Critical-care nurses, CCRNs, are those who handle the more acutely ill patients at a medical facility. This discipline is one of the most challenging, and requires all aspiring nurses to continuously develop the special skills that come with its focus.
Data show that not only has the number of critical-care nursing degrees grown by 18.5 percent in 2017, a significant majority have a master’s degree. Nurses who are not only interested in being on the front lines of patient care but also have the hard and soft skills to handle the increasing demands will reap the benefits.
There’s definitely more to this specialization than what is shown in popular TV shows.
Demand for critical-care nurses
To understand the demand for critical-care nurses, it’s important to realize that while all nurses in the Intensive Care Unit, ICU, are CCRNs, not all critical-care nurses are in the ICU. ICU nurses get the bulk of the attention, thanks for shows like ER. Trauma centers and burn units are a couple of the other areas where critical-care nursing professionals are vital.
These are highly trained registered nurses whose job is to de-escalate the situation and help patients survive. Patients that need to be ventilated, intubated, or put on necessary medication in order to go to the ICU have to pass through the hands of these professionals.
Apart from administering medications, ICU/CCU nurses get to collaborate with other healthcare professionals, educate families about patient diagnosis, track life support and provide compassion and support to critically ill patients. Within this type of nursing there are related subspecialties, including cardiothoracic, psychiatry, and oncology, that play significant roles in supporting their patients through their illnesses.
Intensivist nurse practitioners
Intensivists are board-certified physicians that work exclusively within critical care units with a specific focus. Certified acute care nursing practitioners, ACNP, are also intensivists who provide comprehensive critical care. They team up with their MD counterparts to provide round-the-clock coverage for unstable, critically ill patients. With a pronounced shortage of intensive care specialists, it’s been tough to fill the gap. Qualified ACNPs provide the level of specialized intensive care that can lead the efforts to improve the footprint of critical care medicine and provide cutting-edge treatments.
When looking at the projections within the profession, it’s clear the hospitals and many other medical facilities are looking for critical-care nurses with an average of between one and three months of on-the-job training, while some will even take candidates with less than a month of training. For entry-level opportunities, RNs with at least an associate’s degree are considered to have the minimum. Almost half of the nurses have that, but there is almost as much demand for RNs with a bachelor’s degree, which may indicate that expectations may be shifting upward. CCRNs with post-baccalaureate certificates only account for 4.5 percent of nurses, but that could increase significantly within the next few years.
By 2018, critical-care nurse job growth saw an annual average increase of 2.57 percent. This sector has a 99 percent employment average and vacancies across the sector have also been increasing at 2.4 percent. Increasing levels of technology that come with diagnosing and treating patients goes a long way to improving the prospects. When technology becomes a complement to workers, demand increases. Data and medical device integration are becoming necessary and nurses with skills that utilize technological innovation to optimize patient care will see their prospects open up.
Other factors that affect ICU nurse demand
The number of qualified CCRN available to meet demand can be tricky to predict as historical data is based on previous events that may not be repeated or current events that may not have been immediately foreseen. There are two reliable factors that can feed on each other affecting overall demand for critical-care nurses.
During times of economic downturn, businesses tend to cut jobs as a means of survival, and hospitals are no exception. Prior to 9/11, there was a significant dip in the sector as medical personnel were experiencing layoffs. Seeing this trend, students who were going into nursing school changed their plans, reducing nursing school growth. After 9/11, healthcare institutions broadcast a shortage of qualified nurses, which spurred enrollments. The trend has stayed steady, even through the 2008 financial crisis. The economy has historically had both expected and unexpected effects on the demand for nurses.
The number and rate of retiring nurses also affect demand. As we get closer to 2030, many critical-care nurses will be eyeing retirement and many of them will be nurse educators. This leaves a gap between those who actively practice the profession and those who prepare nurses for the workforce. Reduced resources like this could spike demand across all subspecialties.
Starting salaries for critical-care nurses
When you look at the expected benefits for CCRN professionals, there are a wide array of salary ranges from close to $60,000 a year to $75,000 and higher. There are a few factors that are going to affect nursing salaries and the perks that they can bring.
