Nursing management of critical care unit patients

Critical care units (CCUs) – often also referred to as intensive care units (ICUs) or intensive therapy units (ITUs) – are hospital wards that provide specialist treatment and close monitoring for patients who are critically ill.

ICU patient care is challenging and diverse. Some of the most common reasons for ICU admittance include serious short-term conditions (strokes, heart attacks etc.), serious infections (severe pneumonia, sepsis etc.), serious accidents ( head injuries, burns or falls etc.), and planned or emergency care related to major surgery. Many patients in CCUs present with co-morbidity of conditions – such as metabolic syndrome – and have issues with one or more organs.

CCUs are staffed by healthcare professionals who are trained in critical care medicine, including consultants, doctors, nurses, pharmacists, radiographers and a variety of other specialists. According to the NHS website, staffing ratios of ICU nurses are usually one nurse to every one or two patients. Units also feature a range of specialist equipment – such as ventilation and monitoring apparatus, feeding tubes and IV lines.

What does critical care nursing involve?

Nurses in CCUs are trained to provide highly skilled care for injured or severely ill patients with complex, life-threatening conditions. ICU patients can deteriorate rapidly, and so CCU nurses are deeply involved in all stages of their care. They are generally the very first – and ongoing – point of contact and providers of care for patients for the duration of their hospital stay.

ICU nurses perform an integral and varied role as part of a multidisciplinary care team, providing direct, hands-on care in pre-operative and post-operative medical settings. Common ICU nursing responsibilities include:

• all physical care given to patients – for example, bedside care, administering medication, taking baseline blood samples, changing catheters, intravenous insertion and infusion, for example electrolytes or analgesia, mechanical ventilation management, and any other care detailed in the patient’s care plan
• one-on-one contact with critical care patients and family members
• constant and ongoing monitoring and assessment of patients’ conditions, including close monitoring of heart rate, blood pressure, oxygen levels and other vital signs using specialist equipment
• ordering, interpreting and evaluating diagnostic tests and results
• assisting with sedations, surgeries and other procedures
• maintaining detailed records of patient condition, care and treatment, together with systematic review of care plans and individual patient cases
• collaboration and handovers with others in the healthcare team – from clinicians to case managers – but particularly other nurses.

Essentially, their role is to nurse a patient back to health, and advocate for them, to the best of their ability – the specifics of each patients’ care and treatment will be dictated by their highly individual needs.

Are there different types of critical care nurses?

According to the latest nursing data, published by the Nursing and Midwifery Council, there are more than 731,000 registered nurses in the UK.

CCNs do not just work in Accident and Emergency (A&E) settings and ICUs – intensive care is required in any number of public and private health facilities. They are found across all areas of the healthcare system, including hospitals, coronary care units, hospices, progressive care units, outpatient clinics and nursing homes. In UK NHS Trust hospitals, CCNs tend to be Band 5 nursing roles; with further experience – and often further training opportunities – some nurses may pursue Band 6 Charge Nurse or ICU Senior Nurse roles. Depending on the position, possessing expertise in a particular specialist, such as advanced trauma nursing or paediatric care, may be required.

Job prospects are predicted to grow in critical care nursing roles related to caring for older patients with chronic illnesses.

What skills are needed in critical care nursing?

Intensive care medicine is a highly pressured, complex and fast-paced area to work in. As such, high levels of competency and clinical practice are non-negotiable.

As well as the required level of professional nursing qualification and training, depending on the type of nursing role, general competencies of CCU nurses include:

• Assessment skills: as changes in a patient’s condition can occur rapidly and without warning, nurses need to be able to spot often-subtle changes in condition and act quickly.
• Organisational skills: CCUs are highly challenging, stressful and busy environments. With many conflicting tasks, responsibilities and patient needs, nurses must be adept at prioritisation, time management and self-direction.
• Technological skills: an affinity for technology is key in units featuring specialist equipment such as ECG machines, use of IT and computer systems, and where taking measurements and making the correct adjustments is vital.
• Healthcare knowledge: nurses must have strong working healthcare knowledge in areas including, but not limited to, physiology, anatomy, health conditions and their symptoms, as well as medications – including their actions, interactions, dosage calculations, administration and side effects
• Communication skills and a professional, mature attitude: dealing with difficult, sensitive issues – such as organ donations, handling end-of-life care, decisions to limit life-prolonging interventions etc. – for both the patient and their loved ones –_is a key part of a nurse’s role. The best nurses have highly evolved communication skills; aside from the responsibilities of being a primary caregiver, they must also listen to patients, interpret their needs and communicate effectively and empathetically with all involved.

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