Critical care nursing

Critical care nursing involves providing medical care for patients with life-threatening health problems, such as severe trauma, heart attack, or stroke. Critical care registered nurses (RNs) are also known as intensive care unit (ICU) nurses.

Critical care nursing involves advanced skill and the ability to quickly make decisions and respond to situations. It is among the oldest of nursing specialties, having begun to develop during the 1950s. Critical care nurses may work in emergency rooms, pediatric intensive care units, burn units, and other wards, as well as in many types of facilities.

Background

The nursing profession and the care of critically ill patients have existed since ancient times. For centuries, many nurses in Europe were Roman Catholic nuns. This began to change when a number of military hospitals opened in England during the nineteenth century to treat soldiers. As a result, increased attention was focused on treating severe wounds of war.

A number of prominent individuals, including nurses Florence Nightingale and Clarissa "Clara" Harlowe Barton, advanced the profession in the United States during the nineteenth century. Nightingale famously developed better patient care during the American Civil War, while Barton founded the American Red Cross after the war. They and others drew attention to the need to train nurses in patient care, and some schools operated by and for nurses opened in the late nineteenth century. Modernization in the nursing profession began early in the twentieth century as nursing schools came under the control of hospitals, allowing trainees to gain hands-on experience. Nursing became even more important in many countries during the First and Second World Wars. British nurses served on the battlefields with British troops, and many American women who volunteered to travel overseas as nurses gained critical care experience during the war.

Critical care nursing developed quickly in the latter half of the twentieth century. Prior to 1953, hospitals did not operate units dedicated to critically ill patients. Dr. William McClenahan recognized the importance of such units, and he persuaded hospital administrators in Chestnut Hill, Pennsylvania, to create units to meet the needs of these patients. McClenahan faced a number of obstacles in his efforts. Administrators were concerned about the expense of such units. They also were unwilling to treat men and women together in the same room, because until that time, women and men were housed in different wards. He overcame these arguments and the unit, once established, performed well beyond his expectations. The success of this first ICU prompted other hospitals to open their own.

By the late 1960s, 90 percent of American hospitals with at least five hundred beds had ICUs. Advances in medical care meant that the staffs of these units had to be trained properly to work with equipment such as cardiac monitors and provide cardiopulmonary resuscitation (CPR) and other care. The high concentration of critically ill patients required medical personnel who could make quick decisions about care under pressure.

Nurses in these ICUs organized into a group, the American Association of Critical-Care Nurses (AACN), which was founded as the American Association of Cardiovascular Nurses in 1969 before changing its name two years later. This organization established standards of care, education standards, and a certification exam. The AACN Certification Corporation was established in 1975 to provide and renew certification. The first journals, including Critical Care Nurse and Advanced Critical Care, were launched during the 1980s. As of 2014, the AACN reported membership of more than one hundred thousand nurses.

Medical advances and the creation of critical care units contributed to changes in the role of nurses. A variety of specialty nurse training programs and certifications developed. Nurses took on greater roles in patient care as the late twentieth century progressed. They moved from assisting doctors to shouldering responsibility for duties previously in the control of physicians, such as performing some procedures.

Overview

Critical care nurses must be experienced registered nurses (RNs). Some facilities may have degree requirements, or seek those attaining Certified Critical Care Nurse designation, available through the American Association of Critical-Care Nurses.

Critical care nurses may be employed in emergency rooms and critical care wards, as well as in doctor offices, walk-in clinics, and other facilities. They may have a variety of duties, depending on the situation and institution where they work. Critical care nurses may assess patient conditions, treat injuries, provide life support, assist physicians, record vital signs, ensure medical equipment is functioning, administer medications, order tests, and offer education and support to families. They work closely with other members of critical care teams.

Nurses trained in critical care may specialize. For example, modern technology has provided the means to care for premature and critically ill newborns. Neonatal intensive care nurses specialize in monitoring and caring for these tiny patients, and are trained to help educate parents on assuming care as infants' conditions improve. The care nurses provide includes medical care as well as infant care, such as comforting babies and recording their progress. Other critical care nurses may work in pediatric intensive care, general intensive care, or cardiac care units, for example.

The demand for critical care nurses is generally high, although need from region to region varies considerably. An aging population in the United States as the baby boomers retire has led to greater need for medical care of all types. According to the Atlantic, the number of senior citizens in the United States is predicted to increase by 75 percent between 2010 and 2030, resulting in sixty-nine million seniors. About eighty-eight million Americans are expected to be age sixty-five or older in 2050. Older adults frequently have at least one chronic condition. A twenty-first-century shift toward providing home care to greater numbers of patients has led many in the health care industry to predict that patients treated in hospitals would be the sickest of the sick. Such a shift is expected to increase demand for critical care nurses.

Bibliography

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