- Experience: Nurses getting into critical care have a few months of experience, and in many cases, they can earn between $55,000 and $65,000 annually to start. However, those with more experience can see at least 10% more in their pockets, especially if they have mastered the intricate skills that come with the job, such as readily recognizing a deteriorating patient. Nurses with rapid response, RRT, experience can reduce patient mortality by 40%. This means being able to interpret abnormal signs, getting help fast, and taking steps to prevent further spiraling. Enhancing these skills would make aspiring critical-care nurses more confident and competent in the eyes of their employers and colleagues. On average, annual salaries for nurses with RRT experience can start at over $65,000.
- Geography: Not all states have the same level of demand for acute care nurses. There are some that have an overflow while others have severe shortages in certain specialties. In the regions where supply outpaces demand, medical facilities can pick and choose. Facilities that have a shortage of qualified professionals will offer additional incentives on top of a fixed salary to better accommodate for costs of moving and living.
- Education: There are a couple of ways education factors into critical care. Training plays an obvious part in boosting CCRNs just as experience does. The quality of education, however, has its own effect. Schools that have deeper hands-on training and practical skills will graduate nurses who are more ready to move from academia to the working world. Nursing students with advisers and preceptors provide a good bridge learning what to expect from their licensing exams and getting ready for the rigors of the profession.
Lucrative critical care specialties
For nurses looking for more challenging or autonomous opportunities that are lucrative, here are a couple of considerations:
Travel nurses: Like regular CCRNs, they provide critical care for patients with vitals or are recovering from illness or injury. They deal with specialized equipment and can work in trauma centers as well as hospital units. Being a travel nurse is a versatile profession where nurses can work in emergency, ICU, cardiology, and other areas for short term assignments that last no more than 13 weeks. These nurses work with a staffing agency and help hospitals satisfy the gap in their care help. Travel nurses can earn anywhere from $2,000 to $3,000 a week plus benefits, such as company-owned housing.
Critical Care transport nurses (CCT): These nurses accompany critically ill patients that require life-saving procedures. They monitor and evaluate, and can provide emergency care when necessary. What makes this such a unique position is that these nurses have a level of autonomy and independence that makes it an incredibly specialized field. They don’t have the benefit of a team of professionals as ICU CCRNs do, so they have to rely more on their skills and experience should anything go amiss while in transit to the receiving facility. With about one to four years of experience required, average salary can be close to $30 per hour but can go up to between $40 and $50. Demand for transport nurses is growing.
Expected CCRN salary and benefits
Along with a solid base salary and health benefits to start, there are a few other perks that may be available, including:
- Relocation expenses: Some facilities will provide relocation assistance to reduce moving expenses. The typical stipend is about $2,500.
- Recruitment bonus: There may be a sign-on bonus depending on certain factors, such as experience and certifications. This can range from between $2,000 to $20,000. However, during certain circumstances, hospitals may ramp up this bonus for specialist nurses. During Covid-19, hospitals in hard-hit states offered five-figure bonuses for emergency nurses who could help them out for a few weeks.
- Housing assistance: Hospitals that are desperate to end their nursing shortage may offer living accommodations to out-of-state or commuting nurses. For example, a CCRN that lives over an hour away can stay at hospital-owned living spaces and during their weekend shift. Not only does this save transportation expenses, but for those who may have student loans to pay back, it’s an attractive offer.
- Tuition reimbursement: After nurses have been working for a certain period of time, hospitals will offer to pay for their advanced degrees at local universities or any other approved Institution. This benefit may even extend to the nurse’s children, covering part or all of their undergraduate tuition when they are ready to go to college.
Getting ready for negotiation
Approximately 40 percent of nurses negotiate their salaries. The reason why that percentage is so low is that in some cases, they feel they are too new or may not be qualified enough. However, as they gained more experience and understood their value, older nurses are more likely to negotiate their contracts, For all skill levels, there is still the opportunity to take a savvier approach to getting the best deal for your services.
