Categorising Critically Ill Patients by Critical Care Nurses

Critical care nursing is the delivery of specialised care to critically ill patients or patients with the potential to become critically ill - that is, those who have or are susceptible to life-threatening illnesses or injuries. Such patients may be unstable, have complex needs and require intensive and vigilant critical care nursing. The Department of Health categorises acute hospital patient care into levels from 0 to 3:

• Level 0 is normal acute ward care.


• Level 1 is acute ward care with the input of critical care specialists, e.g. outreach. This may be required because of recent discharge from a critical care unit or because the patient's condition or therapy/equipment used in their care means increased intervention is needed.


• Level 2 is high dependency care for patients requiring an increased level of monitoring owing to their condition or potential for deterioration or patients with single organ failure/support. Nurse to patient ratios for this level of care are usually one nurse to two patients.


• Level 3 is intensive care for patients with two or more organ failure/support or requiring mechanical ventilation. Nurse to patient ratios for this level of care are usually one nurse to one patient.

Illnesses and injuries commonly seen in patients on critical care units, either separate level 2 and 3 facilities or combined units, include:

• traumatic injuries from such events as road traffic accidents, falls and assaults


• cardiovascular disorders, such as heart failure and acute coronary syndromes (unstable angina and myocardial infarction [MI])


• elective surgeries, such as abdominal aortic aneurysm repair and carotid endarterectomy


• emergency surgeries, such as bowel perforation and neurosurgery


• neurological disorders, such as hypoxic brain damage and subarachnoid haemorrhage


• respiratory disorders, such as acute respiratory failure and pulmonary embolism


• GI and hepatic disorders, such as acute pancreatitis, acute upper GI bleeding and acute liver failure


• renal disorders, such as acute and chronic renal failure


• cancers, such as lung, oesophageal and gastric cancer


• shock caused by hypovolaemia, sepsis and cardiogenic events (such as after MI)

Meet the critical care nurse

They are responsible for making sure that critically ill patients and members of their families receive close attention and the best care possible.

What do you do?

Fill many roles in the hospital setting, such as staff nurses, sisters, charge nurses, nurse-educators, nurse-managers, clinical nurse specialists, advanced nurse practitioners (ANPs), nurse consultants and outreach nurses.

Where do you work?

Wherever critically ill patients are found, including:

• adult, paediatric and neonatal intensive care units (ICUs) and high dependency units (HDUs), or combined critical care units caring for both level 2 and level 3 patients


• coronary care units


• cardiothoracic/neurosurgical/burns/liver units


• accident and emergency departments


• postanaesthesia/postoperative care units


• general wards as part of an 'outreach' team (providing care to patients and education to staff caring for patients with complex care needs, potential to deteriorate or recently discharged from a critical care unit).