Your nursing specialty impacts your career, income, and level of happiness. Given the high stakes, choosing your specialty requires reflection and research.
One specialty many registered nurses (RNs) consider is critical care. Let’s take a closer look at this intense but rewarding area of nursing.
What is a critical care nurse?
When contemplating a move to critical care nursing, it’s helpful to first understand what this specialty is and what these nurses do.
Sarah K. Wells, MSN, RN, CEN, CNL, Clinical Practice Specialist at the American Association of Critical Care Nurses (AACN), said critical care nursing is the type of nursing care provided to patients who are seriously ill or injured.
“Critical care nursing is often associated with intensive care units (ICUs) but also occurs anywhere critically ill or injured patients receive nursing care,” she said.
Wells added that critical care nursing is provided in the following areas:
- Adult ICU
- Pediatric ICU (PICU)
- Neonatal ICU (NICU)
- Emergency department (ED)
- Cardiac catheterization (cath) lab
- Operating room (OR)
- Any location where a patient becomes critically ill or injured within the hospital or outside the hospital space
- Rapid response teams
- Critical care transport
What does a critical care nurse do?
Critical care nurses have many responsibilities, including:
- Responding to emergencies (including CPR)
- Cardiac (EKGs) and hemodynamic monitoring
- Starting IVs and phlebotomy
- Administering medications, IV fluids, and IV medications
- Vasoactive infusion titration
- Administering blood products
- Protecting airways, tracheotomy care, and ventilator care
- Central line care/management
- Providing nutrition
- Accompanying patients for procedures away from the ICU
- Patient and family education
- Charting
How to become a critical care nurse
To get hired in this specialty, it helps to have clinical experience or a preceptorship in a critical care environment, said Wells.
According to Wells, other steps nurses can take to help land a job in critical nursing are:
- Complete training and certifications in cardiovascular resuscitation care
- Learn about critical care topics and treatments
- Become a member of a professional organization like the American Association of Critical Care Nurses
New grads
New graduate nurses who want to start their careers as critical care nurses need to find either a new graduate training position in a critical care unit or a new graduate residency program that offers positions in critical care, Wells said.
One nurse who illustrates this path is Rachel Van Skike, BSN, RN. Skike graduated from nursing school in May 2023 and recently landed her first nursing role as a PICU nurse at Lucile Packard Children's Hospital Stanford in Palo Alto, California.
Prior to and during nursing school, Skike worked in acute care with adult and pediatric patients as a CNA. “I feel my experience working as a CNA helped me stand out from fellow applicants when applying to new grad positions.”
Experienced nurses
Experienced nurses who want to work in critical care can pursue cross-training or a transition into practice position in a critical care unit, described Wells.
“These opportunities provide a one-on-one preceptorship to learn the skills and knowledge needed to transition safely to critical care nursing practice,” she said.
Level of education required
According to Wells, critical care nurses are registered nurses and have a variety of educational preparations. They include:
- Associate of Science in Nursing (ASN)
- Associate Degree in Nursing (ADN)
- Bachelor of Science in Nursing (BSN)
- Master of Science in Nursing (MSN)
- Doctor of Nursing Practice (DNP)
- Doctor of Philosophy in Nursing (PhD)
When planning your educational journey, Wells said it’s helpful to research the facility requirements of each organization you wish to apply to.
Certifications needed to land your first critical care role
Wells said the two certifications required to start working in adult critical care are:
To work in pediatric critical care, you’ll also need certification in:
Other specialty critical care areas may have other required certifications, she said.
Certifications to earn once hired
Once employed, additional certifications depend on your critical care specialty area, said Wells. “Generally, all critical care nurses should plan on taking their Critical Care Nurses Certification exam issued by the AACN Certification Corporation. There is a version of the CCRN for adult, pediatric, and neonatal nurses.”
Another certification path that can be explored is earning micro-credentials. “Micro-credentials validate a focused subset of knowledge in a particular practice space,” said Wells. One example: AACN currently offers a micro-credential in Extracorporeal Membrane Oxygenation (ECMO).
Traits and skills needed to succeed
Critical care nurses work in challenging clinical environments with high-acuity patients who have evolving care needs. And according to Wells, this is why nurses must have essential skills and characteristics such as:
- Adaptability
- Curiosity
- Quick processor of information
- Love of learning
- Comfortable asking numerous questions (inquisitive)
- Strong communication skills
- Understand social determinants of health
- Provide inclusive, equitable care to diverse patient populations
- Able to work with interdisciplinary teams
Considering salary
Salaries for critical care nurses vary by organization and location. However, some states have laws requiring compensation transparency, which means companies must list salary information on job postings, said Wells.
“If you live in a state that doesn’t provide compensation transparency, you can often find salaries for your area on websites like Glassdoor,” she said.
Critical care nurse job outlook
While the current nursing shortage brings challenges, it also provides opportunities, said Wells. “The future market for critical care nurse jobs is fantastic.”
According to the U.S. Bureau of Labor Statistics, the predicted job outlook for RNs will increase 6% from 2022 to 2032.
When considering where to launch your career and whether an organization is a good fit for you, Wells said questions to ask are:
- What kind of training is available?
- Are mentors integrated into onboarding?
- Does the work environment seem healthy?
- Is the compensation package competitive?
Challenges and joys of the specialty
Seeing people lose their lives and comforting their loved ones is one of the biggest challenges of working in critical care, said Wells. “There are no words to make up for the loss of a human life.”
While there are certainly difficult aspects of this specialty, recognizing the impact you have on the lives of your patients and their loved ones is a huge positive of working in critical care, said Wells.
“Critical care nursing is an incredible career that offers personal and professional growth opportunities,” she said.
