What is a Critical Care Nurse Practitioner? (Answered by an NP)

Written By: Kasee Wiesen DNP, APRN, FNP-C

Are you ready to take the next step in your nursing career? Do you like working in high-intensity settings that require quick-thinking, confidence in yourself, strong communication skills, and enjoy working with a team? If you answered yes to these questions, then you should become a critical care nurse practitioner.

The critical care nurse practitioner is a growing subspecialty for the nurse practitioner. They typically work in acute care settings, delivering care to patients who are critically sick. It is preferred to have critical care nursing experience, but if you do not, don't let that deter you from becoming a critical care NP. After graduation from NP school, there are critical care fellowship and residency programs that can be completed after your graduate program. This is to better prepare the critical care NP for their new job, environment, and scope of practice.

Below, I provide you with information about what is a critical care nurse practitioner, how to become one, and other questions you may have.

What Does A Critical Care Nurse Practitioner Do?

Have you ever wondered what does a critical care nurse practitioner do? A critical care nurse practitioner is a vital member of the critical care team. They deliver care to patients in the acute care setting and typically work in intensive care units (ICUs). They must act quickly, work well and enjoy working under stress and pressure. The critical care NP works with the interdisciplinary team to ensure all the needs of the critical care patient are met, and ensure they receive the best care possible.

Critical care nurse practitioner duties include assessing, diagnosing, treating, and evaluating patients in the critical care setting. This will include daily rounds, usually happening more than once depending on the patient's status, interpreting labs and other diagnostics to ensure the treatment plan is still appropriate, and evaluating the patient's response to the treatment plan. They consult other specialties as needed and offer services such as physical, occupational, and speech therapy. The critical care NP works closely with the nursing staff, frequently communicating with them, which will improve the care and hopefully the outcome of the patients.

Besides taking care of critically ill patients, a critical care NP will also take time to discuss the treatment plan and status of the patient and answer questions the family and loved ones may have. This takes extra time but will provide an excellent service to the family and loved ones and help them build trust in you as a healthcare team member.

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What Skills And Abilities Are Needed to Work as a Critical Care NP?

To be a critical care nurse practitioner, you need to have a wide range of skills to be successful and to ensure patients receive safe, appropriate, and well-organized care. The typical critical care nurse practitioner skills include being competent in interpreting vital signs, lab work, and diagnostic tests to determine the treatment plan. You must have a strong understanding of ventilation settings, EKG interpretation, management of IV drip medications, and other medications. Depending on the environment, you may also need to demonstrate a vital skill set in caring for patients on extracorporeal membrane oxygenation (ECMO).

As a critical care NP, you are often caring for patients in their sickest state, leading to stress, anxiety, worry, concern, and numerous other feelings from their loved ones. To be successful, you must have strong interpersonal and interprofessional skills. These skills include:

1. Communication skills:

Communication skills are a crucial aspect of healthcare delivery, specifically critical care. This is important as it will minimize mistakes and errors that may occur. Communication needs to happen between all disciplines providing care to the patient to ensure everything is being done and the best possible care is delivered.

2. Leadership:

To be a critical care NP, you must demonstrate leadership skills. The critical care NP is often providing direction in stressful and high-intensity environments. Therefore, leadership needs to be displayed to gain the trust, confidence, and support from the health care team and the family and loved ones of the patient. You need to be quick thinking and work well under pressure and stress.

3. Teamwork:

Teamwork ties hand in hand with communication and leadership skills. A single person is not able to deliver efficient, appropriate, and beneficial care to the patient. Therefore, it takes a team of health care providers to ensure all aspects of the patient’s health are met. This is when the NP needs to step forward, take leadership and ensure all disciplines work together to provide the best care possible to the patient.

Lastly, the critical care NP must always want to build on their knowledge and professional development. This is done by completing CEUs and voluntarily seeking publications, webinars, conferences, and online learning opportunities to build on their knowledge and stay current with evidence-based medicine.

