ICU Nurse in USA To Ask Questions Of

ChipNurse · Mar 17, 2014

I am SICU nurse, so I can give you an idea of what I went through for training and the work environment. My ICU orientation was 12 weeks long, full time hours which included class time and on the floor time; which I thought was more than adequate. However, I did a 96 hour ICU preceptorship my last semester of nursing school, so maybe I felt more comfortable because of that. For ECGs, during orientation we had a 16 hour ECG class at the end of which we were required to pass a test. I am confident in my ECG reading skills and we are required to interpret strips every 4 hours and with rhythm changes. In our unit, the respiratory therapist manages to vent and settings. The nurse monitors patient response to the settings. I do total care on my ICU patients. They get washed on day shift and on night shift, mouth care every 2 hours, turns every 2 hours, up to the chair (if ordered) every shift, assist with physical therapist, assist with turning pt when wound nurse comes, head to toe assessment every 4 hours and as needed with changes, meds, wound care, drain management, I/Os, feeding if on diet, etc. I work at one of the top hospitals in the US and we get some of the sickest patients. I definitely do not sit on my butt all day eating bon-bons and gossiping. I work very hard for the 12.5 hours that I am there.

Esme12, ASN, BSN, RN · Mar 18, 2014

Some of the things the nurse told me were;
That the post graduate ICU course in the USA is only 6 weeks compared to our 12 months.

Nursing education in the US is a generalist education when in school. Specialization occurs after one gets a position in an ICU. Orientation is usually 12 weeks for new grads. Some are longer. New employee orientation with ICU experience will depend in the ICU training you received in the other facility. If you are coming from a "soft" ICU with less acuity to a "hardcore" ICU that uses invasive lines with advanced procedure you woulds require more orientation. For example...not all facilities perform open heart here in the US. If you are in a rural ICU and never cared for heart surgical patients you would be given a longer orientation to learn how to care for these patients and the lines/drips/equipment. The US has national certification that we take to make us certified in our specialty. They are not mandatory at most places but are desired. For example the CCRN....Initial CCRN Certification.

CCRN Exam Content
The CCRN exams are 3-hour tests consisting of 150 multiple-choice items.
Of the 150 items, 125 are scored and 25 are used to gather statistical data on item performance for future exams.
[*]The CCRN exams focus on adult, pediatric or neonatal patient populations.
[*]The CCRN test plans include detailed exam content, organized by body system, with a percentage breakdown for each topic area.
The majority of the exam is age-specific for the adult, pediatric or neonatal patient population, while a portion of the exam covers content that may address any age across the life span.
Initial Eligibility Requirements
Current unencumbered licensure as an RN or APRN in the U.S. is required.
An unencumbered license is not currently being subjected to formal discipline by any board of nursing and has no provisions or conditions that limit the nurse's practice in any way.
[*]Candidates must meet one of the following clinical practice requirement options:
Option 1: Practice as an RN or APRN for 1,750 hours in direct bedside care of acutely and/or critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application.
Option 2: Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct bedside care of acutely and/or critically ill patients, with 144 of those hours accrued in the most recent year preceding application.
[*]Eligible clinical practice hours are those:
spent caring for a single patient population (adult, pediatric or neonatal) matching the exam for which you are applying.
spent supervising nurses or nursing students at the bedside, if working as a manager, educator (in-service or academic), APRN or preceptor.
completed in a U.S.-based or Canada-based facility or in a facility determined to be comparable to the U.S. standard of acute/critical care nursing practice.
[*]The name and address of a professional associate must be given for verification of clinical practice.
A professional associate is defined as either a clinical supervisor or colleague (RN or physician) with whom you work.

The CCU unit she worked in- only one other nurse could read Ecg's. She said that the ecg's taken were sent "somewhere" for someone else to decipher the rhythm?

I don't know what type of CCU your colleague worked in but that is, for the most part, not true. ICU nurses know how to read and interpret 12-lead EKG's. They are sent to the MD/cardiology to be officially read....but the nurse is well versed on the EKG interpretation and will report it to the MD if there are changes.

