Intensive Care Unit (ICU) Specialty: Medical Meaning, Salary, Etc.

ICU Medical Meaning, Nurse Salary, and More

What is the medical meaning of ICU? How can you become an ICU nurse? What is the average ICU RN salary? Discover all this and much more in this ultimate guide to the intensive care unit (ICU) nursing specialty.  

What Is the Medical Meaning of ICU? 

The term ICU stands for intensive care unit. The World Federation of Societies of Intensive and Critical Care Medicine created a task force to define the medical meaning of the term “ICU.” The following is the definition of ICU that the task force created:

“An ICU is an organized system for the provision of care to critically ill patients that provides intensive and specialized medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency.”

The task force also defined the term further by diving it into three different levels of care: 

• Level 1: A level 1 ICU can provide noninvasive monitoring, oxygen, and more intensive nursing care than other hospital areas.  
• Level 2: A level 2 ICU can provide basic life support and invasive monitoring for a short period. 
• Level 3: A level 3 ICU provides comprehensive life support technologies and monitoring, is a regional resource for patients requiring critical care, and may be involved in the development of the intensive care specialty through research and education.

To learn more about levels of care and how they are applied in acute settings, see our blog on trauma levels.

What Patients Are Admitted to the ICU?

Patients are typically admitted to the ICU when they require or are likely to require advanced respiratory support, support of two or more organ systems, or support for an acute reversible failure of another organ when one or more organ systems are already chronically impaired. 

Overall, the decision to admit a patient to the ICU is based on the potential benefit of that decision. For example, a patient with no hope of recovering might benefit more from hospice care. Similarly, a patient who does not require intensive care but is not stable enough for a general floor may benefit from a progressive care unit. See our article on PCU vs. ICU for more information.

The following factors are considered to determine a patient’s suitability for ICU admission: 

• Diagnosis
• Severity of illness
• Age
• Comorbidities
• Physiological reserve
• Prognosis
• Availability of suitable treatment
• Response to treatment to date
• Recent cardiopulmonary arrest
• Anticipated quality of life
• The patient’s wishes

Which Conditions Are Treated in the ICU?

As mentioned, patients are admitted to the ICU based on the severity of their conditions and after evaluating numerous factors. One of those factors is the patient’s diagnosis. Regarding patient diagnosis, the following are health conditions that are often treated in the ICU:

• Acute kidney injury
• Acute liver failure
• Acute respiratory failure
• Acute respiratory distress syndrome (ARDS)
• Cardiogenic shock
• Cerebral vasospasm and edema
• Congenital metabolic disorder
• Drug overdose
• HER2-positive breast cancer and estrogen receptor-positive breast cancer 
• Heart failure
• Influenza (flu)
• Intracranial hemorrhage
• Metabolic disorder
• Multiple organ failure
• Pneumonia
• Post-intensive care syndrome (PICS)
• Pulmonary embolism and fibrosis
• Sepsis and sepsis shock
• Stroke

How Is Vasospasm Managed in the ICU?

A study published in the National Library of Medicine states that angioplasty is the most efficient endovascular treatment of cerebral vasospasm. Complications of cerebral vasospasm include arterial rupture, arterial dissection, or thromboembolism. Since the time window to perform a therapeutic angioplasty is small, prophylactic angioplasty is proposed to limit the consequence of delayed treatment. According to the study, one trial found that fewer patients tended to develop vasospasm after treatment with prophylactic balloon angioplasty. A statistically significant decreased need for therapeutic angioplasty was also found. Another treatment option is the arterial infusion of vasodilators, such as Milrinone. 

What Does the Care of a Stroke Patient Look Like in the ICU?

A study on ICU management and outcomes of stroke patients found the following results:

• Of the patients who required endotracheal intubation, 98 percent were intubated on the first ICU day. 
• Approximately 25 percent of patients received acute-phase stroke therapy, of which 75.3 percent had intracerebral hemorrhage and 24.7 percent had ischemic stroke. 
• Approximately 2 percent of patients developed acute respiratory distress syndrome, and 1.5 percent developed septic shock. 
• About two-thirds of patients developed stroke-related complications during their ICU stay, including intracranial hypertension and hydrocephalus. 
• Among the patients who decided to limit life-sustaining treatments, the median time from ICU admission to the decision was three days. Hospital mortality was 87.1 percent in patients with and 45.2 percent in patients without treatment-limitation decisions.

