Roles: Critical-care nurses practice in settings where patients require complex assessment, high intensity therapies and interventions,

and continuous nursing vigilance. Critical-care nurses rely upon a specialized body of knowledge, skills, and experience to provide care to patients and families and create environments that are healing, humane, and caring. Foremost, the critical-care nurse is a patient advocate. Critical-care nurses work in a wide variety of settings, filling a variety of roles. They are bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse specialists, and nurse practitioners. With the onset of managed care and the resulting migration of patients to alternative settings, critical-care nurses are now called upon to care for sicker patients more than ever before. Managed care has also fueled a growing demand for advanced practice nurses in the acute- and critical-care setting. Advanced practice nurses have received advanced education at the masters or doctoral level. In the critical-care setting, they are most frequently Clinical Nurse Specialists (CNS) and Acute-Care Nurse Practitioners (ACNPs). They demonstrate a high level of independence and in many states, they are now eligible for direct financial reimbursement, just like physicians. A CNS is an expert clinician in a particular specialtycritical care in this case. The CNS is responsible for the identification and intervention of clinical problems and in the management of those problems to improve care for patients and families. They provide direct patient care, including assessing, diagnosing, planning and prescribing pharmacologic and non-pharmacologic treatment of health problems. ACNPs, in the critical-care setting, focus on making clinical decisions related to complex patient care problems encountered in the acute-care setting. Their activities include health history and risk appraisal, interpretation of diagnostic tests and providing treatment, which may include prescribing medication. Critical care unit An intensive care unit (ICU), critical care unit (CCU), intensive therapy unit or intensive treatment unit (ITU) is a specialized department used in many countries' hospitals that provides intensive care medicine. A specially equipped hospital area designed for the treatment of patients with sudden life-threatening conditions. CCUs contain resuscitation and monitoring equipment and are staffed by personnel specially trained and skilled in recognizing and immediately responding to cardiac and other emergencies. Critical Care Team The critical care team includes a diverse group of highly trained professionals who provide care in a specialized area known as the intensive care unit (ICU). This team works toward the best outcome possible for seriously ill patients. All members of the team may be asked to teach patients and their families various strategies to improve health, healing, coping, and well-being specific to their area of expertise. Members of the team include: Intensivists Physicians who are board-certified or board-eligible in a medical specialty, such as surgery, internal medicine, pediatrics, or anesthesiology, and who also receive special education, training, and subspecialty certification, specifically in caring for critically ill patients. Intensivists may be assigned to the ICU on a full-time basis and work with other critical care team members to provide their patients with ongoing and consistent care. These physicians know and understand how specific treatments affect all the organ systems, avoid duplication of procedures and medications, and honor the patient's preferences regarding medical treatment as well as end-of-life care (when appropriate). Intensivists may also coordinate the administrative environment of the ICU by setting policies, developing protocols, and facilitating communication among primary care physicians, specialists, patients, and their families. Critical Care Nurses Critical care nurses provide a high level of skilled nursing for total patient care and often facilitate communication among all of the people involved in the care of the patient. Their expertise and continuous presence allows early recognition of subtle but significant changes in patient conditions, thereby preventing worsening conditions and minimizing complications that arise from critical illness or injury. Because of their close contact with the family and the patient, critical care nurses often serve as the patient's advocate and become integral to the decision-making process of the patient, family, and critical care team.

Additionally, some critical care nurses are recognized as a "CCRN." They have received more specialized education, training and testing and are certified by the American Association of Critical Care Nurses. Pharmacist or Clinical Pharmacologist A pharmacist or clinical pharmacologist is a board-certified or board-eligible specialist in the science and clinical use of medications. The pharmacist with specialty training in the ICU is equipped in recognizing the needs and problems specific to the critical care patient. These specialists work with members of the health care team to foster effective and safe medication therapy. Registered Dietitian A registered dietician is a vital part of the medical team that consults with physicians, nurses, therapists, and family members in the ICU. The registered dietician works to improve the nutritional health and promotes recovery of the critically ill or injured patient. Social Worker A social worker is a licensed professional that works with the ICU interdisciplinary team to provide a link between treatment plans for the critically ill or injured patient and family members. Special knowledge that is acquired through formal, professional social work education, welfare policies and services, and social welfare systems and community resources guide the practice of social work. Respiratory Therapist Respiratory therapists work with the critical care team to monitor and assist with airway management of the critically ill patient. This may include: oxygen therapy, mechanical ventilation (breathing machine) management, aerosol medication therapy, cardio-respiratory monitoring, and patient and caregiver education. Physical Therapist or Occupational Therapist The physical therapist provides services that restore function, improve mobility, relieve pain, and prevent or limit permanent physical disabilities. The occupational therapist is trained to make a complete evaluation of the impact of the disease on the activities of the critically ill patient at home, in work situations, and during recreational activities. Both therapists work cooperatively with other disciplines of the health care team to reduce physical and psychological disability of the patient. Physician Assistants, Nurse Practitioners Physician assistants and nurse practitioners are licensed professionals with advanced training who provide clinical services in the ICU under the supervision of the intensivist. As part of the critical care team, they conduct physical exams, diagnose and treat illness, write orders, interpret tests, and perform procedures. They may be the first responders to assess changes in a patients condition and initiate therapy when the intensivist is not immediately available. Responsibilities may also include answering patients family's questions, providing some teaching responsibilities for the physicians-in-training on rotation in the ICU, and interacting with other health care professionals, such as the patients primary physician, consultants, pharmacists, respiratory therapists, and nutritionists. Hospital Chaplain The hospital chaplain is available to provide pastoral care to the critically ill patient, family members, and staff. The chaplain is available to provide objective crisis intervention and spiritual support. Chaplains may also serve to assist in locating a clergy member of a specific denomination to better meet the patient and family's spiritual needs. Child Life Specialists Child life specialists are licensed professionals who work specifically with children to assist in their recovery from illness. They provide play therapy and distraction therapies for painful procedures. These specialists will work together with other disciplines in the pediatric ICU to help improve the health and well-being of critically ill children.