Executive Summary
Nursing careers have been increasing over the past couple years and will continue to increase even more so with more hospitals and healthcare being needed. There will always be openings for any field in the healthcare system, especially for nurses. This report is information on the different aspects of what it's like being a Nurse in the ICU area and other information related to Nurses in the ICU. In this study as mentioned we will determine many different categories which will include the work environment in the ICU since every hospital is different so one will confront themselves with different environments, being able to monitor and evaluate patients health and care for them when needed, providing long-term emergency care when patients come in from having an accident or something more severe in which a nurse will have to react quickly in that situation. We can also see how to become a nurse in the ICU and the requirements and skills one will need in order to be part of the team , what's the pay for nurses in the ICU since there are many areas for nurses and also the different pay they receive varies from different states depending on where you live. Having opportunities for internships and being able to shadow and look hands on what the job will look like , job outlooks , similar occupations to nurses in the ICU, types of ICU since there varies from each area and the nurses health in the ICU in which we will be able to see what nurses feel like mentally when working in this type of environment and the health problems it brings towards them.
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Introduction
ICU known as Intensive Care Unit or also called Critical Care Unit, (CCU) is a special department, primarily located in a hospital or a healthcare facility that provides intensive treatment to seriously ill patients, treated by special staff. The ICU staff includes doctors, nurses, respiratory therapist, physiotherapists, clinical nurse specialist, pharmacist, speech therapist, dietitians, and other support staff. (Sutter Health 2015). To become a staff of the ICU you have to have special training and experience. Such as, doctors in the ICU unit have to complete training in intensive care medicine, or a related specialty such as anesthetics, cardiology or emergency medicine. The ICU is different from other units in the hospital because it requires close observation and monitoring over the patients. Specialized trained nurses care for one or two patients at a time during one shift. Patients are seen the ICU for various of reasons. Some have a serious head injury, a serious body infection and other acute injury, and can stay in the ICU up to two weeks based on their condition. Patients in the ICU are connected to specialized machines that monitor their heart, blood pressure, respiratory rate, and ventilators, and once a patient's health improve, they will be sent to another unit in the hospital.
Being a Nurse in the ICU
Being a nurse in the ICU takes a person with highly specialized skills. Treating patients suffering from an open wound to brain injury, one of the skills an ICU nurse must hold is technical skills. Nurses in the ICU perform surgeries that require precise, delicate procedures. One technical skill is being able to work under pressure. Some procedures performed in the ICU are done in fast manner, depending on the condition on the patient, and if the procedure needs to be done to prevent decrease in health. Having the ability to work in a fast pace and take care of the patient correctly is a valuable technical skill. Another important technical skill an ICU nurse must possess is decision making. Patients who come into the neuro- ICU are at high risk of having health complications increase at a split second. Nurses must know how to react to these certain situations and have knowledge on how to effectively assist the patients and understand what procedure must be done.
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Another skill needed in the ICU unit is the ability to focus. Patients who are in the ICU unit always in need of close monitoring on their condition, as it can change in a short amount of time. ICU nurses are constantly checking vital signs, blood pressure and response. As well nurses rely on several machine equipment. Therefore, it is important nurses in the ICU closely pay attention and have the ability to focus. Lastly, a valuable skill needed is compassion and patience. When nurses give compassion, it provides understanding to the patients that their condition and concerns are being heard, and that they will be taken care of. Compassion increases the outcome of the patient to recovering and finding peace with their situation. As well families must cope with seeing their loved one in their condition, and nurses must be patient and understanding and educate the family members of the treatment and the long-term results of the patient's condition.
Being a nurse in the ICU takes a person who is strong, dedicated to their patients, and a nurse who could work under pressure.
Critical care nurses are mostly found in hospital facilities and other trauma medical centers. Critical care nurses perform task in handling immediate support in emergency situations, provide care to patients with life threatening illness and performing daily assessment to long term patients. In the ICU nurses perform a variety of task every day.
