According to the American Association of Critical-Care Nurses, a critical care nurses is, first and foremost, a patient advocate. Each day is spent helping patients and their families respond to life-threatening problems, and a critical care nurse is responsible for making sure this care is optimal.

Armed with a specialized body of knowledge, skills and experience, these nurses create healing environments, whether it's in an intensive care unit, a pediatric ICU, a neonatal ICU, a cardiac care unit, a cardiac catheter lab, a telemetry unit, a progressive care unit, the emergency department or a recovering room.

Creating and Achieving a Healing Environment

Patricia Wragg, RN, CCRN, CHTP, practices in the critical care units at Scripps Memorial Hospital in La Jolla, where she is also the leader of the hospital's AACN Beacon Award committee, and she is passionate about creating a healing environment.

Three years ago, the hospital reorganized its 40-bed all-inclusive ICU, splitting the staff into more specialized areas. It was a tough transition for the more seasoned staff members who not only had to pick a new permanent home, but were separated from decades-long working relationships.

In an effort to unify the new teams and foster an environment for the sharing of ideas, the hospital's director tapped Wragg to spearhead a "healing environment" program that would bring positive changes to the newly reorganized unit. So she started a small focus group called "Creating a Healing Environment," where each member chose one of the six Beacon categories to champion. They shared their efforts during a weekly meeting, which often stirred new ideas, and it created such a cohesive and forward-moving group that the hospital, three years later, has achieved two Beacon Awards and are working on a third.

"We have found the journey rewarding well beyond our expectations," Wragg said. "Beacon has provided the means for us to measure ourselves against high-quality standards based on national criteria. To meet or exceed these standards is to be a leader in critical care nursing."

Wragg has been an RN for 25 years, with 21 of them spent in critical care and now as the Certified Healing Touch Practitioner for the critical care units at Scripps. She enjoys the fast pace and critical thinking this specialty requires, and the constant challenges these conditions provide.

However, what she loves most is the people. Patients and families in the ICUs are in crisis, and Wragg feels she can make a difference in their day by listening to their stories, advocating for them, and providing great care and compassionate communication. In sum, a healing touch.

Through many years as a bedside nurse, she knows that a gentle touch with healing intentions really helps establish a connection twith patient, one that is remembered and appreciated. Providing healing touch treatments to patients, patients' families and staff facilitates the return of compassion to the forefront of patient care. 

The Seasoned Nurse

Allissa McCormick, RN, CCRN, practices in the ICU at Children’s Hospital of Orange County, the first children's unit to be honored with the AACN Beacon Award. A nurse since 1991, McCormick started out there as a unit secretary who admired the rapport the nurses had with physicians and the other heath team members.

"It is a real team effort," she said. "The nurses' voices matter and have a hand in patient outcomes as a team. Management gives the team opportunities to recognize their peers, and essentially cheer each other on. The bar is set very high on the unit, so mutual respect is always there."

A culture of excellence on the unit is the expectation, and all nurses are expected to become CCRN certified.

"To be a Beacon unit means excellence, and we all strive to meet those expectations," McCormick said.

As part of a team-building effort, two years ago a group of nurses from their unit, including the nurse manager, trained for and completed the Iron Girl Triathlon in Las Vegas. Everyone finished the race, and since then a group from the unit participates in the event every year. Just one of the great things that they share at CHOC.

The New Nurse

Shannon Voigt, RN, has been working in the PICU at CHOC since 2008. A newer nurse, Voigt feels she relates better with children and enjoys the opportunity to make them happy during their time in the hospital. Most of the time her role is more for the parents: supporting them, answering their questions and being their advocate.

"I feel blessed to have the opportunity to have an impact on the parents," she said. "They need to feel some sort of peace and comfort in all the craziness."

Faith is a very important aspect of her life, as is learning to incorporate it with science to provide good care for patients. Learning how to think in the "nurse way" is something she constantly has to remind herself to do. “You’re always on your toes and you have to think quickly," she said. "You have to have confidence in your abilities.”

Voigt’s favorite part of being a PICU nurse is having the interaction with the patients and families. She asks herself the following questions each day: How can I encourage the family? How can make this child happy and put a smile on their face? How can I comfort them? And how can I be their advocate?

Being on the front line with the family and able to make an impact on a person’s life … she can't imagine doing anything else.

The steps to becoming a critical care nurse include having a degree in nursing, becoming a licensed registered nurse and passing the national licensing exam. Other requirements vary and are dictated by each state’s board of nursing. Many nursing schools offer students exposure to critical care, but most of a critical care nurse’s specialty education and orientation is provided by the employer. Advanced practice nurses must earn a degree at the master’s or doctoral level. 

Statistics From the Society of Critical Care Medicine

▶ More than 5 million patients are admitted annually to ICUs in the United States.

▶ The five primary ICU admitting diagnoses are respiratory insufficiency or failure, postoperative management, ischemic heart disorder, and sepsis and heart failure.

▶ Since 1991, treatment of serious conditions such as gastrointestinal hemorrhage, hemodynamic abnormalities, multiple-organ system failure, respiratory insufficiency or failure, sepsis and shock has become more frequent.   This is attributed in part to the aging U.S. population.

▶ There are approximately 6,000 ICUs in the United States, caring for 55,000 critically ill patients each day. 

▶ In 2001, the total number of pediatric ICU beds (neonatal and pediatric) was 20,610.

About the AACN Beacon Award

This award was created by the AACN in 2003 to challenge critical care nurses to improve the care provided to acutely and critically ill patients. The application process provides the critical care community a quantitative and qualitative way to view achievements in professional practice, patient outcomes and the health of the work environment. Beacon has provided the means for units to measure themselves against high-quality standards based on national criteria. To meet or exceed these standards is to be a leader in acute and critical care nursing.

Further Reference
Society of Critical Care Medicine
Children’s Hospital of Orange County
Scripps Memorial Hospital
American Association of Critical-Care Nurses

Tammy Lochmann, RN, is a registered nurse and writer. She currently practices nursing in critical care. She writes for a variety of online publications.

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