What Does an Intensive Care Nurse Do and Is It Stressful?

By Dr. Stacey Malinowski  |  07/19/2024

With over 100 different specialties in nursing, it can be hard to decide what type of nursing interests you. If you like to think quickly on your feet, problem-solve with colleagues, and save lives, then working in the intensive care unit (ICU) may be for you.

You may have also heard of the term "critical care nurse." A critical care nurse is a registered nurse who focuses on providing care to patients and families facing life-threatening conditions.

Critical care nurses complete specialized training to work in a variety of settings. They can even become flight nurses. Most critical care nurses, however, work in emergency departments, trauma centers, and intensive care units.

The terms "intensive care unit" and "critical care unit" may be used interchangeably. Both terms refer to hospital units where patients have complex needs and require advanced levels of care. Nurses who work in either unit need specialized training and skills. Currently, there are over 63,000 ICU nurses in the United States.

What Is the Difference Between Intensive Care Nursing and Other Types of Nursing Care?

In a typical medical/surgical unit, a nurse may have five or six patients to care for during a single shift. Due to the complexity of nursing ICU patients, however, intensive care unit nurses will usually only care for one or two patients during their shifts.

In addition to managing patients’ care, an ICU nurse works to coordinate efforts with other healthcare professionals on an interdisciplinary team, which may include a:

• Physician
• Advanced practice registered nurse (APRN)
• Respiratory therapist
• Clinical pharmacist
• Physical therapist

ICU patients require more frequent monitoring than patients who are on a general medical floor. This work may include doing head-to-toe physical assessments every four hours, checking vital signs, and monitoring fluid volume balance on an hourly basis.

ICU nurses regularly titrate medication at the bedside to help a patient maintain homeostasis. That requires critical thinking and a solid knowledge of pharmacological principles.

Patients with life-threatening illnesses or life-threatening injuries may be too sick to perform daily living activities. In these cases, ICU nurses will provide basic care – such as bed baths and feeding – and attend to a patient's elimination needs.

What Type of Skills Do ICU Nurses Need?

In addition to basic nursing tasks, such as daily care and vital sign monitoring, most critically ill or injured patients require continuous cardiac or hemodynamic monitoring. Registered nurses who work in the ICU need to be strong observers with sharp assessment skills to treat patients effectively.

A critically ill patient’s condition can change in a matter of seconds. ICU nurses need to know how to recognize changes in their patients and respond appropriately.

There are several certifications that an ICU nurse needs to maintain, including Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS). Nurses must renew these certifications on a biannual basis.

Furthermore, ICU nurses need to be proficient in administering medication by multiple routes, as patients will frequently have central venous access or be “nil per os” ( NPO, or “nothing by mouth”) and require medications be administered via gastric tubes. Patients may also require mechanical ventilation, so it is important for ICU nurses to a strong understanding of the respiratory system as well.

Nevertheless, one of the most important skills an ICU registered nurse needs is the ability to effectively communicate. ICU nurses are the coordinators of care and provide important updates in clinical status changes to other healthcare team members, as well as to their patients’ families.

Family members who have loved ones suffering from life-threatening conditions often are very stressed out and have many questions. A critical care nurse must demonstrate patience and empathy.

ICU nurses must also communicate effectively with other nurses in the ICU, because ICU care is really a team challenge. ICU nurses need to be aware of their surroundings and be able to jump in and help a colleague who needs another set of eyes, ears, or hands.

What Types of Patients Do ICU Nurses Have?

The types of critical care patients you find in an ICU usually depends on a healthcare organization. Some large facilities may have specialized ICUs dedicated to specific needs, such as:

• Neuro Intensive Care Unit – Critical care patients in this ICU have a neurological disorder requiring constant nursing care. For instance, patients may have had a stroke, traumatic brain injuries, brain surgery, spine/neck disorders, or an altered mental status that may be from unknown causes.
• Surgical Intensive Care Unit (SICU) – A registered nurse in a SICU cares for patients who have recently had a major surgical procedure. Those patients either experienced surgical complications or simply need close post-surgery observation.
• Cardiothoracic Intensive Care Unit (CTICU) – Registered nurses in a CTICU care for ill patients who have had chest surgery to address trauma or to treat cardiovascular disease. For instance, a critical care patient may recover from open-heart surgery in a CTICU.
• Cardiac Intensive Care Unit (CICU) – CICU patients usually include people who have suffered cardiovascular emergencies such as heart attacks. A registered nurse who works in a CICU may also care for patients recovering from cardiac intervention procedures such as valve repairs or replacements. CICU patients could also include individuals who have severe heart failure or are in cardiogenic shock.
• Medical Intensive Care Unit – Medical ICUs are for patients who have not had surgery but require a high level of care for their disease processes. A patient may be admitted to a medical ICU for diabetic ketoacidosis, acute kidney injury, or sepsis, for example.

