How To Become An ICU Nurse | What Is It Like To Be An ICU Nurse?

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ICU nurses are the frontline caregivers for critically ill patients, providing life-saving interventions and monitoring their condition. Today, Jenny Finnell is diving into the dynamic world of ICU nursing, exploring its journey, challenges, and rewards. From sharp clinical skills to quick decision-making and emotional resilience, the role demands dedication and compassion. Jenny also offers advice on certifications, career progression, and salary expectations for ICU nurses, providing a realistic perspective on the journey toward becoming a CRNA. So, if you’re ready to embrace the intensity and rewards of ICU nursing, know that you’re stepping into a profession that shapes both your professional growth and personal fulfillment.

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How To Become An ICU Nurse | What Is It Like To Be An ICU Nurse?

We’re going to talk about how to become an ICU nurse. Many of you who are contemplating becoming a CRNA may realize that you first need to start in the ICU. We’re going to discover or reveal what it takes to become an ICU nurse, what it’s like to be an ICU nurse, what types of units you can work on, what the salary of an ICU nurse is, and so forth. Let’s go ahead and get into the episode.

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What Is An ICU Nurse?

Welcome back to the show. We’re going to talk about becoming an ICU nurse. For those of you who have aspirations to become a CRNA and who know that your first step needs to be becoming an ICU nurse, this episode is for you. First, what is an ICU nurse? What do they do? What is it all about? An ICU nurse is a critical care nurse who specializes and is highly trained to care for critically ill patients.

They also can get additional training in advanced life care support modalities such as CVV HD, ECMO, and Impella. Again, an ICU nurse thinks about it as they provide care for the sickest of the sickest population. It could be any age range, any type of illness, and any type of trauma. That is what an ICU nurse cares for. What is their typical work environment like? What are their typical shifts like? This depends on the type of ICU setting that you end up choosing, which we will get into here in just a moment.

As most nurses do, you typically work a range of 8-hour shifts or 12-hour shifts. You either work the day shift or the night shift. I will say, it’s more common to work the night shift as a new grad ICU nurse or some type of day-night rotation. I remember the hospital I started at, which was a level one trauma center, a magnet status hospital of academic center to be able to go to straight days– the nurses who had about 6 to 7 years of seniority were the ones who got to go to straight days.

I remember that feeling heavy as a new grad knowing that I’d have 6 to 7 years of toughing out the night shift before I’d ever see the light. For me, in my experience, I found the day-night rotation to be much harder on me physically and mentally. I made the choice. If I was going to be miserable going back and forth all the time, then I might as well make more money all the time and go to straight nights.

After about I would say a year or maybe probably about a year of day-night rotation, I went to straight nights. That was also the year that I was preparing my CRNA applications. Luckily, I was accepted making my overall ICU experience right around three years by the time I started my program.

I have an entire episode on the work-life balance of a CRNA compared to that of an RN; check it out here: https://crnaschoolprepacademy.com/podcast/episode-83-crna-work-life-balance-compared-to-rn/

What Do ICU Nurses Do?

What do ICU nurses do more specifically? This is again where it depends on what type of unit you work on. Whether you work in a medical ICU, surgical ICU, or CVICU. It’ll depend on the type of patients you care for and what disease processes they have or what medical complexities they have.

Ultimately, if you look overall, your job is to evaluate and monitor the patient’s progress to identify any sudden or subtle changes in the medical condition. I will never forget my first cardiac arrest in the ICU. That experience will always stay with me mostly because the situation was traumatic for me to experience for the first time.

I experienced cardiac arrest as a nurse’s aide, which I will also share with you a little bit later. My first cardiac arrest was a patient who had ITP, which stands for idiopathic thrombocytopenia. I was a medical ICU nurse and this patient was young. They were in their 30s. They had young kids. I remember coming on my night shift that day and they asked me to call their family. They were walkie-talkies as we would call them because it was very unusual to have a walkie-talkie on our unit.

They were already waiting on a transfer to a different unit on the floor to the step-down. They didn’t even have the ICU docs as their main providers at the time. They were just waiting for a bed. Anyways, they talked to their kids and their husbands and went on with a typical night until it did not. I went to do my 2:00 AM blood draws and the patient’s eyes were wide open. She was staring into space. I tried to talk to her and tried to communicate with her. She said nothing to me.