Treating Sepsis in the ICU

Sepsis is a life-threatening organ dysfunction due to dysregulated host response to infection. Septic shock occurs in some patients with sepsis and involves an underlying circulatory and cellular/metabolic abnormality that is associated with increased mortality. 

Not all cases of sepsis require ICU admission. However, approximately 30 percent of patients admitted to the ICU have sepsis during their stay. Infection leading to sepsis is a major concern and cause of death in the ICU. The following are guiding principles for the treatment of patients with septic shock: 

• Initiate the proper dosage and spectrum of antibiotic therapy as early as possible.
• Identify the source of infection and treat the patient with antimicrobial therapy, surgery, or both (source control).
• Resuscitate the patient, using supportive measures to correct hypoxia, hypotension, and impaired tissue oxygenation (hypoperfusion).
• Maintain adequate organ system function by maintaining blood flow and arterial pressure and interrupt the progression to multiple organ dysfunction syndrome (MODS) through antibiotics and surgical debridement.

Which Healthcare Professionals Work in the ICU?

Due to ICU patients’ complex and critical conditions, patient care is provided by a specialized multidisciplinary team. An ICU healthcare team typically includes the following professionals: 

• Resident physicians
• Physician assistants (PAs)
• Nurse practitioners (NPs)
• Respiratory therapists (RTs)
• Vascular access specialists
• Physical therapists (PTs) 
• Occupational therapists (OTs)
• Speech language pathologists (SLPs)
• Nurses and nursing assistants

Critical care medicine specialists (intensivists) also collaborate with physicians from other specialties, including anesthesiology, pulmonary medicine, cardiovascular medicine, cardiovascular surgery, neurosurgery, neurology, nephrology, pediatrics, surgery, and transplant medicine.

What Does an ICU Nurse Do?

ICU nurses’ duties and responsibilities vary depending on numerous factors, such as their experience and level of licensure. With this differentiation in mind, here are the typical responsibilities of registered nurses (RNs) working in the ICU:

• Perform head-to-toe assessments on pediatric, geriatric, and general adult patient populations.
• Assess pain and apply pain management techniques.
• Educate the patient and family regarding pain management.
• Assess the effectiveness of and revise the nursing care plan daily based on the patient's responses to treatment.
• Perform glucometer testing (point-of-care testing).
• Interpret results of laboratory tests and notify providers.
• Perform care responsibilities appropriate for a patient’s age.
• Administer medications, perform treatments, and provide services within the scope of practice and competency level.
• Assist physicians with procedures.
• Interact with patients and family members, involving them in the care plan. 
• Consult other departments as needed to provide an interdisciplinary approach to the patient’s needs.
• Coordinate and supervise patient care as necessary.
• Attend scheduled ICU rounds and other meetings.
• Communicate effectively with the ICU manager, supervisor, physicians, and co-workers.
• Maintain a good working relationship both within the department and with other departments.
• Manage and operate equipment safely and correctly.
• Document care and take accurate nursing notes.
• Identify and address the psychosocial needs of patients and family members, communicating with case management and other departments as needed.

What Do CNAs Do in the ICU?

As with nurse duties, many responsibilities of certified nursing assistants (CNAs) are the same regardless of the setting. Under nurse supervision, CNAs assist patients with activities of daily living (ADLs), provide basic nursing care to patients, and help maintain a safe and clean environment. They also communicate with patients, family members, and the rest of the interdisciplinary team to coordinate care.

Aside from these everyday nursing assistant tasks, CNAs in ICUs may also have the following duties:  

• Assist nurses by emptying drains and suction containers.
• Stock room and unit with supplies.
• Prepare exam rooms for provider evaluation of patients. 
• Assist with data collection for nursing history and physical status (vital signs, height, weight, blood sugar results, functional status) and communicate changes promptly to the supervising nurse.
• Record findings and results in patients’ documents and electronic medical records (EMRs).
• Monitor the patient's functional status and report findings to the supervising nurse.

What Do Nurse Practitioners (NPs) Do in the ICU?

