How to: Become a Critical Care Nurse

As someone who wanted to become a critical care nurse and a critical care nurse ONLY (I was hellbent on it you guys,) I did lots of research about what that would mean for me and my future.

I’ve seen tons of articles that oversimplify the process of becoming a critical care nurse. These articles give you a list of “steps to take,” which often includes things like “go to nursing school, get your degree, apply, get certified.” While these are no doubt important and necessary steps, these lists can also seem a bit daunting (and not really that helpful) for someone who is just starting out.

So here’s my list on how to become a critical care nurse. It includes the best advice I’ve received over the years, as well as the things I’ve seen work (and not work) while trying to achieve this goal.

Let’s start by taking a deep breath and taking it from the top. You got this!

Nursing Education

It goes without saying that you need a degree – whether that be an ADN, BSN, or MSN – in order to be a critical care nurse. You obviously also need to pass the NCLEX. Easy peasy, right? Not really,  but choosing the right nursing program for you is definitely important, and it’s definitely doable – no matter how hard people tell you nursing school is.

I knew I wanted to be an ICU nurse before I even got to nursing school. So I was advised to do two major things that made a HUGE difference when it came time to get a job.

One of those things was to get the best grades I possibly could.

I know what you’re thinking. Do nursing school grades even matter if you’re passing your classes and pass the NCLEX? Not really – unless you’re going into a highly competitive specialty. I was told by several clinical instructors that the one exception to this rule comes into play when applying for ICU positions. So I worked my tail off to get the A instead of the A minus and build an impressive academic transcript.

Does this mean you have to put tons of pressure on yourself and graduate with a 4.0? No, but if you think about it, it makes sense to take the applicant with a strong GPA. Critical care is HARD. Having a strong academic background shows you are up for the challenge, are a hard worker, and are able to apply yourself. These skills are all important, because you will be taking LOTS of classes and learning LOTS of new skills as a new critical care nurse.

During my final year of nursing school, we were asked to rank our desired specialties in order to determine where our final, year-long clinical experience would be. How did they choose who got what? You guessed it: Grades (and a bunch of other things obviously but grades was the biggest for critical care areas.)

Another way you can make yourself stand out? Volunteer or extracurricular experiences!

The second thing? Two words: Clinical Experiences.

Gaining experience in critical care during nursing school was easily the number one factor in securing a job as a new grad in the ICU. 

One of the reasons I keep harping on choosing a nursing program that aligns with your goals is because of clinical experiences. Where you do them and the specialties you have (or don’t have) exposure to are heavily impacted by your nursing programs relationship with the surrounding community. Your clinical experiences can immensely help you get to where you want to be.

I chose a well-respected, well-known, well-connected school where most students had jobs before graduating. This school supported me and helped me get a year-long preceptorship in critical care, which meant I had a year of critical care experience before even graduating. This was actually a requirement when applying to several critical care new grad programs, as the expectation is that you already have some exposure to critical care before applying. Why? Because there is a certain “sexiness” to critical care. Lots of people love the idea, but once they’re actually there, things change. This is why it’s so important to get the exposure to critical care before you end up working there.

I had a year of making connections with leadership members, peers, and preceptors. This involved sitting in on every meeting I could, introducing myself to (and helping) everyone I could, and trying to go above and beyond. Treating everyday like an interview and pretending I was getting paid made such a big difference. Between school and these (night shift) clinicals multiple times a week, I was exhausted. It was brutal! But I knew it would get me to my end goal and that it was all temporary.

So what happens if you don’t have the opportunity to get clinical experiences in critical care? You have a few options.

1) During nursing school, get a job as a volunteer or a nursing assistant in a critical care setting. Work hard and make connections with your managers and coworkers, and you will have priority as an internal candidate when it comes time to apply.