Monitoring and Evaluating Patients Health
One of the main task an ICU nurse is remaining on top of the patient's condition. ICU Nurses monitor exact, and document detailed reports and records of the patient’s symptoms and note down any changes and report it to the physician. Assisting the patient's situation provides information to the doctors and helps interpret the level of care the patient needs.
Provide Long Term and Emergency Care
In the ICU, an emergency can happen any time, and nurses must adapt and respond quickly to the situation. Providing lifesaving care such as emergency CPR, someone having a heart attack and assisting shock to the heart, is an important task in the ICU unit. Another important task is providing long term care. ICU nurses are assigned up to two patients in one clinical rotation.
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Some of the duties in long term is assisting patients pain levels by providing medicine, changing IV bags, assisting patients to the restroom, monitoring the patient’s fluid intake and checking blood pressure, sugar levels, vital signs, heart rate, and keeping up with any other medical levels.
Working with Health care Professionals and Talking to Families
Most of the information documented from the nurses are distributed to other health care nurses and most important to the doctors. As well many nurses assist physicians in procedures such as “bronchoscopy, endoscopy, endotracheal intubation, and elective cardioversion†(Mona 2018).
Another task is talking to families. ICU nurses are also called patients advocates. Their task is informing patients in any upcoming changes in treatment medicine and informing them about their health status. As well the nurses provide support and education to the families and help with any emotional, and spiritual help to the family who may be coping.
Work Environment
In health care, nurses can work in a variety of places like nursing homes, outpatient care centers, the military and some nurses even travel to patients’ home. However, about 61% of nurses are working in a hospital environment. With one of the many important job within the hospital being the Intensive care unit.
Nurses who work in the intensive care unit work strive to create a healthy work environment to create patient satisfaction. It is important for the nurses to keep organization and implement job satisfaction to lower the degree of stress among nurses.
Nurses Health in the ICU
Being a nurse in the ICU takes a lot of work and effort. Not many can do what nurses do in the ICU and in all other areas, they are there to treat patience and make them well from the moment they enter the hospital to the moment they leave using the knowledge and training they have obtained. However, with this brings stress, pressure and other health risks that nurses can be
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affected by. Mental health problems among nurses is very high and common in many hospitals as far as leading to suicide. Some of the problems include:
• High levels of stress in their environment
• Depression
• Anxiety
• Burnout syndrome
• Post – Traumatic stress disorder
From the high levels of stress, they result from long shifts taken in the hospital as well as taking rotating shifts, dealing with patients health (having to care for them 24/7, which is their job but can sometimes become an overload to them ) or deaths (having to deal with families that have lost a loved one can sometimes express abusive behavior toward nurses, having a workload of task to complete, the relationship between hospital workers, etc. ICU nurses are exposed to traumatic events in their stressful environment and throughout their whole careers (cause every day brings in a different task so one can’t know what the day can bring only be prepared for it) which can be the cause for anxiety or depression.
How to Become an ICU Nurse
ICU nurses are registered nurses who have specialized training which prepares them to provide care to patients with life threatening illnesses, injuries or complex medical issues. Intensive care unit nurses work in specialized units; however, some use their expertise to provide educational services to patients rehabilitating from critical health problems. New graduate nurses are not usually hired directly into critical care units. Most employers require that nurses applying to work in critical care areas have a minimum of one to two years of general nursing experience prior to being considered for employment in intensive care.
Intensive care nurses are required to have certification in Advanced Cardiac Life Support. Advanced Cardiac Life Support (ACLS) training prepares nurses and other health care providers to provide emergency care to patients suffering from cardiac arrest, life threatening cardiac arrhythmias, and other medical emergencies.
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Internships
The ability for new nurses to “think critically and make appropriate clinical judgments†is extremely important. “Shadow-A-Nurse†is an ICU internship program with a goal is to integrate nurses into hospitals with some hand on experience.
