Within the field of nursing, there are dozens of specialties and potential career tracks. For nurses in training, the choices can make it difficult to determine the best fit for their particular skills, desired work environment, and ideal career fit—especially without hands-on experience.
For instance, a common topic of debate for would-be nurses is whether to work in the PACU vs ICU.
Although both fall under the auspices of critical care nursing, there are some significant differences between the two. Today, to help ease your decision, we’ll compare and contrast the two nursing occupations.
What Is an ICU Nurse?
Intensive care unit (ICU) nurses operate in arguably the most high-pressure, high-stress environment that any registered nurse will face. These highly specialized and trained healthcare practitioners work in the intensive care units throughout the various departments in a hospital.
ICU nurses deal with a hospital’s sickest and most gravely injured patients. Often those patients have just emerged from surgery or are in the midst of a rapidly deteriorating health episode. As such, a nurse’s extensive training helps them respond and provide potentially life-saving interventions at a moment’s notice.
Common types of ICU sub-specialties include:
- Surgical intensive care unit (SICU) – Nurses provide immediate care and monitor the vital signs of a surgical patient who doesn’t yet have a stable prognosis.
- Trauma intensive care unit – Nurses care for critically injured patients, typically resulting from falls, gunshots, stabbings, motor vehicle accidents.
- Neonatal intensive care unit (NICU) – Nurses monitor and care for newborn infants who suffer from various medical ailments.
- Cardiac Care Unit (CCU) – Nurses work with the hospital’s most critically ill patient.
- Pediatric intensive care unit (PICU) – Nurses treat children who are critically ill or injured.
Because patients in ICUs require so much attention—often, round-the-clock monitoring—the staff-to-patient ratio is typically 2:1 or 1:1 in an ICU setting. Unlike other nursing practices, during a typical ICU shift, a nurse will only be assigned one or two patients to supervise the entire time.
It’s important to mention that emergency room (ER) nurses are not the same as ICU nurses.
ER nurses also treat patients who are suffering from trauma, injury, or illness and are in need of immediate medical attention. But the goal here is to stabilize the patient and move them to the ICU as quickly as possible. In doing so, they can free up ER beds to treat the steady influx of new patients. As such, ER nurses may deal with several patients, if not dozens of patients, during any given shift.
What Does an ICU Nurse Do?
The role of an ICU nurse is fast-paced and physically demanding, regardless of the levels of critical care that a specific shift dictates. Most ICU nurses work in conjunction with a robust interdisciplinary team of healthcare professionals, including:
- Nurse anesthetists
- Emergency residents
- Attending doctors
- Physical, occupational, and respiratory therapists
As noted above, they’re usually assigned to one or two patients per shift. These shifts tend to be done in 12-hour rotations. Generally speaking, their primary duties include supervision and documentation of a patient’s medical progress, caring for the patient’s needs, and providing medical intervention if necessary. More specific duties may include:
- Receiving, documenting, and sharing patient records with departing and arriving nursing shifts
- Evaluating and monitoring of patient’s medical progress, lab data, and vital signs
- Identifying sudden or slight changes in a patient’s condition
- Administering medications and interventions via gastric tubes, intravenously, or injection
- Caring for a patient’s ongoing needs
- Updating doctors, patients, and families about their progress
- Setting up and monitoring medical equipment and devices
How Do You Become an ICU Nurse?
The track to becoming an ICU nurse starts with college. You’ll first need to graduate with a Bachelors of Science in Nursing (BSN) or Associate of Science in Nursing (ADN) from an accredited nursing program.
To be hired, you’ll at least need to be an RN. Because the job is competitive, it helps to have an advanced degree in nursing like a Master of Science in Nursing (MSN). After that, steps include:
- Accumulate two years (1,750 hours) of direct care work experience
- Obtain ICU Certifications and licenses (preferred, though often optional)
- Pass the National Council Licensure Examination (NCLEX–RN) and obtain your state RN license
- Acquire a critical care resident nursing (CCRN) certificate
- Apply for an ICU position
How Much Does an ICU Nurse Make?
There is no national database for ICU nurse salaries.