Nurse practitioners must always work within their scope of practice, which may vary from state to state. For example, the level of autonomy that nurse practitioners are permitted and whether they can prescribe medications depends on their state of practice. Allowing for variations from state to state and one hospital to another, the following are typical duties for NPs working in the ICU: 

• Provide direct clinical services for critically ill neonates, pediatric, or adult patients with multi-organ trauma or multi-system failure, using evidence-based clinical practice standards in collaboration with the supervising physician.
• Obtain and document patient health histories and complete physical examinations, noting normal and abnormal findings.
• Order and interpret diagnostic and laboratory tests as needed, explaining the need for, preparation for, and anticipated effects of procedures to patients, family members, other staff, and healthcare learners.
• Perform approved diagnostic or therapeutic procedures based on a patient's clinical status.
• Formulate and implement treatment plans for the management of acute illness in collaboration with the designated primary supervising physician or the attending backup physician.
• Assess patients for change in status and make appropriate interventions, including emergency interventions to stabilize patients.
• Provide family-centered care by communicating with the family regarding the changing healthcare needs of their infant, child, or family member and assess the family’s adaptation, coping skills, and need for crisis or other intervention.
• Perform and participate in quality/performance improvement activities and clinical research.
• Participate in and support the organization’s accreditation, compliance, and regulatory activities.
• Identify families’ educational needs and participate in teaching opportunities.
• Assess educational needs, plan, provide, and evaluate educational programs for nursing staff, interdisciplinary healthcare teams, and the community, including precepting other healthcare team members and healthcare learners.

Patient-to-Nurse Staffing Ratios in the ICU

RN-to-patient staffing ratios vary by state. However, intensive care units have among the lowest patient-to-nurse ratios. For example, Oregon and California have passed legislation requiring nurses in intensive care units to care for no more than two patients at a time. Additionally, in Massachusetts, nurses in intensive care units may only care for one or two patients at a time, depending on the patient’s stability. Although most states don’t stipulate mandatory staffing ratios, the acuity level of patients in ICUs demands that patient-to-nurse ratios remain low.

Guidelines for CNA-to-patient staffing ratios also vary by state and facility. Although there are no generalized guidelines for CNA staffing ratios in the ICU, due to patients’ critical conditions, ratios are much lower in these settings than, for example, in long-term care facilities.

Regarding nurse practitioner-to-patient staffing ratios in the ICU, a study published in the American Journal of Critical Care (AJCC) found that the average ratio for NPs and PAs is one provider to five patients. In pediatric ICUs, the average ratio is one to four. In critical care settings integrating fellows and medical residents, NP or PA provider-to-patient ratios average one to four.

Numerous factors impact patient-to-provider ratios, including the severity of the patients’ conditions and the number of patients and providers in the unit. Other factors include patient diagnosis, the number of physicians in the unit, time of day, and the number of fellows and medical residents on service.

What Are the Requirements to Work in the ICU as a Nurse?

The following are typical requirements for ICU RN positions:

• Education: Regarding educational requirements, hospitals may require or prefer that RNs complete Bachelor of Science in Nursing (BSN) or Master of Science in Nursing (MSN) degrees. In some cases, facilities may hire RNs with Associate Degrees in Nursing (ADNs), and some may require that they pursue higher education within a given time frame. 
• Licensure: To work in an ICU, a registered nurse must have an active nursing license valid for work in the state of nursing practice. This can include a multistate license if the state is part of the Nursing Licensure Compact (NLC). 
• Certification: A Basic Life Support (BLS) certification is typically required for any nursing role. Furthermore, nurses may be expected to complete Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) certifications upon hire if they don’t already have them.
• Experience: Although hospitals prefer candidates with ICU experience, it typically is not required. Requirements often include one or two years of acute care experience, such as in medical-surgical (med-surg), step-down, or telemetry. That said, hospitals are increasingly open to hiring and training new grad RNs for the ICU.

Nurse practitioners must meet all the previous requirements plus the following:

• Education: After completing a BSN program and obtaining RN licensure, an aspiring NP must complete an MSN nurse practitioner program.
• Licensure: Candidates must pass the board certification exam for their chosen program to obtain their NP licenses. 
• Certification: ICU positions may require NPs to be certified in acute care.
• Experience: ICU positions for nurse practitioners may require up to four years of critical care experience.

