Critical Care Nurse (CCN) Career Overview

What is a Critical Care Nurse?

Critical care nurses are registered nurses (RNs) with expertise in monitoring, medicating, and resuscitating patients with life-threatening illnesses or injuries. Most often found in intensive care units of hospitals, these RNs are detail-oriented, calm under pressure, and able to work as a team to care for the sickest of patients. Critical care RNs also communicate effectively with other providers to advocate for their patients. Patients and their families rely on their critical care RN to provide updates, education, and emotional support during a very challenging time in their lives.

What Does a Critical Care Nurse Do?

Critical care RNs use evidence-based practice to deliver care to patients requiring intensive medical interventions and monitoring. Critical care RNs are often only responsible for one to two patients at a time due to the amount of care these patients need. Although responsibilities will vary by unit and patient assignment, critical care RNs can expect to perform the following daily tasks:

• Completing detailed patient assessments
• Collecting vital signs, such as blood pressure
• Monitoring continuous vital signs, such as oxygenation
• Administering medications via multiple routes
• Titrating medications that patients receive continuously
• Assessing the effects of medications
• Managing invasive equipment, such as catheters and wound drains
• Utilizing machines like ventilators
• Collecting patients samples, such as blood and urine
• Creating plans of care based on nursing diagnoses
• Assisting providers with procedures
• Collaborating with respiratory therapists and other providers
• Educating patients and families on plans of care
• Resuscitating patients by performing chest compressions and other interventions
• Charting details of care and communication in the electronic medical record

Critical care RNs respond quickly and work efficiently to handle health crises. They pay great attention to detail and are able to handle complicated patient details systematically. These RNs stay calm when multiple patient monitoring alarms sound at the same time. Critical care RNs can be a source of reassurance for patients and families as they communicate honestly and openly about the seriousness of a new diagnosis or injury. These nurses also provide end-of-life care and can create a supportive environment for patients and their families.

How Much Does a Critical Care Nurse Make Per Year?

The annual median pay for RNs, including critical care nurses, was $75,330 (or just over $36 an hour) in 2020. The U.S. Bureau of Labor Statistics does not report information on each nursing specialty. Critical care nurses, like other RNs, will note that pay varies by experience, employer, and location. Critical care RNs work almost exclusively in hospitals, where the median annual pay was $76,840 in 2020. Some of the highest-paid RNs in the country work in California and reported annual salaries of over $100,000. RNs can expect higher salaries in metro areas compared to rural areas, but salaries vary widely even among metro areas in the U.S.

Citation: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Registered Nurses, at https://www.bls.gov/ooh/healthcare/registered-nurses.htm (visited January 15, 2022).

Where and When Do Critical Care Nurses Work?

Critical care RNs work in units providing the highest level of care possible, commonly called intensive care units (ICUs) or critical care units (CCUs). Some hospitals have multiple ICUs, each focusing on a specialty such as surgical, medical, cardiac, trauma, burn, neurological, pediatric, or neonatal patients. Critical care RNs often develop skills suited to one of these specialties through experience and additional training. At times, RNs will work a shift in a different ICU to compensate for changes in patient census; this is called floating. Critical care RNs are often expected to float to multiple other ICUs, taking turns with their coworkers. Other hospitals may have just one CCU, whose staff works closely with a step-down unit, which is a level of care in between critical and floor status. CCU RNs may be expected to float to the step-down unit, where they would be responsible for four patients, instead of their usual one or two.

Critical care RNs work in 12-hour shifts to increase continuity of care for patients. Fewer changes in staffing can lead to fewer errors and better patient outcomes. Shifts are usually 7 a.m. to 7 p.m. and 7 p.m. to 7 a.m. There will always be some overlap in day and night shift hours, as the offgoing nurse must give a report to the oncoming nurse. A nursing report, or handoff, is a time when a nurse systematically provides details about patients and their needs to another nurse. Critical care nurses may also find opportunities for overtime and on-call shifts, especially if they are willing to float to another unit that needs additional staff. Critical care nurses are always needed in the hospital, so scheduling options can include all days, all nights, weekends only, rotating weekends, or some combination.

How Do I Become A Critical Care Nurse?

After high school, a college student could complete either an associate’s or bachelor’s degree in nursing. A Bachelor of Science in Nursing (BSN) is becoming the industry expectation. BSN programs are usually four years long, though some schools offer accelerated programs to qualified candidates. After completing a BSN, a graduate nurse is eligible to take the NCLEX-RN examination. Passing the NCLEX certifies the student as an RN, but all RNs must apply to a state board of nursing before practicing. States vary in their requirements, but the application generally includes a fee, transcripts, and a federal background check. Once licensed, an RN is eligible to practice in the state where they are licensed.

Some employers offer critical care positions to newly graduated RNs. Others require bedside patient experience working at a less acute level of care prior to entering critical care nursing. Generally, employers require certain certifications, such as Advanced Cardiac Life Support (ACLS), either prior to being hired or within the first 6 months of employment. Employers offer additional training to critical care RNs, including classes, hands-on skills seminars, and working with a preceptor. New critical care RNs are expected to ask questions and to continue learning from their coworkers for multiple years, even once formal training is complete. Critical care RNs are also required to maintain certain certifications through continuing education seminars.

After two years of critical care nursing, an RN may be eligible to become a certified critical care registered nurse (CCRN). The CCRN exam is administered by the American Association of Critical Care Nurses. While certification is not required, it demonstrates a standardized level of knowledge and can distinguish nurses seeking further education or employment as an educator.

Many RNs who wish to practice at the highest levels of nursing care first become CCRNs. Certified registered nurse anesthetists (CRNAs,) emergency and critical care nurse practitioners (NPs), and clinical nurse specialists (CNSs) often acquire several years of ICU experience and earn CCRN certification prior to applying to their advanced practice nursing program. CCRNs have an excellent understanding of the physiology and pharmacology required for advanced practice nursing positions.

Critical care nursing can be both professionally and personally rewarding for RNs to work with patients who are severely ill. Critical care nurses are often able to observe their patients’ health improve due to their nursing care, and they provide comfort to patients and families through their education and expertise.