ICU Nursing in America

ICU (Intensive Care Unit) nurses are highly trained and specialize in caring for patients with life-threatening illnesses or conditions. As patients in the ICU require frequent attention and a high level of care, it’s crucial that nurses trusted with their care be able to think and act quickly under pressure. Global Nurse Partners interviewed Christine, an ICU nurse with over a decade of experience in critical care nursing, to look at a day in the life of an ICU nurse in the United States.

Christine began her nurse education and experience in the Philippines, where nurse education is modeled closely after American nurse education due to the long-term influence of colonization. Part of Christine’s education included a requirement to spend a year in medical-surgical nursing, which sparked her interest in ICU nursing. “The care I give to my patients is much more intensive. When you see them at their worst, you wonder how they’ll make it. It’s really satisfying to see them improve,” she explains. After three years in the ICU in the Philippines, Christine went on to spend 16 years working in the United Kingdom as an ICU nurse but found “the UK felt so different, even terminology and the spelling of medical terms…I adapted, but I still wanted to go to the US.” In 2016, Christine moved to the United States and currently works in an ICU in the Midwest.

A Day in the Life of an ICU Nurse

As a night shift nurse, Christine begins her workday at 7 pm. Christine notes that in the UK, she couldn’t choose to work day or night shifts; shifts are mixed with few exceptions. She values being able to keep a consistent schedule in her current position as, “I have two kids, and my husband works a day shift, so it’s convenient for me to work the night shift.”

Her shift begins with a shift report from the day nurse on her two patients. Here she notes another major difference from her years as a nurse in the UK, where the ICU patient to nurse ratio is 1:1. Christine says that going from one patient to two patients was challenging, but in the US, she has the additional help of respiratory therapists and a pharmacy in-hospital that calculates and mixes medicine, compared to her UK position where nurses were responsible for mixing medicine.

After the shift report, Christine begins assessing her patients and administering medicine. Sometimes she might have to transfer a patient quickly to get them from the ER to the ICU or calm a confused patient who’s trying to get out of bed. As a neuro ICU nurse, the bulk of Christine’s shift is spent taking care of patients on ventilators, monitoring intravenous drips (IVs), continuous renal replacement therapy machines (CRRTs), and external ventricular drains (EVDs). Christine acknowledges it can look and feel like chaos at times, but “teamwork in the ICU is always high. We have a team leader on the shift, we have respiratory therapists, and we can ask for help. I enjoy how our team works together.” Christine sometimes takes shifts in another ICU and says the teamwork there is outstanding as well. She adds, “People are very helpful. You won’t be left drowning.”

Christine’s shift runs until 7 am the next morning, with no paid break. In the UK, the night-shift has an hour-long paid break, whereas Christine has to clock out and clock back in on break in the US. Even with this difference, she prefers the American system, specifically the emphasis on compensation for hard work. In the US, any time over 40 hours in your work week is considered overtime, meaning you’ll receive 1.5 times your usual hourly rate of pay for those hours. Christine adds that nursing is well-compensated in the US compared to the UK, including extra bonuses, sometimes even triple bonuses, when short-staffed.

Advice For New Nurses Considering ICU Nursing

Working in the ICU can be a big pressure if you’re inexperienced, and you might feel disorganized if you’re not used to it. The stress is high, but it’s a great place to learn and gain an even greater appreciation for nursing. “You just have to embrace the intensity,” Christine says. “You have to expect to have a lot to learn and to know how to manage your time and how to prioritize your care for two very sick patients.”

Her biggest piece of advice? “Always do your best for your patients.” 

Step Forward With Expert Support

Are you interested in expanding your nursing career in the United States? Global Nurse Partners brings internationally experienced nurses and US healthcare facilities together for permanent positions and supports their employment relationships throughout the process. Learn more about our partnership program and opportunities for international nurses here.