The RN's do not do patient washes, observations and other general care. That respiratory therapists look after the ventilators. That even though the RN's do not do those things (as we do here in Australia), that the nurses are run like a "workhorse". I am perplexed to wonder how nurses can be run like workhorses if they do not also do all those things like we do here. On some days here in Australia, when there are no ward beds available and the patient is bed-blocked, the observations and the showers may be all you do all day (apart from helping others when able).

Another fallacy...Nurses in critical care ares bathe their own patients. At least they did in all the ICU's I have worked over 35 years. ICU nurses do primary care of their patients. We do have respiratory therapists that care for the vent, do ABG's, and make changes to the vent. It is a collaborative team. You will have two patients sometimes three if they are stable. Very critical patients are 1:1 in a well run unit. You are responsible for all things for that patient. Lines, drsg changes, drip titration, total care.

That the education in the USA is not as stringent as here in Australia. In Australia, my Masters doesn't mean I am considered any more capable or higher educated than others. In fact it really is a waste of time in Australia unless you wand to teach at a University, for which you typically need a Phd and a certificate IV in training and assessment.

I am not sure that is true. While the US education is generalist in nature it is intensive. In the US a masters is an advanced degree that is required for teaching, clinical specialist position and Nurse practitioners and CRNA's....there is some movement towards the DNP (doctorate) for these position but it is not a requirement. While there are Masters prepared nurses at the bedside it is not the norm. Nurses in the US are able to do IV's without additional certification. PICC line insertion does require additional training. Only physicians, PA's or CRNA's insert central lines. Nurses may insert external Jugular and arterial lines in some facilities.

I would be happy to communicate with you anytime

Stevenyzwife · Mar 19, 2014

Wow I am amazed. To be a CCRN here, you have to be employed in Intensive Care Unit and the at the same time, complete a post graduate course is 12 months long at a University.

We are 1:1 ratio in ICU. If there are 2 patients that are waiting a ward bed, then rarely you will get 2 patients but never, ever three.

The CCRN, looks after the ventilators, it's setting, taking and interpreting ABG's, all lines, dressings, mouth and eye care, Medications, washings, turns/pressure are care (4hrly). If ventilated, the patients are washed during the 12.5hr day shift and again at 0500hrs by the night shift.

We read, interpret and deal with the ECG's. The intensive care doctors that are in the unit 24/7 read and implement any medications or treatments post ECG's.

CCRN's are allowed to insert jelco's/drip cannula's, but we are in no way allowed to insert arterial lines or anything external jugular.

All our post op ICU patients have arterial lines, unless they are only in ICU overnight post op because they use CPAP at home (I know.....crazy huh).

So many ICU's here do cardiac surgery (CABG's, MVR's etc and there are a very large amount of ICU's that have those patient's as 99% of their caseload.

I will be very disappointed with not being able to deal with the ventilators (prefer Purretan Bennets to Draegar's), plus taking and interpreting ABG's as I think they are the most exciting part of my day!

beckster_01, BSN, RN · Mar 24, 2014

As others have said, this will greatly depend on the type of ICU you are in. I work in a 650 bed teaching hospital MICU (affiliated with a university). As such all of the ICUs are specialized, and different ICU nurses have different areas of expertise. Since we have a cardiac ICU I am not as well versed in reading EKGs as a cardiac nurse is. Some nurses that I work with are very skilled in reading a 12 lead. I am obviously capable of identifying the rhythm, and noting ST elevation/depression and other basic changes, however I am not able to look at an EKG and tell you the location of ischemia or other details. For an in depth read the EKG is sent to a cardiologist electronically. We do employ respiratory therapists, but I know how to work a vent. Nursing is great at trouble shooting the ventilator, interpreting ABG's, assessing and monitoring respiratory status, etc. I see RT as an excellent resource since their schooling specializes in one system, and they generally have much more experience than me. I especially love them when it comes to infrequently used ventilator modes. I had my first patient on an oscillator this week. I have had no formal education on this type of ventilator, whereas a respiratory therapist not only receives that education, but they deal with patients on that ventilator more frequently. I do all of my own personal care, labs, meds, run CRRT, etc. Usually patients are 2:1 but if they are very sick then it is 1:1. In cardiac ICUs nurses are trained to run certain equipment: balloon pumps, total artificial hearts, fresh LVADS, and ECMO. Again, it totally depends on the hospital. I did a clinical at a hospital that had 2 ICU beds, but they generally only took care of more stable patients on BiPAP or in DKA. Some units use a "team nursing" model, 1 nurse does meds, 1 does personal care, etc. This model doesn't generally work in the ICU because of the complexity of patients, but I do work with a nurse who used to use that model and liked it.