She looked at me but she said nothing. Acting very strange. At first, I’m like, “You’re having trouble sleeping. Can I do something to help you?” I was thinking maybe I was being too loud or disturbing. In that ICU, we didn’t have doors. We had curtains. It was a row of curtained rooms. That was our ICU. Anyhow, didn’t talk. I started doing a neuro assessment because she was acting very strange.

I’ll never forget seeing her pupils go big and then small. I was like, “Oh.” I immediately knew that she was having a stroke. I didn’t know how severe it was. I tried to go out and had another nurse, another ICU nurse go into the room to stay with her. I went and called the doctors. I went and got the ICU team, even though they were not her primary team. I said, “You got to get in the room. She’s having a stroke. I’m going to call her transfer service that she’s on but she’s having a stroke. You need to go in there.”

Long story short, by the time I even got ahold of her actual team of doctors., she was already massively stroking and saw the Cushing’s triad, which is if you Google it, it’s essentially where you start needing your brain and you have bradycardia, hypertension, and eventually you go asystolic. I say that and as I said, it always sticks with me. I don’t mean to bring some doom and gloom in the situation but ultimately, if you’re considering becoming an ICU nurse or you want to pursue CRNA, you have to become an ICU nurse.

This is one example of what you will routinely see in the ICU. I’m going off on a tangent now, but that being said, working in the ICU can be an emotional and mental struggle. It was some of the darkest days of my career. I don’t regret it. I am grateful for becoming a CRNA. I love it. Could I have lasted in the ICU for my entire career? No. I took every patient’s death and everything personally. I felt the pain emotionally and it became very taxing.

I cannot imagine what just has unfolded over the last several years with the pandemic and seeing that much patient suffering and death. It takes a toll. That being said, there are ways you can cope with that and you need support to become an ICU nurse. Step number one is to research what type of ICU nurse you want to become. Step number two is to think about how you plan to support yourself during your time as an ICU nurse.

This is something that I did not think about until I was already in it. It became very heavy. I didn’t know what to do, didn’t have a plan, didn’t know who to reach out to, and didn’t know if I felt comfortable talking to a regular therapist. I considered going on antidepressants. I would say, looking back, I leaned a lot on my fellow ICU nurses for support.

That was what got me through those hard times. My coworkers were like a second family. I called them my work mothers and fathers because that’s what they felt like to me. I was young. I was 22 years old. That’s like a baby to me now. Have a plan in place to provide yourself with some type of mental space. It’s not a bad idea to think about getting a therapist that you know, like, and trust. That way, if you have a traumatic experience, you have someone you can talk through that with who can understand how to help you cope with that grief and that loss. These are all things to consider and think about as you embark on your ICU nurse journey.

Back to what do ICU nurses do. They do take care of life-and-death situations. They run codes. They titrate vasoactive drips. They delegate. That was a big part of being ICU nurses, to delegate, especially in a critical situation. I will never also forget a situation where I had a GI bleed. Those were nobody’s favorite patients. It was critically a dire situation but it’s bloody poo, which is not so pleasant. It smells. It has a real distinct smell.

This episode is getting totally gross but anyway, I remember giving a massive transfusion like blood product, every blood product, and checking labs. It was all hands on deck and I needed a massive amount of help from my team. I had to ask for help. I had to delegate tasks to nurses who came into my room. I had to know what needed to be done and I had to be okay and comfortable asking for it.

Now, that’s not the type of assignment you get on day one in the ICU. You’ll be managing patients who require massive fluid and blood protocols. You’ll also be managing patients like DKA, which is diabetic ketoacidosis, whose electrolytes are all messed up. They’re acidotic. You’ll be managing people who have ARDS, which is acute respiratory distress syndrome, who need to be intubated. Their lungs are essentially full of liquid and water and even with 100% oxygenation or 100% FiO2, they’re not oxygenating.

They’re getting more acidic. They can turn into DIC, which is disseminated inner coagulopathy, where you bleed and you clot at the same time. DIC is a terrible process and not many survive. Once that cascade of clotting and bleeding starts, it’s incredibly hard to ever stop. Things of that nature. Again, these are very serious conditions. Those are some to give you an idea of the types of patients.

