Scoping out the Surgical Intensive Care Nurse



An outgoing nature, a desire to act as a patient advocate, and a willingness to function outside your comfort zone are among the attributes you need to be a successful surgical intensive care nurse.

So says Kristina Massey, BSN, RN, CCRN-CSC, ECMO specialist and nursing unit director, cardiac surgery ICU/cardiac flex team at Carilion Roanoke Memorial Hospital Cardiovascular Institute in Roanoke, VA.

Nurses considering this role will find high demand, as surgical intensive care nurses joined the list of the 25 top roles growing in demand this year, according to LinkedIn Jobs on the Rise 2022. These nurses, according to the LinkedIn report, care for patients who are critically ill after surgery, usually following complex procedures such as open heart surgery.

The surgical intensive care unit can be a “very overwhelming environment,” says Massey, who has been the unit director since 2009, and an ECMO specialist since 2012. Nurses in the surgical ICU, she notes, need to be able to go out on a limb or outside their comfort zone to approach a surgeon or provider if something isn’t right.

Her unit also includes nurses who want to grow into more advanced roles, such as CRNA or NP. “I would rather have someone who is highly functional, who is always looking to increase their education and skill set, even if that only means having them for a few years,” she says.

Leading Staff

As the unit director, Massey leads 70 staff members, including RNs, LPNs, and nursing assistants. In her 11-bed unit, she focuses mainly on day-to-day operations, such as patient throughput and determining what patients can move to a step-down unit or who needs to do a lateral transfer to another ICU.

She also ensures that she has the right mix of nurses with the skills to care for the current acuity in her ICU. She can also be a bedside nurse, for instance, in an emergency.

Patients come to her unit only for cardiothoracic intensive care. Patients who had open heart surgery, she notes, come directly to her ICU, not a PACU or recovery unit. Her nurses work as a team with respiratory therapists to extubate the patients.

Experience a Plus

When Massey needs to hire a nurse for her unit, she prefers nurses with a BSN degree. If the nurse is a new grad, she wants to see healthcare experience, such as working as a nursing assistant in a hospital or having an EMS background. She will hire associate degree nurses based on their experience. For instance, in May, she hired an associate degree RN who had worked under her as a nursing assistant for three years. Another associate degree nurse she hired had worked as a paramedic before attending nursing school.

“Our ICU is a very high-acuity ICU, and we see a lot of incredibly sick patients,” says Massey. So having this prior medical experience “helps with their transition into the ICU.”

Massey’s interest in the surgical ICU started in nursing school during a rotation through the cardiac surgery operating room. There, she observed a patient undergoing open heart surgery and followed that patient through the ICU and the recovery process, including extubation. “I was very fascinated by what the ICU nurse was doing in the room that day. And I knew that I eventually wanted to end up in the ICU.”

Before joining the surgical ICU, she worked in the cardiac surgery step-down unit for about three and a half years. She joined the surgical ICU as a staff nurse in 2004, was promoted to preceptor, then clinical team lead, and ultimately became unit director in 2009.

Setting the Direction

For nurses interested in joining a surgical ICU, “if you know that’s what you want to do, you need to set yourself up in the right direction,” she notes. “Contact people who can help you get the position you want. If that means applying for a role as a patient care tech or a nursing assistant in the surgical ICU that you want to be in, do it while you’re in nursing school. It will help that staff get to know you and be your advocate when you graduate nursing school.”

“If you spend time on that unit, reach out to the unit director and let them know that this is something that you’re very interested in and ask what their recommendations are. Then, when they request the ICU, I’ve had many students make sure I know who they are. They seek out experiences, make themselves available to staff, and show interest.”

Learning Never Stops

Once you’re working in a surgical ICU, keep learning, Massey says. “Continue to expand your knowledge and grow yourself professionally,” perhaps through certification or becoming an ECMO specialist like her. “It helps with that validation of knowledge, and it will only elevate your profession and skill set if you continue to explore growth opportunities.”