Required Skills, Knowledge, and Abilities for ICU Nurses

In addition to the mentioned requirements, nurses must demonstrate the following skills, knowledge, and abilities to meet the demands of working in an ICU: 

• Computer skills, such as the ability to use electronic mail and EMR systems
• Efficient oral and written communication and listening skills
• Ability to maintain positive, professional relationships with patients, team members, and physicians
• Ability to work confidently and efficiently under pressure and in ever-changing situations
• Ability to work autonomously and as part of a team, demonstrating coordination, collaboration, delegation, and team-building skills
• Excellent organization, prioritization, critical thinking, and problem-solving skills
• Time management skills, as well as the ability to prioritize tasks and multi-task amid frequent interruptions

Typical Physical Requirements for ICU Nurses

Working in the ICU demands not only education, experience, knowledge, and skills but also physical strength and abilities. The following are typical physical requirements for nurses working in the ICU: 

• Ability to sit, stand, walk, lift, squat, bend, reach above shoulders, and twist frequently throughout the workday
• Ability to lift up to 50 lbs. from floor to waist, lift up to 20 lbs. over the head, carry up to 40 lbs. a reasonable distance, and push/pull with 30 lbs. of force
• Ability to perform a sliding transfer of 150 lbs. with assistance
• Ability to speak, see, hear, and touch
• Fine hand manipulation skills for IV insertion and other procedures/functions

What Are Requirements to Work in the ICU as a CNA?

Hospitals typically require CNAs to meet the following criteria to work in ICUs:

• Hold a high school diploma or equivalent
• Complete a CNA program and obtain certification/license if required in the state of practice
• Have a BLS certification 

Regarding experience, some ICUs may accept CNAs without experience, whereas others may require at least a year of experience in an acute care setting. Additionally, some hospitals may require CNAs to complete training upon hire, including basic dysrhythmia or certified telemetry courses.

How Long Does It Take to Become an ICU Nurse?

Naturally, the pathway and time nursing professionals take to enter the ICU vary. 

• CNAs may be able to work in an ICU in as little as four weeks or less depending on the facility and its policies.
• RNs can begin working in the ICU straight out of nursing school, which typically takes two to four years. Some hospitals may require two years of acute care experience and/or a BSN if they hire a nurse in-house for an ICU position. PRN ICU nurses with experience can request shifts on Nursa and the hospital can decide whether to schedule them. Typically, only a valid RN license and ICU experience is required when picking up shifts.
• To become intensive care nurse practitioners, aspiring NPs must complete a BSN and an MSN, pass the board certification exam for their chosen program, and obtain NP licenses. Therefore, becoming an intensive care NP takes at least six to eight years.

Certifications for ICU Nurses 

In addition to the basic credentials that many ICUs require nurses to maintain, such as BLS, ACLS, and PALS, nurses can pursue many specialized certifications to increase their knowledge and skills and become more competitive in the nursing market.

ICU Certifications for Registered Nurses

The American Association of Critical-Care Nurses (AACCN) offers three direct care pathway certifications for critical care registered nurses (CCRNs) based on the patient population they work with:

1. Adult
2. Pediatric
3. Neonatal

Although some ICU nurses, such as neonatal intensive care unit (NICU) nurses, work exclusively with one of these populations, many care for patients of all ages. 

Besides holding a current, unencumbered RN or advanced practice registered nurse (APRN) license in the US, here are the eligibility requirements for obtaining a CCRN certification:

• Two-year option: Applicants must have practiced as RNs or APRNs for 1,750 hours in the direct care of acutely/critically ill patients (adult, pediatric, or neonatal, depending on the specific certification) during the preceding two years, accruing 875 of those hours in the most recent year before application.
• Five-year option: Applicants must have practiced as RNs or APRNs during the previous five years with at least 2,000 hours in the direct care of acutely/critically ill patients (adult, pediatric, or neonatal, depending on the specific certification), accruing 144 of those hours in the most recent year preceding application.

