Categorising Critically Ill Patients by Critical Care Nurses

Critical care nursing is the delivery of specialised care to critically ill patients or patients with the potential to become critically ill – that is, those who have or are susceptible to life-threatening illnesses or injuries. Such patients may be unstable, have complex needs and require intensive and vigilant critical care nursing. The Department of Health categorises acute hospital patient care into levels from 0 to 3:

Level 0 is normal acute ward care.
Level 1 is acute ward care with the input of critical care specialists, e.g. outreach. This may be required because of recent discharge from a critical care unit or because the patient’s condition or therapy/equipment used in their care means increased intervention is needed.
Level 2 is high dependency care for patients requiring an increased level of monitoring owing to their condition or potential for deterioration or patients with single organ failure/support. Nurse to patient ratios for this level of care are usually one nurse to two patients.
Level 3 is intensive care for patients with two or more organ failure/support or requiring mechanical ventilation. Nurse to patient ratios for this level of care are usually one nurse to one patient.

Illnesses and injuries commonly seen in patients on critical care units, either separate level 2 and 3 facilities or combined units, include:

traumatic injuries from such events as road traffic accidents, falls and assaults
cardiovascular disorders, such as heart failure and acute coronary syndromes (unstable angina and myocardial infarction [MI])
elective surgeries, such as abdominal aortic aneurysm repair and carotid endarterectomy
emergency surgeries, such as bowel perforation and neurosurgery
neurological disorders, such as hypoxic brain damage and subarachnoid haemorrhage
respiratory disorders, such as acute respiratory failure and pulmonary embolism
GI and hepatic disorders, such as acute pancreatitis, acute upper GI bleeding and acute liver failure
renal disorders, such as acute and chronic renal failure
cancers, such as lung, oesophageal and gastric cancer
shock caused by hypovolaemia, sepsis and cardiogenic events (such as after MI)

Meet the critical care nurse

They are responsible for making sure that critically ill patients and members of their families receive close attention and the best care possible.

What do you do?

Fill many roles in the hospital setting, such as staff nurses, sisters, charge nurses, nurse-educators, nurse-managers, clinical nurse specialists, advanced nurse practitioners (ANPs), nurse consultants and outreach nurses.

Where do you work?

Wherever critically ill patients are found, including:

adult, paediatric and neonatal intensive care units (ICUs) and high dependency units (HDUs), or combined critical care units caring for both level 2 and level 3 patients
coronary care units
cardiothoracic/neurosurgical/burns/liver units
accident and emergency departments
postanaesthesia/postoperative care units
general wards as part of an ‘outreach’ team (providing care to patients and education to staff caring for patients with complex care needs, potential to deteriorate or recently discharged from a critical care unit).

Critical Care Nursing Career Tips

Critical care nursing is the specialty within the nursing profession that ensures the delivery of optimal care to acutely and critically ill patients. Critically ill patients are patients who are at high risk for actual or potential life threatening health problems. These patients are highly vulnerable, unstable, and have complex healthcare needs that require vigilant and intense nursing care.

These types of nurses and nurse practitioners are essential in intensive care units (ICUs), including medical, surgical, pediatric and neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments, and recovery rooms. Critical care nurses are also part of medical evacuation and transport teams.

In the United States, most critical care nurses are registered nurses; because of the unpredictable nature of the patient population, licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) rarely assume the primary care role in caring for critically ill patients.

Registered nurses can obtain certification in critical care nursing through the American Association of Critical Care Nurses (AACCN), an advisory board that sets and maintains standards for critical care nurses. This certification, known as the CCRN, describes the holder as a certified critical care nurse for adult, pediatric and neonatal patient populations.

Several subspecialties of this type of nursing can be found in units composed of similarly aged patients. These subspecialties are in the following areas:

• Neonatal Intensive Care Unit, also called Nursery ICU or NICU. The NICU’s patients are primarily newborn and premature infants who are cared for until they reach the gestational age of one month. After this period, their care will be assumed by the Pediatric Intensive Care unit.
• Pediatric Intensive Care Unit, or PICU. Here, the patients are about one month to eighteen years of age.
• Adult Intensive Care, or ICU, takes care of patients who are beyond eighteen.

There may, however, be deviations from the above setup, such as sending newborns who get admitted in the Emergency Department to the PICU, rather than the NICU. There may be rare cases where an adult patient with congenital heart disease will be admitted to the PICU, as their current treatment is a continuation of treatment they had been receiving from their physicians since they were children.

Care subspecialties may also be based on the type of disorder, disease or primary injury of the patient population. For example, the Adult Intensive Care Unit may have a specialized unit for trauma patients called the Adult Trauma Intensive Care Unit.

There is a variety of equipment used in the critical setting with which intensive care nurses need to be thoroughly familiar. These include hemodynamic and cardiac monitoring systems, mechanical ventilator therapy, intro-aortic balloon pumps, ventricular assist devices, continuous renal replacement equipment, and other advanced life support devices. All of these are at the critical care nurse’s disposal when providing medical intervention to the critically ill.

With advances in healthcare and technology, medical conditions previously described as critical can now be treated outside the critical units. Nonetheless. critical care nurses continue to keep abreast with new treatment methods and technologies in this growing profession.