The types of ICUs within a healthcare facility will depend on the organization’s overall size and the scope of its resources. ICUs in rural areas, for instance, may not have neurosurgeons on site. Without a neurosurgeon, a facility is not equipped to handle severe emergency situations affecting the neurological system.

For patient safety, an emergency department will stabilize patients as much as possible before transferring them to the closest facilities with the most appropriate levels of care. In small organizations that just have one general ICU, ICU nurses really do need to be prepared for anything.

What Are the Hardest Parts of Being an ICU Nurse?

Being a critical care nurse is a very fulfilling experience, because it revolves around providing life-saving care to patients and families who are at their most vulnerable. Still, there are some common challenges that arise in this type of nursing career:

1. Patients don't always make it. Even when we do everything right, our critical care patient is just too sick to overcome illness. Sometimes, the death of a patient is sudden, and other times, patients and families make the decision to stop life-sustaining measures by turning off life support equipment. Either way, the death of a patient can be very difficult for both the registered nurse and the family. Critical care nurses need to remain strong and provide emotional support to the families during these difficult times.
2. Families are under a lot of stress, and not everyone handles it well. As the face of the healthcare team, an ICU nurse is typically in close contact with a patient’s family. Consequently, these registered nurses can often bear the brunt of family members’ anger and frustration, which frequently take the form of verbal abuse.
3. Conflicts in ethical/moral standards often collide with critical care. Due to the high-acuity nature of the ICU and frequent end-of-life situations, nurses may encounter situations that do not align with their personal values. This situation creates what is known as "moral distress," a phenomenon that is receiving more and more attention. In fact, studies suggest that up to 80% of critical care nurses experience moral distress at some point in their careers. Over time, moral distress can lead to decreased job satisfaction, burnout, and even physical and emotional symptoms.

What Are the Best Parts About Being an ICU Nurse?

Being an ICU nurse isn't easy, but it can also be very satisfying because:

1. You get to save lives on a regular basis. There is nothing better than starting your shift with a very unstable patient and seeing your interventions help that patient make it through the worst of an illness.
2. You get to help patients and families at the end of life. While we always hope we can help our patients, the best interventions in ICU nursing sometimes involve coordinating palliative care. In these instances, the goal is to stop ineffective treatments and instead facilitate a quality end-of-life experience for patients and their families.
3. Patient needs warrant low patient-to-nurse ratios. In ICU nursing, you normally tend to just one or two patients during each shift. As a result, an ICU nurse has the opportunity to build rapport with patients, as well as their families.
4. The experience you gain nursing critically ill patients can help you prepare for future opportunities. Some forms of specialized care require experience in critical care nursing. An ICU nursing career might pave the way to a role in flight nursing, for instance. Alternatively, an ICU nurse may wish to progress to a role as a Certified Registered Nurse Anesthetist (CRNA).

The US Healthcare Industry Needs ICU and Critical Care Nurses

With millions of patients admitted to ICUs each year in the United States, there is no denying that intensive care unit nurses are essential patient care providers in various healthcare settings. If you are interested in becoming an ICU nurse, the first step is to earn a nursing degree and obtain RN licensure. You will also need to do your homework and find healthcare organizations with ICU opportunities for new graduates.

Some organizations may have stricter requirements than others. For example, you may need to meet a minimum number of years of medical-surgical nursing experience before you can join an ICU internship or residency program.

Don't be discouraged. You will use all your patient care skills as an ICU nurse, so the more experience you have, the better.

If you are already an experienced nurse and you want to work in an ICU, talk to your nurse manager about your desire to upskill. Find out about any training opportunities your current facility may offer.

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