What Types of ICUs & ICU Specialties Are There?

Now my background talking about all these patients is a medical ICU. If you’re in the surgical ICU, you’re going to be dealing with trauma, neuro, and surgical patients, such as maybe someone who had a liver transplant. They have hospitals and ICUs that just take liver transplants. Maybe you’re a major liver transplant center and that entire ICU is dedicated to liver transplants. That is a real thing.

Know that ICUs can be incredibly specialized. You can have an ICU dedicated to burns. Again, it might be part of the SICU, but maybe there’s a burn unit within the SICU. It depends on what you work on as far as the types of critically ill patients you will take care of. Another responsibility of a nurse in an ICU is to talk to your team. Be an active participant on rounds, which all nurses do those types of things. In the ICU, it seems to be a much bigger part of your role because those physicians rely on you to communicate these changes because you are at the bedside 24/7. You don’t leave that patient side.

ICU Nurse: In the ICU, talking to your team and participating in rounds is a much bigger part of your role. This is because physicians rely on you to communicate changes, as you’re at the bedside 24/7, constantly monitoring the patient.

Typical ratios for ICU nurses are 1 to 2. Now, in the past few years, that has crept up sometimes to three patients potentially. Maybe even four in the pandemic stages or whatever it was. That is not safe because you could have a stable double, is what they would call it. That stable double can turn into two critically ill patients or one critically ill patient who needs all of your time and attention.

The other one is not like they’re a walk in the park either. They’re just not actively dying. It can go south quickly in the ICU. Usually, it’s 1 or 2 patients is the ratio. I always enjoyed having a 1 to 2 ratio. It allowed me to pour and give my all to the patients I had versus something like med surge where you have 6 or 7 or 8 patients and you’re spread thin. You don’t get that much time with your actual patient.

I enjoyed the low ratios that you would experience in the ICU. It also allows you again to go in more depth with your patient, meaning what’s your disease process? Why are you on these drips? Why are you taking these meds? Why are we doing these therapies? These are all enjoyable things that you get to do as an ICU nurse. If you love pathophysiology and pharmacology, ICU nursing is cool. You will learn a lot. Every day is a new experience. Every day is a learning opportunity.

If you treat it like that, it will be way more successful experience in preparing for CRNA school than if you walk in and take orders and do your thing and fall. You want to be a scientist. You want to ask why. If you operate like that from day to day, you will be leaps and bounds ahead of any competition for CRNA schools. ICU nurses, again, manage vasoactive drips, and paralytics. They give vasoactive drugs and narcotics. They keep their patients comfortable. Sometimes your patients are on the ventilator. They need continuous sedation with things such as Propofol. Also called Diprivan.

It’s the white medication. Also known as the Michael Jackson drug. I’ve thrown it out there. For a while there, everyone was like, “You’re giving me the Michael Jackson drug?” I’m like, “Oh my gosh,” but it’s Propofol. It is the name of the drug. Very commonly used in the ICU for sedation. You could also have mono Precedex drip as well, which is also called Dexmedetomidine.

We covered where ICU nurses work but to cover some different specialties, there’s a cardiothoracic ICU which is also abbreviated CTICU. You can have a variety of cardiac ICUs. You can have this CVICU, cardiovascular ICU. You can have the CCU which is the cardiac care unit. You can have post-MI patients. There are blends of cardiac ICUs. Medical ICUs are relatively standard medical ICUs but you can also have a mixed ICU.

It could be med-surgical and medical ICU combined. This gets confusing. You can have a neonatal ICU, NICU but you can also have a neuro ICU, also a NICU. Those can be confusing. You want to make sure you’re differentiating between, does the NICU mean neonatal ICU or does it mean neuro ICU? A lot of times neuro ICUs are lumped into the surgical ICU.

Know that, again, a lot of SICUs have neuro patients on them. Some hospitals have a very specific neuro ICU only. You have the PICU, which is a pediatric ICU. The pediatric ICU is great. You see a wide range of patients all the way from babies to teenagers. A lot of CRNA schools do take pediatric ICU experience. However, in the neonatal ICU, not so much. That is considered a very niche part of ICU nursing. It’s incredibly specific for the neonate.