Where Do Critical Care Nurse Practitioners Work?

Critical Care NPs work in the acute care setting, primarily in intensive care units (ICU), emergency departments, and other units that deliver care to critically ill patients. This may include cardiac, pulmonary, trauma, medical-surgical, and neurology ICUs. Therefore, most of these jobs are in larger cities or hospitals that offer various services to the patient. The critical care NP can deliver care to either adults or pediatrics depending on the board certification exam passed.

What Is The Typical Work Schedule For A Critical Care NP?

The typical work schedule for a critical care NP consists of 12 hour days, three days a week in the inpatient/critical care setting. This may vary among the hospitals and could include four 10-hour days or five 8-hour days. The critical care NP will often have to work weekends and holidays, just like a critical care nurse. Depending on the hospital, they may also work overnight shifts.

What Is The Difference Between Critical Care NP And Critical Care Nurse?

There are differences between the critical care registered nurse (RN) and the critical care nurse practitioner. This is due to the difference in education and scope of practice.

The critical care RN is often referred to as an ICU nurse since the primary setting they work in is the ICU. They are at the bedside of critically ill patients 24 hours a day. They assess patients, initiate treatment plans, and work closely with the doctors, advanced practice providers (NPs and PAs), and other healthcare services to ensure all patients' needs are met. The critical care RN must have excellent communication skills as they update the provider on how the patient is doing and notify if there is a change in their status. They may also suggest possible consults such as palliative or therapies for the patient and help coordinate the care between all specialties and services involved. The critical care RN also communicates frequently with the family, updating them on the status of their loved ones, answering their questions, and providing support to them as needed.

Becoming a critical care nurse practitioner leads to a greater scope of practice and builds on the RNs role. A critical care NP can assess, order and interpret diagnostic tests to determine a diagnosis and then initiate treatment as needed. They work closely with the nurses, respiratory, physical therapy, occupational therapy, and other services to receive updates on the patient, make adjustments to the treatment plan as needed, and ensure everything is done to improve the patient's health. They also consult and work closely with other specialties to ensure all needs of the patient are met. They also take time to answer the family and patient's questions and provide education and support as needed.

Pros And Cons Of Becoming A Critical Care Nurse Practitioner

One of the pros of becoming a critical care nurse practitioner is the environment. Most critical care NPs work in ICU-like settings, leading to fast-paced, high-intensity, and quick-thinking situations throughout the day. You also will get the opportunity to work closely with the interprofessional team and other healthcare providers. The patients are sick, meaning they need support and care from multiple specialties and services, including nurses, physical therapy, occupational therapy, speech therapy, respiratory, dietary/nutrition, and care management. You will also work with other specialties, including neurology, cardiology, nephrology, pulmonology, hematology, infectious disease, and many others based on the patient’s problems and condition.

For some people, this may be viewed as a pro and others as a con. Since you are primarily working with critically ill patients, you will not typically deliver care to them for weeks and weeks. The patient population is constantly changing in the acute care setting. You will still develop a relationship with the patient, their family, and loved ones; it just may not be to the degree of other medical providers such as family practice or other outpatient services who manage patient’s care over months to years.

I do not like to think there are cons to becoming a critical care nurse practitioner, but you must have passion and drive to pursue this career path. The critical care NP will most likely work some weekends and holidays, depending on where they work. Their days may be longer based on the status of their patients. They will be working with critically ill patients, leading to difficult conversations that may need to happen with the patient’s family members and loved ones. Patience, kindness, listening, and communication with the family during these times is helpful for both the patient and their family.

How Long Does It Take To Become A Critical Care Nurse Practitioner?

A couple of factors influence the length of becoming a critical care nurse practitioner. Getting your Bachelor of Science in Nursing (BSN) typically takes four years and your Masters of Science in Nursing (MSN) NP degree takes on average 2-3 years to complete. If you choose to pursue a terminal degree such as a Doctorate in Nursing Practice (DNP), this will be another 2-4 years. Therefore, it can take 6-7 years to obtain your MSN-NP degree or 6-8 years to obtain your DNP. These numbers are all variable on whether you attend full-time or part-time. If you’re choosing to pursue your DNP, the length is also influenced by whether you take the BSN-to-DNP or the MSN-to-DNP route.

