ICU and critical care nurse staffing

Units we staff

Medical ICU, surgical ICU, cardiovascular and cardiothoracic ICU, neuro and neurosurgical ICU, trauma ICU, burn ICU, PACU and post anaesthesia recovery, and mixed ICU in community hospitals where one unit covers everything.

We also staff the step-down layer, progressive care and intermediate care, which is frequently where the actual gap is when an ICU cannot discharge.

How we screen critical care nurses

A requisition saying "ICU RN, 2 years" tells a recruiter almost nothing, and the resulting submissions waste a manager's time. We screen against the things a charge nurse would ask on the first day.

• Drips titrated independently. Vasoactives including norepinephrine, vasopressin, epinephrine and dobutamine. Sedation and analgesia. Insulin, heparin, amiodarone, nicardipine.
• Ventilator management. Comfort with modes, weaning protocols, and working alongside respiratory therapy rather than deferring entirely.
• Devices. Arterial lines, central lines and CVP, Swan-Ganz where still in use, chest tubes, external ventricular drains, intra-aortic balloon pump, CRRT, therapeutic hypothermia, and ECMO where the unit runs it.
• Unit specifics. Open heart recovery is a distinct competency from medical ICU. Neuro ICU expects a level of neurological assessment that general critical care does not.
• Certification. CCRN where the role calls for it, plus ACLS and unit specific requirements.

We ask candidates the same questions we would want asked if we were the manager, and we do not submit someone whose answer to a drip question is that they have seen it run.

Why ICU is hard to fill

Critical care has the smallest transferable candidate pool of any nursing specialty. You cannot convert a med-surg nurse into an ICU nurse over a thirteen week contract, and facilities are not paying contract rates for someone who needs eight weeks of orientation.

That has three consequences worth planning around. Lead times are longer than for med-surg. Nights and weekends are considerably harder than days. And single state licence markets such as California and New York add weeks before anyone can start, because the licence has to exist first.

We will tell you which of those apply to your requisition on the first call rather than letting it sit open.

For critical care nurses

Critical care experience is the most portable currency in agency nursing. It also means you will be asked precise questions and expected to answer them precisely.

Before your first submission, write down your ratio, your usual patient population, the drips you titrate without checking, the devices you manage independently, and your EHR history. Having that in front of you turns a fifteen minute interview into an easy conversation. Our note on preparing for a travel interview covers the format.

The question worth asking them in return is the float policy. A CVICU nurse floated to a medical floor is an expensive misuse of the assignment, and a CVICU nurse floated to a unit they were never oriented to is a licence risk. Get it named in writing before signing.