It’s not as good of an experience for CRNA school. Therefore, a lot of programs do not accept experience from there. Make sure before you pick your ICU, that you’re researching what your school takes. If you see the words individual basis, that’s a red flag to know that’s not a preferred experience. They will consider it if all else looks great but it’s not going to be competitive. Given how competitive CRNA schools are, I would go with the preferred experience. But don’t get yourself down- if you do have a less-than-preferred experience, still go after it. Still get it. You got it. I know you can do it.

I’d like to warn you ahead of time. If you have the choice to try to pick a unit that is preferred by your CRNA program versus one that is not. You have the surgical ICU, which again can be a surgical neuro. It could be a surgical burn or a surgical trauma. There’s a variety of different types of surgical ICUs. Know that there’s some variation in that.

I want to mention things like flight nursing. I see that a lot and it’s a good experience. Typically to become a flight nurse, you need to have a solid ICU nurse background, which is why it can also work as a pre-CRNA experience. Again, the reason why it tends to work is because you have a solid ICU background first. The experiences you get as a flight nurse, such as intubations and being like the first responder is a good experience for CRNA.

You don’t need to be a flight nurse. I’d also encourage you to double-check because a lot of CRNA programs tend to not see units or experiences that are short-term management as true ICU experiences. The caveat, a lot of people are like, “Why would flight nursing work and not ER nursing? They’re both triaging and doing quick stabilization then getting the patient somewhere else.”

The difference is the fact that an ER nurse has a lot less autonomy. They don’t do things like intubations and things of that nature. They also have a wealth of resources around them, where a flight nurse is on the field and doing intubations and has a very small team to work with, and is taking a lot of action autonomously.

Another big difference is an ER nurse might not have solid ICU background, where a flight nurse will. That is a big difference. Again, I would confirm with your CRNA program that flight nursing is an okay bridge after you’ve had solid ICU experience to then be considered current in the ICU. I would say the majority ones that I have come across do take flight nursing. It’s still worth asking to make sure that you don’t pick a unit or an experience that would set you up to be less competitive for your program.

Steps To Becoming An ICU Nurse

What are the steps to becoming an ICU nurse? Step number one is in nursing school to get experience as an SNA, CNA, or Student Nurse Assistant. That way, you can explore different ICUs and understand what it is you’re getting yourself into, and see the work the nurses are doing. It also gets your foot in the door. It gives you a good reference. That way, if you apply to a nurse residency program for the ICU, you’re more likely to get it because you’ll have a good reference.

My biggest piece of advice for you is to take your role as an SNA or a CNA in the ICU as a long-term job interview because these nurses that you’re working with as an SNA will be the ones who support you and guide you to become a nurse on their unit. That is, in my opinion, step number one. Step number two is you have to get your nursing degree. Whether that’s a BSN or ADN.

A lot of magnet hospitals will now only take BSN-prepared nurses because that is part of the magnet criteria of some kind. All that I know is it has to do with that. Be cognizant of that. If you pick a hospital where, if you’re getting your ADN, and you’re picking a hospital that only takes BSN nurses in the ICU, you may be setting yourself up to not be able to get in right away.

I would think about that prior. Maybe your hospital will take you as an ADN-prepared nurse knowing you’re going back within a certain timeframe for your BSN. That is like the hospital I worked at. That was the understanding. If you were hired as an ADN nurse, you were going back for your BSN relatively quickly after you were done with your ADN. Those are all things to think about and look into prior to picking your role as an SNA.

Getting your BSN and your ADN are all bridges to becoming an ICU nurse. Getting experience, you want to find what unit resonates with you. However, I don’t encourage you to jump around too much, especially if you want CRNA. You want to establish good leadership roles and good references. In order to do that, you need to stay put.

If you’re job hopping every year, it’s going to be hard for you ever to build up a lot of leadership roles or experiences and good references. Plus, it also could come across as a red flag to these admissions committees that like, “What’s wrong? Why can they not stay put for a while?” It’s not wrong to move around if there’s a reason for it. Maybe you moved or maybe you had a toxic unit. I don’t know. It’s not wrong to move but deliberately to pick a unit to jump around on.