Regarding specifically becoming a critical care NP, on average, it will take between 6-8 years to complete schooling. Some NPs, depending on their bedside RN experience, may get a critical care NP job out of school. Others will attend a one-year fellowship or residency program focused on critical care. Others will work for 1-2 years, achieve their critical care NP certificate from the AACN and then start their critical care NP job.

How Much Does It Cost To Become A Critical Care Nurse Practitioner?

The cost of becoming a critical care nurse practitioner is dependent on several factors. First, you must obtain your BSN, which is a four-year degree. On average, obtaining your BSN will cost $40,000-$200,000, depending on the school and program selected. Another way to get your BSN is to complete an Associate's Degree of Nursing (ADN) first and then graduate from an RN-BSN program. This second route may be less expensive.

After graduating with your BSN and passing the NCLEX-RN, you must select a graduate program to complete. The average cost of obtaining an MSN-NP degree is $81,810 to $185,280. Getting your DNP will be an added expense, as it is more school. There are two ways to achieve this. You can attend a BSN-to-DNP program with an average cost of $26,490 to $254,260 or an MSN-to-DNP program with an average cost of 17,660 to $169,510.

The cost of all of these programs will depend on whether you choose a private or public university; if you attend an in-state university or out-of-state, as out-of-state tuition will be more expensive; and last, if you attend full time or part-time.

Step-By-Step Process Of Becoming A Critical Care Nurse Practitioner

There are multiple steps necessary to become a critical care nurse practitioner. These steps include obtaining a BSN degree from an accredited university and then applying and graduating from an NP program. Next, you must become board certified, licensed in your state of practice, and accept a position as a critical NP. Below, I have listed, in more detail, the steps necessary to become a critical care NP.

1. The first step to becoming a critical care NP is obtaining your BSN.

This is a requirement before applying and starting graduate school. You may complete your BSN through a traditional four-year program. You can also get your BSN by completing an associate’s degree (ADN) and then going to an RN-to-BSN program. Regardless of the path you choose, to apply for graduate school, you must have a BSN degree and an active RN license before applying to graduate school.

2. Practice as an RN at the bedside for a couple of years.

This is important, as it will build your skills, confidence, and knowledge of nursing. It will also help you narrow down the path you wish to pursue in graduate school.

3. Choose a graduate school or schools you want to apply to and review their pre-requisites.

If you are missing any of the pre-requisites, complete them before applying to NP school. Schools will be less likely to accept you if you have not completed the pre-requisites before submitting your application.

4. Apply, attend and graduate from NP school.

5. After graduating from NP school, you must pass the board certification exam for the program you completed.

Your school should help ensure you apply to sit for the correct board certification exam. If you are seeking dual certification, you must pass both exams.

6. After becoming board-certified, apply for licensure in the state you will be employed.

Please remember that you must have an active RN license in the state you are seeking licensure. Once you obtain your NP (also known as advanced practice registered nurse (APRN)) license, you will have to maintain both the RN and APRN licenses. Refer to your state board of nursing for specific information regarding licensing and renewal of your licenses, as it may vary from state to state.

7. Apply for critical care nurse practitioner jobs.

This may also require you to complete various certifications based on the requirements of the job.

8. Accept your new position as a critical care nurse practitioner and enjoy!

9. Obtain critical care certification(s):

This step may need to occur before step 7. Some NPs may choose to obtain the certification(s) before applying for a position, and some jobs may require it. It is important to note that some positions will allow the critical care NP to obtain their certification(s) during the first 6-12 months of practicing. Regardless, it is essential to get the appropriate certifications for critical care NP. Below, I have discussed four different certifications that may be required—please be aware there are other certifications your employer may want before starting your new job as critical care NP.

