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Critical care nurses today can work at the patient's bedside in a traditional CCU or ICU, or provide remote assessment and monitoring in an eICU to support the bedside staff. To learn about these environments, we interviewed Mary Jo Cimino, RN, CCRN, BSN, clinical director for the ICU and CCU-both of which won a 2008-09 Beacon Award for Critical Care Excellence-at Cooper University Hospital in Camden, N.J.; and Catherine McKillip, RN, CCRN, BSN, assistant nurse manager and monitoring nurse, and Elaine Ryan, RN, CCRN, BSN, assistant nurse manager, both at Sutter Health's Sacramento eICU in California.
"A critical care nurse's main responsibility is to maintain stability," says Cimino, noting that extensive assessment and critical thinking skills, confidence, assertiveness, and compassion are crucial for nurses in this field. They also advocate for and educate patients and families, act as a liaison with interdisciplinary team members, and provide grief counseling.
For Cimino, the most rewarding aspect of her work is seeing a patient and family through a critical time. The most frustrating aspect? "Doing anything other than being at the bedside."
Yet this is just what eICU nurses do. "We could never replace the bedside clinicians," say McKillip and Ryan. But, they add, eICUs and telemedicine are growing trends. Patient outcomes improve with round-the-clock coverage by intensivists and experienced critical care nurses, both in short supply nationwide. At an eICU, practitioners use early warning software and advanced video and remote technologies to assess and monitor patients' conditions, alarms, labs, and physiologic trends from afar. This lets an entire hospital network-including the bedside RNs-benefit from their expertise and 24-hour vigilance. Great eICU nurses are comfortable with multitasking, computer technology, troubleshooting, rapid change, and acting as nurse mentors and are excellent communicators and critical thinkers, say Ryan and McKillip. "Having a broad experience base is also helpful as we serve medical, surgical, neurosurgical, cardiovascular, and trauma ICUs in both rural facilities and large tertiary care centers."
Clearly, bedside and eICU nursing are two great sides of the critical care coin. For nurses considering this field, Cimino recommends an 8-week critical care course and a 1-week dysrhythmia course. The nursing shortage has sparked an increase in internships and preceptorships. She and McKillip and Ryan all advise certification, for better expertise and pay. Average pay for a staff position with full benefits is $34/hour at Cooper.
At Sutter, eICU nurses are required to have at least 5 years of critical care nursing experience, and they receive pay and benefits on the same scale as bedside nurses.
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