However, we do know that for registered nurses—which ICU nurses are—the U.S. Bureau of Labor Statistics puts the median RN salary at $75,330 per year.1 There are several factors that impact nursing salary, including location, hospital, level of education, and the specific job.
Because the job of an ICU nurse is so demanding, they’ll likely make more than the average RN.
What Is a PACU Nurse?
A post anesthesia care unit or PACU nurse provides critical care to patients in the recovery room. Nurses in this critical unit work within the anesthesia department. Usually, a patient will be transferred to the PACU after they’ve had a medical or surgical procedure that required them to be anesthetized. According to Health TImes:2
“PACU nurses are charged with the task of monitoring patients in the post-operative phase until they have regained consciousness, have stable vital signs, and meet the PACU discharge criteria. Typically, a PACU nurse will have in-depth knowledge of anesthesia and must also be proficient in managing respiratory instability, cardiac and neurological issues, and hemodynamic.”
Seeing as they operate in the recovery room, a PACU nurse or PACU travel nurse is often the first face a surgical patient will see as they wake up. For patients, the combination of a strange new setting, drugs in their system, and their uncomfortable health condition can be unsettling—which is why it’s important for PACU nurses to help keep them relaxed and assuage any concerns.
Also, because every patient responds differently to anesthesia, PACU nurses need to carefully monitor their vital signs and psychological state. Patients may be in a state of unconsciousness, semiconsciousness, or consciousness. And they could be experiencing pain, nausea, difficulty breathing, fear, and anxiety. To ensure a safe recovery, nurses need to maintain careful supervision until the patient is fully conscious and stable.
There are some similarities with a PACU vs ICU nurse. It’s also a fast-paced environment that can be quite demanding. And nurses often work with just one or two patients at a time. That said, the care environment tends to be less stressful and more controlled, which is why many ICU nurses eventually chose to transfer into the PACU.
What Does a PACU Nurse Do?
The post anesthesia care unit is a temporary care environment. The goal of a PACU RN is to reduce the turnaround time of the patient. They welcome them into the post-op recovery room, make sure they’re stable, and then transfer them to their respective ICU. Common responsibilities include:
- Monitoring a patient in their postoperative post-anesthetic state
- Keeping an eye on vital signs
- Dressing bandages and sutures
- Helping patients who are in pain or feel nauseous
- Maintaining and updating patient files, charts, and medical records
- Handing off patients to the next shift or receiving the previous shift’s patients
Most patients will spend anywhere from 30 minutes to 4 hours in the PACU before they’re transferred.
How Do You Become a PACU Nurse?
Like an ICU nurse, a PACU nurse must also undergo schooling to become an RN by obtaining either an associate or bachelor’s degree, which can then be supplemented with an MSN.
You’ll need to accrue 1800 hours of clinical experience over two years. And many programs would like that experience to be providing critical care or serving in the ER. Depending on the hospital, you may also be required to acquire basic life support (BLS) and adult advanced cardiovascular life support (ACLS) certificates.
How Much Does a PACU Nurse Make?
Similar to an ICU nurse, how much a PACU nurse makes depends on several different factors. According to ZipRecruiter, the median PACU nurse salary is $92,397 nationwide.3
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Both ICU and PACU nurses provide invaluable critical care. And because both jobs are so demanding, they require a highly skilled nurse and command a top-rate salary.
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- “Registered Nurses : Occupational Outlook Handbook.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 8 Sept. 2021, https://www.bls.gov/ooh/healthcare/registered-nurses.htm.
- “PACU Nurses a Vital Aid to Recovery.” Health Times, https://healthtimes.com.au/hub/paediatrics/17/news/nc1/pacu-nurses-a-vital-aid-to-recovery/496/.
- “Pacu RN Annual Salary ($92,397 Avg | Jul 2021) – Ziprecruiter.” https://www.ziprecruiter.com/Salaries/PACU-RN-Salary.
- Gillette, Journi. “Average Intensive Care Unit (ICU) Nurse Salary.” Incredible Health, 9 Sept. 2021, https://www.incrediblehealth.com/blog/icu-nurse-salary/.