10. Obtain a terminal degree if you choose.

For those interested in pursuing a terminal degree, completing a DNP program may be a great option. There are many options in obtaining this degree, and it provides additional leadership skills and learning the importance and how to apply evidence-based medicine into practice. If you are interested in teaching at the university level, this may also be the best option, as many schools require your doctorate to teach.

Top Critical Care Nurse Practitioner Programs

A critical care NP is considered a subspecialty of a broader category of NP that requires board certification. In other words, there are not necessarily specific programs dedicated to becoming a critical care NP. Some nurse practitioner specialties to consider include

• Adult Acute Care
• Adult-Gerontology Acute Care
• Pediatric Acute Care

Once you complete these degrees and become board certified, there are various programs you can complete to enhance your knowledge in critical care. Below I have listed one of these programs, and further in the article, I discuss various residency and fellowship programs to become a critical care nurse practitioner.

• Columbia University New York: The Columbia University critical care NP program is a 12-month program. It is required that you have graduated from an MSN program with a specialty in acute care, and highly recommended you have one year of experience before applying. The program is dedicated to preparing you to practice as a critical care NP and deliver high-quality, efficient care.

Recommended Certifications to Enhance Your Job Role As A Critical Care NP

To become a critical care NP, there are a few certifications that will enhance your job role as a critical care NP.

Certification from the American Association of Critical-Care Nurses (AACN):

The AACN currently offers 15 certificates for the critical care nurse, dependent upon the specialty area of work. Some examples include a critical care certification for the adult, pediatric and neonatal population. They also offer critical care certifications for progressive care units, cardiac surgery, and teleICU. The acute care NP certification is geared specifically at the adult acute care NP. NPs with this certification demonstrate their knowledge, passion, and competence in delivering care to the adult patient in the critical care setting.

Basic Life Support (BLS):

For most health care jobs, BLS is a required certification. It provides education on how to deliver cardiopulmonary resuscitation (CPR), use of an automated external defibrillator (AED), and care for a person who may be choking or has an airway obstruction. These skills are taught for both adult and pediatric patients. You must renew every two years.

Advanced Cardiovascular Life Support (ACLS):

Advanced Cardiovascular Life Support is required for most healthcare professionals working in an acute care setting, regardless if it is a critical care unit or not. ACLS is for those caring for adults or may care for adults and builds on the information learned in BLS. It teaches you recognition and early management of various acute events, including respiratory and cardiac arrest, cardiac arrhythmias, airway management, and stroke. It also details medications given to these patients, managing shock, and stresses the importance of communication to care for critically ill patients successfully.

Pediatric Advanced Life Support (PALS):

Pediatric Advanced Life Support is required for most healthcare professionals delivering care or may provide care to the pediatric population in the acute care setting. PALS builds on the knowledge learned in BLS. It will teach you how to deliver high-quality CPR to the infant and child, identify and manage cardiac arrhythmias in patients, and post-cardiac arrest management. PALS will also educate on identifying respiratory distress versus failure, managing respiratory distress and failure, identifying cardiopulmonary arrest quickly, and treatment. Lastly, it will teach identification treatment of shock along with the importance of effective communication between the team members to improve outcomes in the patient.

List Of Fellowships & Residency Programs For Critical Care Nurse Practitioners

There are numerous fellowship and residency programs available for those who want to become a critical care NP. The majority of programs are dedicated to the population served, whether adult, pediatric, or neonate. Below, I have provided information on two programs dedicated to the aspiring adult critical care NP.

• Mayo Clinic Minnesota:

The Nurse Practitioner of Physician Assistance Critical Care Fellowship is a 12-month program directed towards NPs or PAs pursuing a career path in critical care. The intensive curriculum will prepare the advanced practice provider (APP) in delivering high-quality, comprehensive care to the critically ill.

