A Comprehensive List of ICU Nurse Responsibilities

By Indeed Editorial Team

Published 19 November 2022

The Indeed Editorial Team comprises a diverse and talented team of writers, researchers and subject matter experts equipped with Indeed's data and insights to deliver useful tips to help guide your career journey.

An intensive care unit (ICU) nurse is a health professional who oversees critically ill patients who require specialised medical supervision. They work in the intensive care units of healthcare facilities and hospitals. Knowing an ICU nurse's duties can help you decide if this is the right medical career path for you. In this article, we discuss what ICU nurse responsibilities are and list some duties and roles they fulfil as healthcare specialists.

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What are ICU nurse responsibilities?

ICU nurse responsibilities include providing vital care to seriously injured or ill patients. They undergo additional training to treat patients who have suffered heart attacks, strokes or major invasive surgery. ICU nurses monitor their patients closely and respond swiftly to any changes in the patient's condition. An ICU nurse requires analytical skills, excellent interpersonal skills and communication skills. Their responsibilities may include:

Monitoring patient progress

An ICU nurse monitors a patient's vital signs, including oxygen levels, respiratory rate, blood pressure, temperature and pulse rate. They check their patients regularly and record all their observations. If there are significant changes in the patient's condition, they report them to the physician or senior members of the healthcare team. They also look for signs of sepsis or shock that require urgent intervention.

Assisting physicians with procedures

An ICU nurse can prepare equipment for the procedures a patient requires. They may assist the doctor in performing the procedure. Some procedures may include:

  • Diagnostic or therapeutic bronchoscopy

  • Endoscopy

  • Endotracheal intubations

  • Elective cardioversion

  • Bone marrow transplant

  • Chest or peritoneal drain insertion

  • Mechanical ventilation

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Performing diagnostic tests

An ICU nurse may order or perform diagnostic tests to assess a patient's progress or as part of medical discovery to determine suitable treatment. Some examples of these tests may include:

  • Fluoroscopy: to determine an intestinal disease or heart disease

  • Colonoscopy: to examine the colon for signs of cancerous growth

  • Electrocardiogram (ECG): to assess the levels of cardiac markers that indicate heart function

  • Arterial blood gas (ABG): to check the levels of oxygen and carbon dioxide in a patient's blood, plus blood acidity

Observing a patient's diet and fluid intake

Close observation of a patient's fluid intake and output can alert the nurse to emerging problems, such as fluid and electrolyte imbalances. ICU nurses monitor each patient's diet to prevent the risk of complications due to nutritional status. They assess the need for nasogastric tube feeding or nutritional supplements for post-operative patients who are not able to eat what their bodies require.

Overseeing physical activity levels

An ICU nurse may work with physiotherapists to introduce levels of movement for post-operative patients. This includes small milestones, such as moving to sit in a chair for short periods or assisted walking. During these activities, the nurse may watch the patient closely to ensure they're making progress, but not getting overtired by doing too much, too soon.

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Administering medications

ICU nurses administer medications to patients according to the doctor's orders. Setting up and monitoring intravenous fluids is part of this area of responsibility. They keep a close watch on patients after administering new medication to watch for adverse side effects and contact the doctor in charge of the patient with any concerns.

Managing pain and sedation in patients

Managing a patient's pain and sedation levels is an important part of creating an environment that promotes healing. If a patient experiences unrelieved pain, it can have a negative psychological effect on their healing by compromising immune function. The ICU nurse can assess whether the dosage of pain relief is correct or if it needs adjusting by using different pain assessment methods. This includes the level of sedation a patient requires at different stages of the healing process.

Managing wounds

Bedridden patients in ICU can develop sores from lying in the same position. ICU nurses help them move and change positions throughout the day. They treat any wounds that may develop to prevent them from becoming advanced or chronic wounds. Nurses change bedding regularly, as clean bedding can help create a germ-free environment that is conducive to healing.

Providing life support

Life support augments failing body organs by assisting them to continue to function with mechanical aid. Ventilators keep the lungs functioning and dialysis machines aid kidney function. Other procedures considered as life support are feeding tubes for patients who are unable to eat and electric shocks for a heart that is failing.

