CAPITAL HEALTH

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
Critical care nurses 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?
Critical care nurses fi ll many roles in the critical care and 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?
Critical care nurses 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).

What makes you special?
As a nurse who specialises in critical care, you accept a wide range of responsibilities, including:

being an advocate
using sound clinical judgment
demonstrating caring practices
collaborating with a multidisciplinary team
demonstrating an understanding of cultural diversity
providing patient and family teaching.

About the Video: This program covers different aspects pertaining to critical care medicine, also commonly referred to as intensive care. In part one of this two-part program, viewers will learn about some of the common issues, treatments and complications related to intensive care. Specific topics covered include: What is critical care? Intensivists Surgical intensive care Trach tubes Respirators/ventilators ECMO (extra corporeal membrane oxygenation) Kidney dialysis Digestion support Liver dialysis What to ask when someone is in intensive care Estimating prognosis Lowering infection risk Sepsis About the Expert: Dr. Steven Johnson is the chief of surgical critical care at the University of Maryland Medical Center, including the R Adams Cowley Shock Trauma Center. Dr. Johnson is also a professor of surgery at the University of Maryland School of Medicine. Related Links: Critical Care (Part 2) www.youtube.com Dr. Steven Johnson www.umm.edu UMMC Shock Trauma Center www.umm.edu Feature Story: Improved Service for Critical Care Patients www.umm.edu Shock Trauma Patient Success Story www.umm.edu Distributed by Tubemogul.

Whenever the term critical care is mentioned – most people immediately think about severely sick patients in intensive care units or ICUs. They are not mistaken. Intensive Care Units and Critical Care specialized areas in the hospital that care for patients in need of intense and one on one attention. These are the areas where a critical care nurse Practices.

What is a Critical Care Nurse

A Critical Care Nurse or a CCN is a highly specialized nurse that has been trained to work in Critical and Intensive Care areas. Critical care nurses care for patients who are severely ill and in need of individualized care. A CCN cares for patients of all diagnoses and gender. Patients may vary depending on the category of the Critical Care Unit. Critical care nurses also deal with complex technology that helps sustain patients.

The History of Critical Care Nursing

Critical Care Nursing is a relatively new nursing specialty. It wasn’t until the 1950’s that the very first Intensive Care Units appeared in the Western world. These units were created to deal with gravely ill patients. They were considered to need a more intensive form of care compared to the patients in the regular wards. The notion of a critical care unit quickly spread. Today, most hospitals are required to have these specialized areas and in turn specialized nurses and physicians to run them.

Back then, nurses assigned in CCUs and ICUs were not seen as different from regular ward RNs. It was only a few years later that critical care nursing was considered as a specialized nursing field.

Roles of a Critical Care Nurse

Like any other registered nurse, the roles of the critical care nurse are very complex. These nurses have to deal with severely ill patients. They also need to be familiar with complex technologies that are continually present in a critical care setting. The critical care nurse also has to know basic and advance life support. Such skills may be called upon at any point during his/her service.

The critical care nurse must also be skilled in the art of diagnosis. He/she must be able to diagnose and identify a patient’s immediate needs. This part of critical care nursing is important as it may be the difference between life and death for a patient. Nonetheless, the nurse must remember that despite being skilled at diagnosis, one must not overstep her boundaries and perform roles reserved for a physician alone.

Aside from dealing with patients and their needs, the CCN also has to deal with the patient’s family. The CCN often works as a counselor that helps the family get through the crisis at hand. He/she may have to deal with questions and concerns from the patient’s immediate family and significant others.

Qualifications and Requirements

IN THE PHILIPPINES – Locally, any registered nurse can become a critical care nurse. It is only a matter of area assignment. Most of the time, nurses who are assigned in critical care units are those who have shown promise in their previous areas of exposure. They are also the ones who have worked in similar areas such as medical/surgical or pediatric units.

ABROAD – Abroad, in the US specifically, there are no specialized requirement to be a critical care nurse other than an RN License. However, there are bodies of authority that certify CCNs.

 Although, certification is not required, most CCNs abroad are choosing to go for it because it increases their credibility. Employers also often require their CCNs to be certified in the field. Certification is achieved post graduation. It is not something taught in school. Some schools may expose their students to ICUs, but this is not considered enough for certification. The RNs get their CCN certificates while they are on the job. It is also often sponsored by the employer.

Work Opportunities in the Philippine Nursing Scene

There are a lot of opportunities to become a critical care nurse in the Philippines. But, nurses have to understand that these critical care units are often hard to get into. These units only require a limited number of nurses. Most of the time there are only a total of 12 nurses that work in a typical ICU with 8–10 beds.

Those who do get into these areas are considered lucky because their position opens great opportunities to work abroad. In most settings, CCNs have a lesser work load compared to nurses in large wards. Patients in ICUs need more attention but the numbers are much smaller compared to wards. A typical government hospital ward may hold 50-70 patients and with only a nurse or two to manage it.

Work Abroad as a Critical Care Nurse

There are a lot of work opportunities for a critical care nurse abroad. The CCN can work in any area where there is an intensive or critical care unit. Certification is often an option provided by employers to deserving and promising nurses. The employers are often the ones who fund certification seminars and the likes.

With the present shortage in nursing manpower, hospitals are clamoring to get their hands on specialized nurses. These employers would often offer big sign-in bonuses just to get a nurse to work with them. The average salary of a critical care nurse in the US often ranges from USD50,000 – USD 75,000. It is estimated that nearly 70% of the critical care nurse population earn that much.  Some earn slightly lower while others earn upwards of USD90,000 to USD100,000 annually

From: http://nursingguide.ph/article_item-427/The_Ins_and_Outs_of_the_Critical_Care_Nursing_Field.html

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