In addition to these direct care pathways, the AACCN offers three knowledge professional pathway certifications for critical care nurses working with the same three patient populations:

1. Adult
2. Pediatric
3. Neonatal

These certifications are for nurses who influence the care delivered to acutely/critically ill patients but whose primary role does not involve direct care.

Besides holding a current, unencumbered RN or APRN license from the United States, these are the eligibility requirements for obtaining a CCRN certification (Knowledge Professional Eligibility Pathway):

• Candidates must have practiced as RNs or APRNs for 1,040 hours during the previous two years, with 260 of those hours accrued in the most recent year preceding application. Practice hours for this pathway are those in which the applicants apply knowledge in a way that influences patients, nurses, or organizations to positively impact the care delivered to acutely/critically ill patients (adult, pediatric, or neonatal, depending on the specific certification) and families.

ICU Certifications for Nurse Practitioners

For acute care nurse practitioners (ACNPs), the AACCN offers the ACNPC-AG®. AG stands for adult gerontology. This certification is for nurses educated at the graduate level to provide continuous and comprehensive advanced nursing care to acutely ill adult-gerontology patients (young adults, older adults, and frail elderly) experiencing episodic illness, exacerbation of chronic illness, or terminal illness.

In addition to holding current, unencumbered US RN or APRN licenses, candidates must complete graduate-level advanced practice education programs as adult-gerontology ACNPs at nationally accredited nursing schools. The school’s curriculum must include supervised clinical and didactic coursework consistent with competencies of adult-gerontology ACNP practice.

Additionally, the American Nurses Association offers the Acute Care Nurse Practitioner Certification (ACNP-BC™). However, this certification is only available for renewal. 

What Is the Average ICU Nurse Salary?

Nurse compensation depends on several factors, including type of license, location (city/state), and specific hospital or other work setting. According to the most recent data from the U.S. Bureau of Labor Statistics, the following are the average national wages for nursing professionals working in general medical and surgical hospitals:

• Certified nursing assistants: $40,840
• Licensed practical/vocational nurses: $55,380
• Registered nurses: $96,830
• Nurse practitioners: $135,610

What Is the Highest-Paid ICU Nurse?

As is evident from the previous average wages, the higher the level of licensure, the higher the pay. Therefore, nurse practitioners are the highest-paid ICU nurses. In fact, the critical care nurse practitioner specialization is one of the top 10 highest-paying nurse specialties. 

Is ICU Nursing Difficult?

There are many ways to assess the difficulty of a nursing role. Difficult can be a synonym for challenging, an aspect nurses may view as positive since nurses who feel challenged can gain more knowledge and experience. However, difficulty can also be a synonym for stress, which may lead to nurse burnout. ICU nursing is certainly challenging since nurses care for patients with complex critical conditions, but is it more stressful than other nursing roles?

A study compared the frequency and sources of work-related stress among ICU, med-surg, and hospice nurses and found no significant difference in stress frequency among the three groups. However, the causes of stress varied.

• ICU and hospice nurses perceived significantly more stress than medical-surgical nurses related to death and dying.
• ICU and medical-surgical nurses perceived significantly more stress than hospice nurses related to floating.
• Medical-surgical nurses perceived significantly more stress than ICU and hospice nurses regarding work overload/staffing. 

In summary, ICU nursing is generally not more stressful overall than other nursing positions. Significant causes of work-related stress for ICU nurses include patient deaths and floating. Workload and staffing are not significant sources of stress for ICU nurses.

Is ICU Nursing Right for You?

Nursing is a field with nearly endless career options. There are numerous educational pathways, levels of licensure, specialty certifications, work settings, and patient populations. Not only do nurses have multiple options upon graduating from nursing school, but they can also change career paths as they go. 

A new grad nurse may start their career in a nursing home and then transition into acute care. In a hospital setting, a nurse may begin in the med-surg unit and then work in the emergency room (ER), the operating room (OR), or the ICU. They may decide to switch again and end up travel nursing or working PRN. Again, the opportunities are nearly limitless. 

Do you think the ICU is right for you? If so, what’s stopping you? 

Do you already have ICU experience? Then, pick up PRN ICU RN jobs on your own terms with Nursa.

Sources:

• National Library of Medicine: What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine
• National Library of Medicine: ABC of intensive care: Criteria for admission