Within the internships they provide salaries for the graduates during the time the students are participating, allow the graduates to “shadow†an experienced nurse in the ICU, and have an educational curriculum outside the normal classroom setting. The program was successfully evaluated with both quantitative and qualitative methods. With these results the data showed that the novice nurses that participated in this program ended with higher test scores on knowledge exams. The participants were also required to partake in recording all their experiences in a journal. This journal showed that these qualities of self-confidence and self- esteem were being built on throughout the internship.
Internships can be found by contacting nearby hospitals and asking for information on any internships that they are providing. Some of the internships come with a salary and others do not.
However, all need to be applied for on the hospitals website. The applications will provide the education level required, experience
required, and other necessary information for
any graduate to make the right choice in
Figure 1
applying for an internship that fits him or her. It is highly recommended that a graduate applies for internships because they help someone understand the depth of what nursing has to offer in the hospital. Internships are also great for applications for when you do apply for the ICU or any other nursing position, and they help gain experience in a hospital.
This graph presents the annual wages that a Registered nurse receives in the United States in 2016. Outlines the pay that nurses receive when they are a Registered Nurse while in the ICU and in other areas of the hospital.
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Pay
A nurse that works in the Intensive care unit is a Registered Nurse (RN). Therefore, the median salaries are the same of any RN that works in any part of the hospital. The average pay for an RN in 2016 was about $68, 450 a year. However, the lowest 10% of nurses earned $47, 120 and the top 10% of the nurses working in the intensive care unit earning almost $102,990.
Patients in the ICU require round-the-clock mind care. Therefore, nurses may fill in for late shifts, ends of the week, and occasions. Nurses in the ICU need to accessible always, which implies that they are on obligation to arrive on call at short notice. Because nurses receive a lot of overtime pay, along with unorganized work schedules.
Texas, California, Colorado, North Dakota, New York City, and Florida are the highest paying ICU nursing states.
The average pay for ICU nurses:
• California – $80,363
• Colorado- $71,704
• Texas – $70,201
• Florida- $68,699
• New York City – $65,980
• North Dakota- $56,990
Job Outlook
Employment of registered nurses is projected to grow 15 percent from 2016 to 2026, much faster than the average for all occupations. Growth will occur for several reasons. Demand for healthcare services will increase because of the aging population, given that older people typically have more medical problems than younger people. Nurses also will be needed to educate and care for patients with various chronic conditions, such as arthritis, dementia, diabetes, and obesity. The financial pressure on hospitals to discharge patients as soon as possible may result in more people being admitted to long-term care facilities and outpatient care centers, and greater need for healthcare at home. Job growth is expected in facilities that provide
Figure 2
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long-term rehabilitation for stroke and head injury patients, and in facilities that treat people with Alzheimer’s disease. In addition, because many older people prefer to be treated at home or in residential care facilities, registered nurses will be in demand in those settings. Growth is also expected to be faster than average in outpatient care centers, where patients do not stay overnight, such as those which provide same-day chemotherapy, rehabilitation, and surgery. In addition, an increased number of procedures, as well as more sophisticated procedures previously done only in hospitals, are being performed in ambulatory care settings and physicians’ offices.
Figure 2
This graph illustrates the
estimated supply and demand
of ICU nurses from the years
2013 to 2025. The estimated
percentage of critical care
nurses is expected to grow by
57 percent. The left side of
the column representing the
different demographic
statistics and the bottom
column representing the number of nurses. This chart will be able to give us an estimated percentage of how much of a necessity are ICU nurses in the health care setting.
Similar Occupations
As mentioned earlier surgical ICU require a big set of skills in which are similar to other fields of nursing. For example, “Emergency Room†nurses treat patients with acute problems for short periods. If and ICU nurse were to decide to move to an emergency room nurse position, then the rapid pace of ICU nursing and their mastery of technology make them ideal emergency room nurses.
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Divisions of the ICU
Within the ICU there many types of units, that focus on certain types of treatments for the different body systems. A few of the divisions are listed in detail below.
