a critical care concentration, applicants can then pursue national certification. The majority of states require national certification as a condition for licensure.
The American Association of Critical Care Nurses offers the following certifications:
- Certification for Adult, Neonatal and Pediatric Acute and Critical Care Clinical Nurses Specialists (CCNS)
- Certification for Adult Acute Care Nurse Practitioners (ACNPC)
- Subspecialty Certification in Cardiac Medicine (CMC)
- Adult Tele-ICU Acute/Critical Care Nursing Certification (CCRN-E)
- Certification for Adult, Pediatric and Neonatal Critical Care Nurses (CCRN)
- Certification for Progressive Care Nurses (PCCN)
To qualify for certification applicants must meet the following requirements:
- Hold a current, unencumbered RN or APRN license
- Hold an advanced practice graduate degree in nursing with an acute and/or critical care concentration from an accredited institution
- Provide proof of curriculum in biological, behavioral, medical and nursing sciences, including pathophysiology, pharmacology, physical assessment; legal, ethical, and professional responsibilities; and supervised clinical practice relevant to the acute/critical care specialty
- Provide proof that the curriculum:
- Is consistent with competencies of acute/critical care practice
- Includes at least 500 supervised clinical hours in the applicant’s instructional track/major
- Includes supervised clinical experience that is directly related to the role of the acute/critical care CNS or NP
- Includes at least 500 hours in direct clinical practice with one patient population within the master’s program
- Includes a minimum of 2 didactic courses that are specific to the care of acutely or critically ill patients
Recertification is every 5 years, and applicants eligible for renewal must meet specific clinical practice and continuing education requirements.
Critical Care Nursing Resources
- Society of Critical Care Medicine
- American Journal of Critical Care
- Critical Care Nurse Journal
- American Association of Critical Care Nurses
- National Association of Clinical Nurse Specialists
Critical Care Salary Expectations
The Society of Critical Care Medicine published the Compensation of Critical Care Nurses Second Edition in 2009, which included a salary survey of critical care professionals. The survey reported that the average salary among CNS critical care nurses was $81,000, while CNS critical care managers or directors earned an average of $93,000 in 2009.