Understanding the pay structure: There are numerous factors that inform a potential employer about what to pay new critical-care nurses. Experience, skills, and certifications are considerations, but you need to understand how these factors fit with the overall structure. For example, public institutions have tiered pay structures that are virtually immutable, while private organizations may have policies that guide the upper and lower salary threshold. When you understand the pay structure of the medical facility you’re dealing with, you will be in a better position to put your best foot forward.
Knowing your value: As an experienced CCRN, you know what you can do. This is why it’s important to state the value you intend to bring to the role up front. Your resume is only a snapshot of your career, but the stories that you tell about what you saw and learned provide a more comprehensive picture of your capabilities.
Knowing when to negotiate: Not all salaries are negotiable. If you’re a new graduate, you have no negotiation room. The same applies to government institutions as their tiers are already set and it’s just a matter of adding you to the roster. In cases where you’re dealing with a union, the ability to negotiate is completely out of your hands. Understand where and when you can negotiate because choosing the wrong time can undermine your future efforts.
Earn your future raise now: If you’ve been locked out of the ability to negotiate for now, the best way to prepare for your future raise is to increase your education and skills now. Getting those specialist certifications along with continuing your advanced practice education goes a long way to showing your value. Your ability to expand your knowledge and skills makes you a valuable addition to your current or future employer.
Average critical-care nursing salary by state
When it comes to being a critical-care nurse across the US, salaries will vary dramatically for several reasons. For one thing, the type of work that you do and your specialization are key factors. If you are a newly minted general CCRN, the competition may be tougher than for those who may have achieved a specialist certification that is in higher demand.
In light of the saturated supply, you may have to choose to do one of two things. First, you may decide to get whatever relevant certifications you can that will help you stand out. Of course, if you don’t have the necessary experience beforehand, you may not be able to go for that. You could pursue free continuing education courses from organizations, such as the American Association of Critical-Care Nurses, ACCN.
Second, there’s the relocation option. You need to open to this possibility, because it’s also an opportunity for growth. Many can expect the requisite benefits to help them make the move to a less saturated area in another city or state. The change in venue could work in your favor especially when it comes to your salary and benefits.
What to consider when moving to a higher pain CCRN job
If you get a higher-paying out-of-state job offer, for example, one of the first questions you need to ask yourself is if this move is worth it. To figure that out, take a look at scenes from a couple of different perspectives.
Pay is great, but what about raises: The good thing is that every salaried position comes with incremental, periodic pay raises which is why you need to understand the pay structure of the position and the institution. Public hospitals have a fixed system which makes them reliable when it comes to what to expect. Private hospitals tend to be less transparent, which makes it even more challenging to navigate.
Great way to build your resume: With more salary comes more responsibilities, making a higher-paying position a great way to build your resume. The fact that you may now be able to list that you experience and knowledge about dealing with head injuries or ventilating patients means that you’ll have a new baseline from which to negotiate your next raise or position.
Cost of living: Cost of living varies wildly within states and across the country. It follows that if you’re going to be paid more, it would be enough to help you find a place to live. It’s a good idea to look at rental options around the area, in surrounding neighborhoods as well the corresponding commuting options. Living near work is ideal, but if it’s more than a third of your paycheck, that trade-off may not make sense.
Trying new specialties: When it comes to critical-care nursing, knowledge really is power. If you have a job that provides you ample opportunity to dive deeper into your specialization or to discover a new avenue you want to pursue, your ability to grow in this position means your professional value is increasing daily.
Now that you’ve thought about both sides of moving to another location to pursue your career, it’s important to know where you can find the best opportunities. Here are five of the top states with plenty of opportunities for CCRNs.
- Maine is one of the best states for critical-care Nursing opportunities for those with two or more years of experience. Hospitals are offering signing bonuses and there are plenty of opportunities for travel and per diem nursing. MaineGeneral Health is a top employer in the state and the average salary across all critical care positions available is approximately $91,000. The cost of living of Portland is about 13 percent more than the national average but Bangor stands at 1.2 percent lower than the national average.
- New Hampshire at any point average annual salary for CCRN in New Hampshire is close to $88,000. One of the facilities looking for ICU nursing practitioners is the Dartmouth Hitchcock Medical Center, which is one of the largest employers. New Hampshire cost of living is higher than the national average but seems like Manchester and Bedford are on the lower end of that spectrum.
