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CRITICAL-CARE NURSE Critical-care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. A critical-care nurse is a licensed professional nurse who is responsible for ensuring that all critically ill patients and their families receive optimal care. Although very sick and complex patients have always existed, the concept of critical care is relatively modern. As advances have been made in medicine and technology, patient care has become much more complex. To provide appropriate care, nurses needed specialized knowledge and skills, while care delivery mechanisms also needed to evolve to support patients’ needs for continuous monitoring and treatment. The first intensive care units emerged in the 1950s as a means to provide care to very sick patients who needed one-to-one care from a nurse. It was from this environment that the specialty of critical-care nursing emerged. According to the March 1996 report, “The Registered Nurse Population,” by the U.S. Department of Health and Human Services (DHHS), there are 273,850 nurses in the U.S. who care for critically ill patients in the hospital setting. Critical-care nurses account for an estimated 24 percent of the total number of nurses working in the hospital setting. Roles: 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 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. Critical-care nurses work in a wide variety of settings, filling a variety of roles. They are 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 now called upon to care for sicker patients more than ever before. Managed care has also fueled a growing demand for advanced practice nurses in the acute- and critical-care setting. Advanced practice nurses have received advanced education at the master’s or doctoral level. In the critical-care setting, they are most frequently Clinical Nurse Specialists (CNS) and Acute-Care Nurse Practitioners (ACNPs). They demonstrate a high level of independence and in many states, they are now eligible for direct financial reimbursement, just like physicians. A CNS is an expert clinician in a particular specialty—critical care in this case. The CNS is responsible for the identification and intervention of clinical problems and in the management of those problems to improve care for patients and families. They provide direct patient care, including assessing, diagnosing, planning and prescribing pharmacologic and non-pharmacologic treatment of health problems. ACNPs, in the critical-care setting, focus on making clinical decisions related to complex patient care problems encountered in the acute-care setting. Their activities include health history and risk appraisal, interpretation of diagnostic tests and providing treatment, which may include prescribing medication. Specialties: Critical-care nursing includes the sub-specialties of adult, pediatric, and neonatal nursing practice. Practice Settings: According to the March 1996 DHHS report, 60 percent of all nurses work in the hospital setting. Within the hospital setting, critical-care nurses are found wherever there are critically ill patients: intensive-care units (ICUs); 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 health, managed care organizations, nursing schools, outpatient surgery centers, clinics, and flight units. Qualifications: Critical-care nurses must have education and training beyond their basic preparation as a registered nurse (RN) to meet the needs of patients and families who are experiencing critical illness. Most critical-care nurses will complete a critical-care training course or orientation that includes essential information on the care of the critically ill patient. 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, as they tend to demonstrate a higher level of knowledge in their specialty and often have more specialty practice experience. Certified critical-care nurses (CCRNs) validate their knowledge by passing a rigorous test and by meeting extensive continuing education and clinical experience requirements. Salary Range: Critical-care nursing salaries can vary by geographical location, practice setting, and the size of the institution. Other factors that influence salary are educational level, experience, and position. The growing nursing shortage is especially acute in the specialty areas of nursing. Hospitals are offering critical-care nurses ever-more attractive incentives including generous sign-on bonuses, relocation bonuses, and reimbursement and other attractive benefits. According to a recent membership survey conducted by the American Association of Critical-Care Nurses, 50 percent of the total membership reported the following annual salary ranges: $24,999
or below
( 4%) According to a 2000 salary survey of 2,784 nurses by SpringNet.com, the average annual salary for full-time nurses is $37,980. The salaries of certified nurses were compared with those who aren't certified and results found that some 23 percent of certified nurses earn more than $50,000 per year. Only 11 percent of nurses who aren't certified in a specialty earn more than $50,000. Education: To become a registered nurse, one must either 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. The requirements vary from state to state and are 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 are provided by his or her employer. Advanced practice nurses must earn an advanced degree, either at the master’s or doctoral level. Associations: American Association of Critical-Care Nurses Society of Critical
Care Medicine Publications:
AACN Clinical Issues: Advanced Practice in Acute & Critical Care
AACN News
American Journal of Critical Care(r)
Critical Care Nurse Journal |