As far as patient population, in the medical ICU the majority of my patients are septic (so think a-lines, CVP monitoring, fluids, and vasoactives). We very rarely use Swans, although they are used in all cardiac surgery cases, and usually in transplant and complex vascular cases. We also care for patients with respiratory illness (COPD, flu), autoimmune disorders, neuro overflow, "mystery" diseases, DKA, oncology, and so forth. Pretty much I take care of every sick patient that is not a surgical candidate.

Hope that helps answer some questions!

Here.I.Stand, BSN, RN · Mar 29, 2014

I don't typically feel I'm run like a workhorse...but perhaps since we typically have 2 critical pts that makes a difference? So there's more to do even though we're not running the vent ourselves? Most nights I feel like I'm earning my pay, but run like a workhorse, no. I worked in a long-term acute care hospital for a year; that place ran me like a workhorse.

Back to the vents, we do have to be able to do at least preliminary troubleshooting assess the pt's response to any vent changes since the RT isn't right there all the time. Like the previous posters though, I really really appreciate the RT's expertise in this area because their education and work is SO focused. I've learned so much picking their brains!

We are taught how to read ECGs, although some RNs are better at it than others. I'm one that's got the basics down, but still working on learning the finer points as far as what the changes in specific leads mean relating to the location of the ischemia/infarct. An MD does the official read though, since they are the ones that ultimately determine the course of action. The ICU's I've worked in have been in big hospitals so we don't send them anywhere to be read. Kind of like head CTs in my ICU...we have a lot of neurotrauma pts, and I can look at their head CT and see a midline shift, a SAH vs. SDH, etc. but my interpretation ability is very different than a radiologist's ability.

I might be in the minority, but the RNs in my ICU draw our own ABGs. :)

The RN does most of the personal care w/ help from a CNA. Typically what I do is wash the pt's front and then get the CNA to help me turn, and we wash the pt's back and change the linens together. That way the other RN's aren't pulled from their own pts too much when we need help w/ the muscle work. We turn q 2 hrs (unless they're an unstable spine of course) and do oral care w/ subglottic suctioning q 2 hrs while on the vent. We do the baths on the noc shift if they're sedated, on days if they're not. We're also trying to get away from having Foleys in so many people, so there is more incontinence care and intermittent cath'ing.

So many ICU's here do cardiac surgery (CABG's, MVR's etc and there are a very large amount of ICU's that have those patient's as 99% of their caseload.

Most of the bigger hospitals do CVT surgery, but there is variation among them. The hospital I work for is most known for trauma and psych, and while we do have CVT surgical pts, it's not the go-to hospital for that. We also don't have a dedicated CVICU so the surgical pts that we do have come to the SICU while the medical ones go to the MICU. Another hospital I worked at did have a dedicated CVICU which took both med and surg ICU pts. That would be something to look for in a hospital if you really enjoy this pt population.

Hopefully I'm making sense, I'm starting to get tired.