Sometimes people are like, “I need a well-rounded experience. I need to have CVICU, MICU, and SICU. I need to have it all”. I’m not sure where it’s coming from but that’s not true. Pick one that you like. Stick with it and grow. Become the best nurse on that unit. Take the sickest of the sickest patients. Get leadership roles. Do charge. Do whatever and build that establishment there then go to CRNA school. You’ll be fine.

I only had MICU experience. I did fine in CRNA school. I didn’t need CVICU. Everybody has a heart, including MICU patients. At the end of the day, does it matter? No. As long as it’s solid ICU experience. Remember, quality over quantity. You want quality ICU experience. We took the sickest of the sickest. They didn’t ship these patients out. They got shipped to us when they were on their last thread.

ICU Nurse: Remember, quality over quantity. You want quality ICU experience.

I always tell pre-CRNA students inside the CRNA School Prep Academy, “If your patients in the ICU get shipped somewhere else because they become too acute or sick for your unit, then you want to get in your car and follow the ambulance and apply for a job at that hospital.” You want to be the endpoint. Your patient either leaves or they don’t. That is your unit. If that’s the kind of ICU you’re working in, you have found a good ICU. It doesn’t matter what type. As long as you’re happy, thriving, and feel supported. That’s what matters at the end of the day.

ICU Certifications- Which Certifications Do I Need for CRNA?

Let’s go into ICU certifications. You don’t need alphabet soup, let me just start there. I would plan on having at least one critical care certification, primarily the CCRN. The reason is that most CRNA schools either require it or recommend it. Do it if you can. Sometimes you’re not going to have the amount of experience. It’s 1,750 hours that you would need and that’s equivalent to about one year of full-time 36 hours a week of ICU experience to sit for that exam.

You must have that amount of hours prior to even applying to take the exam. I had to ask that question because someone wanted to apply before they had the hours. They’re like, “No, you have to have hours first then you can apply to take the test.” That is the exam that I recommend the most because it is the most widely accepted and recognized by CRNA schools.

There are other additional certifications such as the CMC, which is for nurses in the medical ICU. You can have the CSC, which is for surgical critical care. You can go on and on. There are neuro ones. There are all kinds of additional certifications. If you go to the AACN’s website, you will find additional certifications that you can take as an ICU nurse.

They’re all listed there. Remember, you do not need alphabet soup. One thing that I have realized sometimes when I see this is you’re setting the bar. If you have alphabet soup and you have every certification under the sun, you are then setting the bar incredibly high for your CRNA school interview; meaning if you have CMC, CSC, and CCRN and they start drilling you on critical care knowledge, you better be sharp.

Unfortunately, I don’t think you need to do that. You could also be setting yourself up to have a grueling interview process where if you’re not at the top of your game. They’re going to be like, “Why do they have all these certifications?” Be careful with that. Again, it’s not that have one, having two is cool, but any more than that, your time may be better spent doing other things to boost your application for CRNA School than continuously getting certifications.

What is the Salary of an ICU Nurse?

Getting involved in the AACN is a great leadership activity. That is something to put on your radar. What do you make as an ICU nurse? A lot of you are probably wondering, “If I go to ICU nursing, is it going to be realistic that I can save for CRNA school being an ICU nurse? That being said, according to the Bureau of Labor Statistics, ICU nurse employment is projected to grow by over 6%. That’s more than average.

Again, this is considered fast when compared to all occupations. The average salary for an ICU nurse is about $90,000. I took this from Incredible Health’s recent data, but there’s a range of 80s. You could be in the area of the country where maybe you only make $70,000 as a new ICU nurse. I have heard that. In fact, I was walking through my hospital and I had a team of PICU nurses behind me. They were chit-chatting. Maybe I was being nosy.

They were saying they were only making $31 an hour. That’s equivalent to about $62,000 a year. This is in Ohio. Again, I don’t assume you’re going to make $90,000 a year. Know that it’s going to depend on the area that you are working, whether you’re doing travel assignments. All those things going to play a factor in it. I would say, set your expectation to be on an average, but start researching to understand what you can expect where you live.

I also have a cousin who doesn’t live near me, but she’s an ICU nurse. She’s in Ohio randomly, but she’s also traveled. I know in Ohio, she was making $35 an hour at another Ohio hospital as a brand new ICU nurse, which is $70,000 a year. She’s now started traveling to make more money. I got this $90,000 thing but I’m like, “I know that’s not always accurate depending on where you live.”