- Even though there aren’t as many critical-care nursing jobs when compared to other states, North Dakota still ranks as one of the top locations, and the state is one of the largest employers. They do require at least five years of RN experience. Average salary across all CCRN posts is about $91,000. Cost of living in the state is slightly higher than the national average with Fargo and West Fargo being the cities that are optimal.
- St. Francis Health System and Tact Medical Staffing for travel nursing opportunities are two of the top CCRN employers in Oklahoma. St. Francis offers a sign-on bonus for full time nurses with valid state licensing. They do require at least one year of experience as a critical care nurse and provide Advanced certification and other education reimbursement opportunities. Average salary comes in at about $83,000, while cost of living across the state is lower than the national average with Lawton and Altus being the lowest.
- Penn Medicine, Holy Redeemer Health System, and the University of Pennsylvania Health System are the top employers in Pennsylvania. Intensive care, advanced practice, and nurse practitioner are some of the positions available. The average annual salary for critical-care nursing professionals is approximately $82,000. Cost of living varies widely, depending on location. Philadelphia has the highest with around 14 percent above the national average while Johnston and Erie are well below the average.
Skills that could affect a critical-care nurse’s salary
When you’re ready to look for a position, it’s important to make sure that your resume is crisp. This means that your tasks and accomplishments are properly highlighted with the right terms.
Skills and qualifications
On top of your college degree and maintaining an unencumbered registered nursing license, there are some other specialist certifications you can achieve to catch the eye of potential employers.
- CCRN: While this is the fundamental certification for all CCRNs who provide direct care to critically ill patients, there are neonatal, pediatric, and other focuses you can go for.
- CWCA: A wound specialist certification from the American Board of Wound Management demonstrates advanced knowledge and practice in wound care.
- CCRN-E: With this certification nurses are able to provide TeleICU or remote care to ill patients.
- PCCN: Progressive care certification requires vigilance of acutely ill patients that are still at elevated levels of instability but not so much that they need to be in ICU. This refers to helping patients to step down or transition safely.
- CMC: Cardiac Medicine certification for CCRN who want to be cardiac nurses.
- CSC: Cardiac Surgery certification for nurses working with patients who have some form of cardiovascular surgery. They provide 48-hour postoperative care. Combined with the CMC, you cement your specialty.
- CNRN: Certified Neuroscience Registered Nurse. For CCRNs working in the neurologic critical care specialization.
While some of these certifications require a specific focus, there are accredited providers that offer complementary course certifications, such as Burn Therapy or Advanced Life Support techniques that can ramp up your skill set. Check with national health and medical associations to see what they offer.
Strengthening your resume
Writing a job resume requires you to tailor it to the job you want and not just list the skills you have. You also need to use power verbs in your summary. For example, skip the traditional experience and entry level additives as they tend to be bland. Use more Energetic words to make your summary pop.
When showing your skills, highlight both hard and soft skills at the bottom of your resume. Hard skills, such as ventilator operation or advanced life support are keywords that will help your resume be more visible to potential employers. Soft skill keywords, such as active listening, efficient, and problem-solving definitely match the characteristics employers are looking for in their new hire. Find accurate ways to correlate those soft and hard skills with your experience to bring everything together. As self-care is important, remember to include fun off-work activities.
After going through all of the interviews, you finally receive an offer. The good news is that you’ve already done a bit of research ahead of time and understand the organization’s pay structure. For entry-level critical-care nurses, it will be more difficult to negotiate the salary, but you can leverage the fact that you are applying to or are enrolled in a higher education program, such as a bachelor’s or master’s degree. This may move the needle in the initial interview or prompt them to revisit the salary later on during your evaluation.
Active nurses with more certifications may have an easier time negotiating. Enter talks with your upper and lower salary number already in mind, because it’s unlikely that the employer will quote their salary number first. To support your range, talk about relevant experience and share any documentation to prove your competency. If they are firm on their number and maybe some wiggle room with the benefit package that can offset a lower salary.
When you are confident and prepared, you know that you can walk away if the offer isn’t providing you with livable benefits you deserve.