Esme12, ASN, BSN, RN · Mar 29, 2014

Wow I am amazed. To be a CCRN here, you have to be employed in Intensive Care Unit and the at the same time, complete a post graduate course is 12 months long at a University.
We are 1:1 ratio in ICU. If there are 2 patients that are waiting a ward bed, then rarely you will get 2 patients but never, ever three.
The CCRN, looks after the ventilators, it's setting, taking and interpreting ABG's, all lines, dressings, mouth and eye care, Medications, washings, turns/pressure are care (4hrly). If ventilated, the patients are washed during the 12.5hr day shift and again at 0500hrs by the night shift.
We read, interpret and deal with the ECG's. The intensive care doctors that are in the unit 24/7 read and implement any medications or treatments post ECG's.
CCRN's are allowed to insert jelco's/drip cannula's, but we are in no way allowed to insert arterial lines or anything external jugular.
All our post op ICU patients have arterial lines, unless they are only in ICU overnight post op because they use CPAP at home (I know.....crazy huh).
So many ICU's here do cardiac surgery (CABG's, MVR's etc and there are a very large amount of ICU's that have those patient's as 99% of their caseload.
I will be very disappointed with not being able to deal with the ventilators (prefer Purretan Bennets to Draegar's), plus taking and interpreting ABG's as I think they are the most exciting part of my day!

The acuity of the unit depends on the facility. Not all facilities perform open heart or transplants. Nurses interpret the ABGs and are actively involved in the vent and patient care. But the respiratory therapist is your best friend.

We do total patient care and all lines drips and equipment. You need to be actively working in a critical care to be eligible and certified as a CCRN

Option 1: Practice as an RN or APRN for 1,750 hours in direct bedside care of acutely and/or critically ill patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application.
Option 2: Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct bedside care of acutely and/or critically ill patients, with 144 of those hours accrued in the most recent year preceding application.

depending on the facility nurses deal with PA lines/Swan Ganz, IABP. Ventricular assist device, continuous renal therapy (Gambro filter CAVHHD). The acuity seems similar.

LNRN11 · Mar 30, 2014

You will certainly still have some say so as far as the ventilator is concerned. Most RTs are good about collaborating, like previous posters have stated. I work in CV surgery and all of our open hearts come out vented. We wean them down with the RT, but at the end of the day, that's still my patient. If we extubate and they don't fly, that's on me. So, say I don't feel comfortable with extubating (ex: their NIF, VC, and/or ABG aren't good), I will be the one that calls the anesthesiologist or CT surgeon to get their decision. Additionally, even if we aren't necessarily the ones obtaining the ABG (I know some nurses do at their facilities), we still know how to interpret and treat them. If the RT calls the pulmonologist/attending/whomever and that patient needs bicarb, for example, the phone is going to be passed to the nurse to take the order and administer. I hope that kind of clarifies for you! Good luck.

chemokine · Apr 4, 2014

That the post graduate ICU course in the USA is only 6 weeks compared to our 12 months.

There is no universal "post graduate ICU course" in the US. Once you are done with nursing school, you will not go through more university based schooling to work in the ICU. You will be trained for ICU by whatever hospital hires you. The length of training can vary depending on whatever the hospital wants pretty much. Typically you will find new grad RN to ICU programs lasting from around 12 weeks to one year with many programs in the 4-6 month range.

The CCU unit she worked in- only one other nurse could read Ecg's. She said that the ecg's taken were sent "somewhere" for someone else to decipher the rhythm?

Not true from anything I've ever heard. You can expect to read and interpret your own ECG strips as an ICU nurse.

The RN's do not do patient washes, observations and other general care.

Again, not true. We do all of these things.

That respiratory therapists look after the ventilators.

That's true. We don't manage vents like they do in Australia. We still handle some basic troubleshooting such as realizing when we need to suction or when the circuit gets disconnected. Also we can realize when a vent setting might need to be changed and discuss that with the RT.

That even though the RN's do not do those things (as we do here in Australia), that the nurses are run like a "workhorse". I am perplexed to wonder how nurses can be run like workhorses if they do not also do all those things like we do here. On some days here in Australia, when there are no ward beds available and the patient is bed-blocked, the observations and the showers may be all you do all day (apart from helping others when able).

