Becoming an ICU Nurse: Education and Career Guide

Not everyone is cut out for the intensive care unit (ICU), an area of the hospital where lives literally hang in the balance. If you can handle the pressure of working with the critically ill and injured, you’re one crucial qualification closer to __becoming an intensive care unit registered nurse (sometimes called a critical care nurse).

ICU RNs treat those patients most likely to die from life-threatening health problems. Some have experienced severe injuries; others suffer from critical illnesses. Some are dealing with complications related to surgery or genetic conditions. Every day is different in the ICU.

If you’re dreaming of a career in nursing and you have a knack for staying calm in chaotic situations, why not become an intensive care unit registered nurse?

In this article, we’ll cover:

• What makes ICU nurses special
• The educational commitment to become an intensive care unit registered nurse
• The typical advancement path for an intensive care unit registered nurse
• Certifications for intensive care unit registered nurses
• Specialties for nurses in the ICU
• Is this the right career for you?

What makes ICU nurses special?

Many people assume that ER nurses and ICU nurses practice in the same specialty area, but that’s not true. The differences between the two practices are significant.

ER nurses are trained to deal with trauma, injuries, and illness in all patients. The goal of the ER nurse is to act quickly—in both life-threatening situations and less dire ones—to stabilize patients so they can move on to their next destination (home, the ICU, radiology, etc.). ER nurses are typically not focused on patient outcomes, but rather on transitioning a patient to his next level of care.

ICU nurses, in contrast, only treat the most critical patients, who are often intubated, ventilated, and on high doses of pain medication. The goal of ICU care is always to restore wellness. Patients don’t come and go quickly; they stay in the ICU until they improve enough to recover, or until they pass on.

DailyNurse interviewed Erin Sullivan, BSN, RN, CEN, about how and why she made the transition from ER nurse to ICU nurse. She had this to say about the difference between the two specialties:

“In the ED, the goal is to assess, diagnose, and stabilize patients quickly, and then to move them out to an appropriate level of care as soon as possible. In the ICU, the goals for the patient are more long term, and you have to consider a bigger picture and a larger scope than I would in the ED. It’s a completely different way of thinking, organizing, and prioritizing patient care.”

Intensive care unit registered nurses tend to be:
Extremely detail-oriented
Organized
Not easily rattled
Good communicators
Excited to develop a rapport with their patients and their families

If that sounds like you, keep reading to learn more about what it takes to become a nurse in the critical care unit.

The educational commitment to become an intensive care unit registered nurse

The path to an intensive care unit registered nursing career begins in a degree program and concludes with the continuing education needed to maintain required certifications.

The first step in the ICU nurse career path is either earning an associate’s degree in nursing (ADN) or a bachelor’s degree in nursing (BSN). Choosing between these two paths can be tough. Earning an ASN takes about two years for full-time nursing students. It’s an attractive option for aspiring nurses who want to start working as soon as possible or who are worried about the cost of college. Most BSN programs, on the other hand, take four years for full-time students to complete and are more expensive, but BSN holders are usually much more attractive to employers. Students who have already completed an ADN can apply to RN-to-BSN programs that let working nurses earn bachelor’s degrees in less time.

Fully-accredited undergraduate nursing degree programs can be found at:

• Duke University
• Johns Hopkins University
• University of California – Irvine
• University of Massachusetts – Amherst
• University of North Carolina at Chapel Hill
• University of Pennsylvania

There’s also a third, less-common option for those who aspire to a nursing career. Some nurses choose to pursue a nursing diploma from an accredited nursing school or hospital. While these programs have been disappearing for decades, a few still remain Western Pennsylvania Hospital School of Nursing and Roxborough Memorial Hospital School of Nursing.

The biggest benefits of these programs are that students:
Do a lot more clinical work
Have access to more clinical rotations
May have an easier time finding employment because hospitals often hire new nurses out of their own diploma programs

You’ll have to decide which degree best fits your needs. The BSN is likely the best overall option for anyone who wants to become a critical care nurse, as it is generally considered the highest-level degree of the three.

After working as an intensive care unit registered nurse, you may decide to pursue a master’s degree in nursing (MSN) and become an acute care nurse practitioner (ACNP).

The typical advancement path for an intensive care unit registered nurse

No matter what specialty area of nursing you choose, becoming a licensed RN will mean passing the National Council Licensure Examination (NCLEX) exam and showing proof of your ADN, BSN, or nursing degree. In some states, you will need to renew your license every two or three years, but you won’t need to retake the NCLEX to do so.

After you pass the NCLEX, you’ll look for new graduate internship placements. In these internships, you’ll be able to assist RNs working in the ICU before looking for a job. Sometimes working in the intensive care unit will mean completing a hospital-specific training program, working with a mentor, or spending time working under the guidance of a senior ICU nurse.

Certifications for intensive care unit registered nurses

After passing the NCLEX and completing an internship, you’ll have all the credentials you need to work in the intensive care unit. That’s a good thing because you must spend at least two years working in the ICU before you can take the ICU certification exam offered by the American Association of Critical-Care Nurses (AACN) and become certified as a critical care nurse.

The Adult CCRN certification is the best broad certification for intensive care unit RNs. It’s actually for all nurses who work with critically ill or unstable patients, whether in the ICU, ER, or elsewhere. There are also many specialty certifications available depending on what types of patients you work with most often. For instance, there is a Pediatric CCRN and a Neonatal CCRN (for those who want to work in the neonatal intensive care unit), along with certifications for nurses who provide indirect care or work with cardiac patients. ICU nurses who hold master’s degrees can earn an ACNPC-AG certification from the AACN.

Note that none of the above certifications are legally required for registered nurses who want to work in the ICU. However, having specialty-specific certifications should make you a more attractive job candidate.

Specialties for nurses in the ICU

Not all intensive care unit registered nurses specialize in working with adults. There are specialties within ICU nursing that you might want to explore. These include:

• Cardiac ICU nurses
• Neurological ICU nurses
• Trauma ICU nurse
• Burn ICU nurse
• Pediatric ICU nurse

• Neonatal ICU nurse
  -Transplant ICU nurse

Is this the right career for you?

A paper from the Critical Care Nurse journal shows that effective critical care nurses must have:

Excellent communication skills
Great decision-making ability
Contribute to a good work environment

You should also enjoy working autonomously, have a sentry’s sense of impending peril, and understand and accept that you will lose patients. One of the genuine downsides of becoming an ICU nurse is that the likelihood you’ll experience the death of a patient is higher.

You might think that given the more advanced work intensive care unit nurses undertake that they’d be paid more than RNs in other specialties. Alas, that’s not really the case. According to PayScale, the average hourly salary for ICU nurses is $30.41 compared to $29.68 for registered nurses across specialties. So yes, they get paid more, but if that pay differential represents a ‘death bonus,’ then life truly is cheap. Half a buck an hour cheap, to be precise.

On the upside, you’ll also likely work with fewer patients than do other RNs, so you’ll get to know your patients’ families (and the patients, as they recover) better, which many ICU nurses consider a perk. Best of all, however, is that you’ll be a lifesaver when you become an intensive care unit registered nurse.

Questions or feedback? Email editor@noodle.com