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Nursing:
doi: 10.1097/01.NURSE.0000387064.52873.08
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Are you ready to move into critical care?

Cottrell, Damon RN, APRN-BC, CCNS, CCRN, CEN, MS; Kendall, Stephanie M. RN, CCRN, BSN

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Damon Cottrell is assistant professor at the University of New England in Portland, Me., and Stephanie M. Kendall is a clinical care facilitator in the coronary care unit at the Washington Hospital Center in Washington, D.C.

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Abstract

Discover whether this highly valued specialty is your calling.

IF CRITICAL CARE NURSING intrigues you, consider what a day in your life might entail: As you enter the critical care unit, you see that it's going to be a busy day. You receive report about the patient you'll take care of today, Mrs. Walker, who's intubated, sedated, and surrounded by a tower of I.V. infusion pumps and other equipment.

After your initial assessment shows that Mrs. Walker is stable, you bring her anxious family to the bedside. Recognizing that the family is also your patient, you answer questions and provide information to reassure them while you continue to perform your assessment and provide care. You also ask a chaplain to visit to help tend to their spiritual and emotional needs.

In the blink of an eye, it's 9:00 a.m. and the healthcare provider team is expecting you to join them for multidisciplinary rounds. The team greatly values your assessment of the patient's status, and your opinion is crucial for developing a plan of care.

As the day progresses, many of your suggestions for Mrs. Walker are implemented, and you continue to see improvement. Eight hours into your shift, she's made so much progress that you can discontinue some of her medications. Keeping the family informed and providing a chaplain have helped to relieve many of their fears.

As your 12-hour shift winds down, Mrs. Walker continues to show clear clinical evidence of improvement. You begin to plan your report to the night shift, feeling a strong sense of accomplishment.

If this account of critical care nursing has piqued your interest, read on to find out how you can become a critical care nurse.

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Is it for you?

To move into this field, you'll need a strong desire to care for acute and critically ill patients, specialized education that includes skilled precepting and mentoring, and support systems within the clinical environment.

The American Association of Critical-Care Nurses (AACN) has a conceptual model that outlines competencies that are considered essential and reflect knowledge, skill, experience, and attitude needed when caring for acute and critically ill patients.1 This synergy model indicates that when patient and family characteristics are matched appropriately with nurse competencies, synergy occurs.

Taking care of critically ill patients is a huge but rewarding challenge. To take it on, you should be a detail-oriented person who can stay calm in an emergency and manage complex patient situations and patient care equipment. Along with these challenges, you must be prepared to care for patients in crisis, educate family members, and use excellent communication skills for interdisciplinary collaboration and patient care.

If you think you have the qualities needed for critical care nursing, make sure you possess the necessary clinical skills and knowledge.

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Getting up to speed

Many hospitals have residency or internship programs designed to prepare nurses for a career in critical care. Speak with nurse recruiters at hospitals that interest you.

Although some are longer, most programs take 12 to 16 weeks. These programs are often geared to the development of new nurses, but experienced nurses seeking to transition into an unfamiliar critical care setting can benefit as well. For more about the types of units where critical care nurses work, see A range of possibilities.

Make sure to ask the right questions as you seek a program that suits your needs. Take the time to get a feel for the unit and facility. Look for a program that fits closely with your ideals and personality. Do you agree with the facility's nursing mission, vision, and values? Does it value certification, empower its nurses, and regard collaboration and education? Consider what kind of facility will be the best fit for you.

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Proving your worth

After you've completed the educational program and worked for a while, consider becoming certified. The certification in acute and critical care nursing (CCRN) offered by the AACN Certification Corporation is well recognized in critical care nursing as a mark of excellence. See Which certification is which?

Certification exams ensure that nurses have met entry-level knowledge and skills, are competent, and can provide the best possible outcomes for critically ill patients and their families.2,3 Research continues to demonstrate links between certification and better patient outcomes, greater nurse satisfaction, higher salary, more nurse empowerment, and many other positive outcomes.2-5

You'll need to work for a minimum number of practice hours to sit for an exam. While you're working and gaining experience, you can begin to prepare by studying and taking advantage of additional educational opportunities.

Next, you can consider the benefits of joining a professional organization.

Being active in your professional organization is a responsibility and a privilege. AACN sets the standard in acute and critical care nursing and in its educational programs such as the National Teaching Institute and through its advocacy and public policy work. Benefits of membership include practice, educational, and networking resources.

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The power to heal

This is an incredibly exciting time to become a critical care nurse. Your skill and expertise will touch more lives than you can imagine. Critically ill patients need your compassion, skill, and knowledge to heal their bodies, minds, and spirits.

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A range of possibilities

Some facilities have several CCUs that are highly specialized; others have fewer providing care to a more diverse group of critically ill patients. Specialized units may be focused on cardiac medicine, cardiac surgery, neurology, neurosurgery, burns, trauma, neonatology, medicine, or surgery.

Because medical-surgical patients have much more complex problems today than they did even a few years ago, elements of critical care nursing are also needed in procedural areas such as cardiac catheterization labs, electrophysiology labs, and interventional radiology. Many patients in progressive care units now have implanted devices such as cardiac ventricular assist devices that wouldn't have been seen outside the ICU in the past.

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Which certification is which?

American Association of Critical-Care Nurses Certification Corporation www.certcorp.org

* CCRN: certification in acute and critical care nursing. Adult, pediatric and neonatal certification exams are offered for nurses who have achieved the designated number of practice hours in the appropriate setting.

* PCCN: certification in progressive care nursing.

* CMS: a subspecialty exam, which signifies knowledge in cardiac medicine, used with a certification exam such as the CCRN or PCCN.

* CSC: a subspecialty exam, which signifies knowledge in cardiac surgery, used with a certification exam such as the CCRN or PCCN.

American Association of Neuroscience Nurses www.aann.org/cnrn/certification.html

* CNRN: certification in neuroscience nursing.

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REFERENCES

1. American Association of Critical-Care Nurses. The AACN synergy model for patient care. http://www.aacn.org/WD/Certifications/content/synmodel.pcms?menu=Certification.

2. American Association of Critical-Care Nurses. Safeguarding the Patient and the Profession: The Value of Critical Care Nurse Certification. Aliso Viejo, CA: American Association of Critical-Care Nurses, 2003.

3. Twibell RS, Siela D, Riwitis C, et al. Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation. Am J Crit Care.2008;7(2):101-111.

4. Kendall-Gallagher D, Blegen MA Competence and certification of registered nurses and safety of patients in intensive care units. Am J Crit Care. 2009;18(2):106-113.

5. Craven H. Recognizing excellence: unit-based activities to support specialty nursing certification. Medsurg Nurs. 2007;16(6):367-371.

© 2010 Lippincott Williams & Wilkins, Inc.

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