You’re probably wondering, “How does that compare to being a CRNA, Jenny?” You can always expect a CRNA’s salary to be at least $100,000 more dollars as a brand-new CRNA than a brand-new ICU nurse. As an ICU nurse, you’re making $70,000. As a new CRNA, you could be making right around $170,000. That’s a good rule of thumb to go by. Is it going to vary? Yes, it’s going to vary, depending again on whether you’re a 1099 or doing locums, what they call it. It’s a similar avenue to like PRN nursing or travel nursing but it’s what they call locums or whether you’re a W-2.

As a W-2, you make a little bit less. According to the survey done in 2022 and 2023 by the AANA, on the median CRNA salary, the W-2 median CRNA salary was $235,000. That was for full-time employed CRNAs. They’re making $235,000 a year. That’s over $107 an hour-ish. If you were to put in per-hour terms, $110 an hour around there. A full-time self-employed, meaning 1099 in 2022, the median was $272,000. Again, whether you’re working W-2, PRN, or locum, your salary is going to fluctuate per hour.

I always say a good rule of thumb is that a CRNA typically always makes at least $100,000 if not more than a salary compared to an ICU nurse. That wraps up the majority of this episode. I want to leave it with that, ICU nursing is hard. Being a CRNA and becoming a CRNA is hard. It’s equally incredibly rewarding. I wouldn’t get discouraged.

I started this episode with some doom and gloom but I wanted to be realistic and paint a realistic picture of what you should be expecting as an ICU nurse. It is not all rainbows and sunshine. It’s the opposite. It’s a lot of storm clouds. It builds a solid foundation because as a CRNA, while the majority of your cases are smooth sailing- when things go wrong, they go wrong quickly.

Falling back on those skills you develop as a critical care nurse, saves patient’s lives. It will save you. It will allow you to react under pressure. That is one thing that as an ICU nurse you get good at. It is dealing with pressure and dealing with critical conditions that are life and death and being able to operate in those conditions. It prepares you for that. As a CRNA, when something goes wrong, one minute is all great. The next minute, it’s not, or maybe you’re getting a crashing patient to the OR, which does happen.

You fall back on those ICU skills. It’s hard but it’s worth it. It does pay off. Make sure that you get quality over quantity, remember. Follow the ambulance to wherever they’re taking your patient. It doesn’t mean that the rural ICU experience is a no-go. You can be accepted to a serious school with rural ICU experience that is not a trauma-level designation.

However, you want to make sure that you’re still taking care of most critical patients, patients that are requiring advanced life support modalities such as CVVHD at minimum. Seeing an occasional ventilator or doing occasional vasoactive drips may not be enough given how competitive CRNA School is. The reason why people always say level one and level two is because the CRNA programs who are evaluating your resume can be certain that those are going to be high acuity units where maybe they’re a little more unsure about a rural community hospital.

Your resume has to be tip-top, meaning you have to make sure you’re clearly conveying what you have done as a rural community nurse and ICU. Again, keep in mind, if those patients that you’re taking care of are so critically sick that they have to be shipped to another hospital, it’s  probably a good indication that you’re not taking care of sick enough patients. The nurses that are getting those critically sick patients are the ones who are also applying to CRNA school.

It’s something to keep in mind. I know it’s disheartening, especially if you have to relocate and move far away to get ICU experience. The reality is that you’re probably equally going to have to move away and go to CRNA school because CRNA schools are usually in bigger cities. Maybe one of those things where you just consider relocating for the time being until done becoming a CRNA then you can move back home.

I’ve had nurses tell me that they find at the midpoint where maybe they don’t have any level one ICUs or any high acuity ICUs near them but they’re near a CRNA school. They may move an in-between point so they can still be closer to family but then have easier access to go to work. Maybe it’s an hour’s commute each way but they now have a midway point where they can make both work. I know that may not sound like realistic or even achievable. You have to know your own situation but those are things that I have heard students within CRNA School Prep Academy do to achieve their goals. I’m rooting for you. I hope you folks enjoyed. I hope you folks all become ICU nurses and then CRNAs. Until next time, take care. Bye-bye.

Important Links

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