ICU's are 2:1 in the US not 1:1 like I believe they are in Australia. You will not have any ICU days in the US where you are just doing "observations and showers" all shift.

That the education in the USA is not as stringent as here in Australia. In Australia, my Masters doesn't mean I am considered any more capable or higher educated than others. In fact it really is a waste of time in Australia unless you wand to teach at a University, for which you typically need a Phd and a certificate IV in training and assessment.

I can't make sense of this statement. You are implying that a Masters is more pertinent to bedside nurses in the US than in Australia. You are also implying that US education is less stringent because of this.

In the US, a Masters is also more geared towards jobs in education/teaching or something other than bedside. I'm not sure how this makes the US education less stringent.

cubby777 · Feb 16, 2015

Hi Guys!
I am an ICU nurse in Australia and as my husband is from Phoenix, we are in the process of getting an immigration visa for myself, so we can return to the USA permanently.
Our daughter already has dual citizenship.
I am looking for an ICU nurse who is currently working in the field in the USA so that I can converse with via emails/Facebook/however.
An older ICU nurse in my unit here in Australia told me of some things with regards to working as a nurse in the USA that are deeply troubling me and I would like to chat with someone about working in the field in the USA.
Some of the things the nurse told me were;
That the post graduate ICU course in the USA is only 6 weeks compared to our 12 months.
The CCU unit she worked in- only one other nurse could read Ecg's. She said that the ecg's taken were sent "somewhere" for someone else to decipher the rhythm?
The RN's do not do patient washes, observations and other general care. That respiratory therapists look after the ventilators. That even though the RN's do not do those things (as we do here in Australia), that the nurses are run like a "workhorse". I am perplexed to wonder how nurses can be run like workhorses if they do not also do all those things like we do here. On some days here in Australia, when there are no ward beds available and the patient is bed-blocked, the observations and the showers may be all you do all day (apart from helping others when able).
That the education in the USA is not as stringent as here in Australia. In Australia, my Masters doesn't mean I am considered any more capable or higher educated than others. In fact it really is a waste of time in Australia unless you wand to teach at a University, for which you typically need a Phd and a certificate IV in training and assessment.
I look forward to someone allaying my concerns and questions. I am actually very amazed as I always persumed the education in the USA is of higher quality, but now I am unsure.
Thanks!

Yes, a 6 week course is probably right, although I took a critical care course in 1991 and it was

4 months long. That's the longest critical care course that I've heard of here. Also, nurses here do baths and nursing aide type work in addition to passing meds, iv's, etc. We also have to start iv's, draw labs, ekg's, etc. If you are talking about working in a hospital, there are very few nursing aides in the hospitals and the nurses have to do it all. Right now, a new RN probably would have to have a BSN, as there's talk of phasing out the ADN, but I don't think that will happen, as it would make the supply of nurses very low. If you have a Master's, they will probably expect you to teach or do some type of administrative job. Most nurses that work in hospitals have an ADN or a BSN. You may find yourself with higher patient to nurse ratios in a for profit hospital, whereas a not for profit may have a better ratio and better working conditions, but less money. The for profits actually offer a better wage, but work you a lot harder. Anyway, wishing you the best on your new career!

DizzyFeetRN · Apr 5, 2016

I'm an ICU nurse 28 years old 3 years ICU 5 years tele experience in a smaller (217 bed, 12 bed ICU) hospital on the east coast. Were considered a MICU/SICU, do not do any cardiac surgeries or traumas, strictly stabilize and transfer those patients. Id be willing to converse or discuss anything you'd like. Although I'm not very familiar with Australia's system. I am also in contact with the 2 other hospitals in my city and their ICUs as well as two much larger level 1 trauma centers and two university hospitals within driving distance and our critical care transport teams MICU and flight teams (all contacts are professional in nature). I love what I do and I enjoy talking with others about it, don't hesitate!

-I mention east coast because you mention Phoenix which is west, and believe it or not the east and west coast have more differences than you'd expect.