1. Cardiovascular ICU
The Cardiac surgery intensive care unit (CICU) or cardiac care unit (CCU) provides round the clock monitoring and treatment for adult patients during the critical phases of recovery. A patient will be administered to the CCU or CICU for cardiovascular surgery recovery. All Intensive care units are operational 24 hours a day, 7 days a week for treatment of the patient. Therefore, there are always nurses in the unit and on call (University of Florida Health)
Patients are admitted to CICU following cardiothoracic surgery for:
• Coronary Artery Revascularization
• Heart Valve(s) Repair or Replacement
• Surgical Repair of Congenital Cardiac Anomalies
• Cardiac Transplantation
• Lung Transplantation
• Heart-Lung Transplantation
• Thoracic Aortic Repair
Patients are admitted to CCU for the following:
• STEMI
• Congestive Heart Failure Exacerbation
• Therapeutic Hypothermia following ROSC
2. Pediatric ICU
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Pediatric Intensive care unit (PICU) is the area in the hospital where pediatrics specializes with care for critically ill/ injured children, infants and teenagers. Many of the illnesses treated include:
• multi-system trauma, (also trauma caused by abuse)
• respiratory distress/failure
• Congenital heart defects
• Complications of diabetes
• Apnea
The unit also cares for children who are recovering from any procedures that were performed on them such as cardiothoracic surgeries, brain surgeries, kidney transplants and spinal surgeries. These children require life support and/or intensive monitoring. Two physician specialists (also including neurologists, pulmonologists, oncologists and cardiologists for consultation or referrals) are on site 24 hours a day, seven days a week as well as a nurse practitioner who specializes in the ICU unit (Cook children's Hospital).
Some of the services for the ICU include:
• Level 1 pediatric intensive care unit
• Extracorporeal membrane oxygenation (ECMO)
o ECMO is available for very critically ill infants and children that are suffering lung/ heart problems and or certain birth anomalies. Extracorporeal is very similar to adult cardiac bypass procedures. The equipment used in ECMO are pumps, artificial lung, filter and blood warmer that allows blood to bypass the patient's heart and lungs. This will allow the lungs and heart to rest, heal and grow so in hopes that in time after ECMO the organs will function normally, and the child will be able to recover (Cook Children's Hospital).
• Respiratory management
• Specialty gases for respiratory support
• Level II trauma service
Figure 3
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3. Neurological ICU
Another medical divisions in the ICU, is the neuro-
intensive care. The neurological intensive care unit is
medical field that treats life threatening diseases of
the nervous system, and brain injuries. The neuro
ICU is operated by a team of “neurologists,
neurosurgeons, intensive care specialists and
anesthesiologists, highly trained nurses, respiratory
therapists, nutritional experts, and more†(Pressman
2017). All intensive neurological units hold up to 30
patients with nurses assigned up two patients a rotation for close supervision.
Compared to other intensive care units the Neuro-ICU focuses on specific disorders in patients that have:
• Traumatic brain injury
• Cerebral Hemorrhage
• Strokes
• Autoimmune disorders
• Spinal trauma
• Other central nervous system infections
Figure 4
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Figure 5
4. Surgical ICU
Surgical ICU nurses are providing care for patients with life-threatening medical conditions. These nurses work in the critical care unit of a hospital or healthcare facility and look after patients who have experienced invasive surgery. Surgical ICU nurses specialize on intensive care units. Intensive care nurses are at a high demand because they are of a more advanced practice.
As well surgical ICU nurses have smaller patient care assignments than nurses in other settings due to the severity of illness and high number of tasks extremely ill patients need performed. Surgical ICU nurses provide care to a diverse population. They care for dying patients and provide education and support to family members faced with critical decisions such as discontinuing life support and deciding how to care for people with brain injuries.
The job market for intensive care nurses is consistently excellent. With increased complexity of medical technology and need for expertise required to help seriously ill patients survive, the outlook for continued growth in the field of intensive care nursing is excellent. Increasingly complex surgical interventions are frequently being performed. The need for expert nurses to care for patients postoperatively in intensive care units is great.