• Emory University:

Emory University offers a critical care post-graduate residency program for both NPs and PAs. The program is 12-months long and is geared towards extensive training of the APP to be competent, confident, and prepared to deliver care to critically ill patients. This residency will allow the APP to obtain experience in various settings, including the surgical ICU, cardiac unit, and operating room.

Continuing Education Requirements For Critical Care Nurse Practitioners

Continuing education requirement (CEU) hours are required for most, if not all, health care professionals. The specifics regarding the number of hours needed for your degree and license are determined by the state you are licensed and practice. It is important to note that if you are licensed in more than one state, you must pay attention to the CEU requirements in both states.

CEUs are, again, determined by the state you are licensed. You must complete CEUs for both your RN and your NP (APRN) license. There is some overlap in the education accepted between the two licenses. The APRN may require more specific and advanced hours due to their scope of practice. Many states require a specific number of pharmacology-based CEUS and CEUs dedicated to prescribing controlled substances. If you hold certifications, such as an acute care RN or NP, you may have to complete specific CEUs to maintain the certification.

As I have stated above, to maintain an active APRN license, your RN license must remain active as well. Therefore, when relicensing, refer to the state guidelines for NP and RN state license requirements. For specific information regarding the CEU requirements for your state of practice, visit your state board of nursing website.

Starting Salary of A Critical Care Nurse Practitioner

If you want to become a critical care nurse practitioner, you are probably wondering, what is the starting critical care nurse practitioner salary? For a new graduate critical care NP, the average starting salary is $36.62 per hour or $76,160 a year for those working 40 hours a week. Again, this number is an average and is influenced by the city and environment you work in. Years of experience as a registered nurse may impact the average starting salary, especially if you have critical care RN experience.

Per Hour	$36.62
Per Month	$6,350
Per Year	$76,160

Average Salary of a Critical Care Nurse Practitioner

Above, I discussed the average starting salary of a critical care nurse, which has probably piqued your interest regarding what is the average salary of a critical care nurse practitioner? The average critical care nurse practitioner salary is $50.30, which leads to $104,634 annually for those who work 40-hour weeks. As I stated above, these numbers can change based on where you live and how the environment worked.

Per Hour	$50.30
Per Month	$8,720
Per Year	$104,634

Job Outlook for Critical Care Nurse Practitioners

The job outlook for critical care nurse practitioners is optimistic, regardless if you care for pediatric or adult patients. Advancements in medicine are always happening. This will lead to successfully managing critically ill patients, leading to a greater demand for critical care providers. There is a shortage of physicians, and nurse practitioners can help fill this void. As medicine continues to advance, the ability to successfully care for and treat critically ill patients is advancing as well. Many years ago, there were only general ICUs in hospitals, and now, larger hospitals have individual ICUs based on the patient's needs. This, again, supports the promising job outlook for critical care NPs.

Useful Organizations & Associations

American Association of Critical-Care Nurses (AACN):

The AACN is an excellent resource for the critical RN or NP to build confidence and competence in delivering care to critically ill patients. I have briefly discussed the AACN above, specifically the 15 certifications they offer for the critical care nurse or nurse practitioner. They also provide a variety of educational opportunities, including webinars, CEU activities, and online courses. There are also publications available for you to read to build on your knowledge and skills.

AACN Career Center:

The AACN is a component of the American Association of Critical-Care Nurses. This resource allows the RN or NP to search for open critical care jobs in their area. This is an excellent tool as it helps narrow down the job search and helps the NP find the perfect critical care job.

Finally, Is Critical Care Nursing The Right NP Specialty For You?

I hope the article above answers the question, what is a critical care nurse practitioner? This sub-specialty for a nurse practitioner can be intense and adrenaline-filled due to the population served. There are steps that need to be taken to prepare you to be competent, confident, and successful as a critical care NP. Becoming a critical care nurse practitioner is a rewarding career path for many NPs and can lead to high job satisfaction as you care for patients in some of their sickest states and provide many positive outcomes for the patient and family.