2) If you can’t get a job or can’t work during nursing school for personal reasons (I was in this camp so I totally get it,) you can still apply for critical care positions upon graduation. Really emphasize your academics, your extracurriculars, your passion for critical care, and work on nailing your interview. However, since those with critical care experience are heavily favored, you should still apply to PCU or IMU settings and plan on transferring to ICU when a position becomes available.

3) What if you’re already a nurse and want to switch to critical care? Again, make connections and keep an eye out for “new to ICU” or “transition to ICU” postings. In the meantime, take the time to beef up your resume and take on leadership roles (think resource, charge, being involved in special committees, etc.) Start thinking about why you want to work in critical care and how your experiences will benefit you in this new position.

4) Ask around and see if any providers are open to the idea of you shadowing them. I actually initially became interested in critical care after shadowing a cardiac NP who worked in an ICU setting. She was amazing, taught me so much, and genuinely loved her job – all things that made me even more excited about critical care.

What’s even more important than having opportunities to be exposed to critical care? Creating opportunities for yourself. The nursing world can be very small, so now is not the best time to be on bad terms with any of your clinical or academic instructors. Make connections everywhere you go, be kind to everyone, and treat everyday like an interview.

The Interview(s)

Critical care positions are highly sought after and highly competitive. I say this not to scare you but to say that your charisma may not be enough to nail your interview. Check out this amazing list of over 100 possible interview questions here. I felt extremely prepared for all of my new grad ICU interviews thanks to that list (and because I am a chronic over-preparer, but it worked out.) This meant having a neat, organized portfolio, doing research on the hospital I was applying for, bringing a copy of my resume, and asking the right people to write recommendations for me.

My recommendations came from a mix of academic and clinical instructors, at least one of which also worked in a critical care setting and/or had a leadership role. Try to choose a wide variety of people who can speak to different perks of your wonderful personality and work ethic!

ICU nursing involves making rapid, evidence-based decisions in high stress situations. During your interview, your interviewers want to know that you can work as part of a team, take direction from others (which is especially important in emergency situations) and are teachable. You don’t have to know everything, but you do have to be adaptable, flexible, and willing to admit when you are wrong. Trust me when I say that you don’t want to be that person who acts like a know-it-all. Show that you are not afraid to ask questions and that you’re okay with not being the smartest person in the room. You can always learn new things. If you emphasize your desire to learn and grow (instead of rattling off all the advanced degrees you plan on getting after you get your years of critical care experience,) you will do great.

You got the job! Yay! Now what? How do you become a GOOD critical care nurse?

Once you’ve nailed the job interview and landed your first critical care job, you should consider doing a few things.

• Stay on good terms with your coworkers and management. Help out your friends when they’re drowning, and remember that nursing friendships are truly the best. You will never be closer than you are with your critical care buddies.
• Think about joining committees. Joining a unit based practice council really helped me identify what the unit was lacking and think of ways to fix it. It was also a great way to bond with coworkers and management and come up with creative solutions.
• Consider getting certified. Though this might bring you a salary bump and be a good resume booster, the main reason I encourage this is to educate yourself. There will always be something to learn in critical care. Educating yourself will help you feel more confident at work.
• Keep learning and asking questions. Always.
• Once you feel more comfortable (this might take a few months or a few years,) don’t be afraid to start pursuing leadership roles. Challenge yourself by taking on a resource nurse or charge nurse role, or even just advancing your skills so you can take care of patients with more complicated devices.
• Don’t be afraid to take on new roles if critical care is not for you. Trust me when I say that critical care nurses are burnt out for a reason. It is a hard, emotionally draining job. If it’s been a few years and your job is impacting your personal life, that is not normal and not okay. If you’ve tried other coping strategies and had a true heart to heart with yourself, know that you can still be in a critical care setting without being an ICU nurse. Having critical care experience opens up a ton of doors for you, so don’t be afraid to walk through them.

Still need some help figuring out how to become a critical care nurse, or can’t seem to get to the interview stage? E-mail me using the “contact” page and we can chat about it!