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.