Ensuring all ICU equipment works

ICU nurses typically check that all the equipment at their station is functioning and in good condition. They identify malfunctioning equipment or devices and arrange for urgent repairs. They clean and store all equipment correctly after use. Some of the equipment they may use includes:

  • Ventilators

  • Patient monitors

  • Defibrillators

  • Arterial lines

  • Central venous pressure lines

  • Endotracheal tube (ET Tube)

  • Feeding tubes

  • Pulse oximetry meters

  • Cervical braces

  • Shunts

  • Test tubes

Providing pre-operative care

Pre-operative care involves preparing the patient mentally and physically for surgery. An ICU nurse helps the patient remain calm by explaining the procedure, reassuring them and medicating if necessary. The physical preparation of a patient for surgery includes taking a patient's history in detail to alert the surgeon of anything that may cause complications, such as a history of smoking, diabetes or allergies. The nurse verifies the surgical site, notes any ethical concerns and lists any medications the patient is on. During this stage, the patient signs consent for the operation.

Providing post-operative care

Post-operative care starts when a patient arrives in the recovery room. The nurses oversee the patient's mental state as they recover from the effects of being under anaesthetic and return to normal. Caring for a patient in the recovery room often involves controlling pain and monitoring for any post-operative complications. Post-operative infections can occur and a trained ICU nurse watches their patient for any signs showing an infection.

Responding to medical emergencies

An ICU nurse monitors their patient for any subtle or sudden changes in their medical status and vital signs. If the condition of the patient changes, an ICU nurse responds by stabilising the patient and alerting the doctor. They may assist the doctor in performing any necessary procedures to restore the patient to a stable condition.

Knowing the Glasgow Coma Scale (GCS)

GCS is a scoring system to describe the level of consciousness in a patient after experiencing a traumatic brain injury. Using GCS allows an ICU nurse to assess and record the initial and subsequent levels of responsiveness in coma patients. This assessment often applies to victims of car crashes, sports injuries or brain injuries sustained during work-related accidents.

Providing emotional support to patients

The emotional mindset of a critically ill person can play a significant role in their recovery. An ICU nurse can help their patient remain in a positive frame of mind. ICU nurses often have excellent interpersonal skills, are highly empathetic and possess an optimistic, encouraging outlook.

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Providing emotional support to families

ICU nurses can provide emotional support to the families of those under their care. They may educate the patient's family on the illness or injury responsible for their loved one being in ICU. As they work closely with each patient, they can provide current updates on the patient's condition. They may explain all the machines attached to the patient. It can be difficult for a family to cope with seeing their loved one connected to all the strange-looking equipment. The ICU nurse can assess whether each family is coping or if intervention is necessary.

Supervising less-skilled nurses

An experienced ICU nurse may mentor less-experienced nurses in the field. While some institutions have organised mentoring programs, mentorship that happens informally can provide just as much value for the less-experienced nurse. Healthcare professionals in an intensive care setting often work in teams to provide the most holistic care for each patient. Mentorship can be a helpful part of that dynamic.

Related: Types of Mentor Skills (With Definitions and Examples)

Documenting and reporting

An ICU nurse records precise, detailed reports of the patients in the ICU. This typically includes any symptoms and changes in the patient's condition. Keeping notes of a patient's medical history is vital, plus any assessment findings as this keep a record of the patient's progress. They consult with the healthcare team responsible for patient care and document patient treatment plans. They monitor and record any interventions, plan outcomes or modifications to the plan as determined by the patient's condition and responses.

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Types of ICU nurses and their responsibilities

ICU nurses work in many departments of a hospital and can work with patients of all ages. These are some of the main types of ICU nurses and their responsibilities:

  • Cardiac ICU: Cardiac ICU nurses work with patients to treat life-threatening heart conditions or those who've just had surgery.

  • Neonatal ICU: Neonatal ICU nurses work with premature and newborn babies with critical illnesses or conditions

  • Paediatric ICU (PACU): Paediatric ICU, also known as PACU nurses, care for injured or critically ill infants, children or teenagers.

  • Trauma ICU: Trauma ICU nurses oversee patients who sustained critical injuries.

  • Surgical ICU: Surgical ICU nurses train to provide care and monitor the vital signs of patients that undergo surgery.

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