Become a Neuro ICU Nurse in 3 Steps

Nurse Types / Neuro ICU Nurse

The brain is one of the most vital organs of the body. A healthy, functioning brain is critical to survival. 

An injury to the nervous system affects the entire body. Patients who sustain such devastating injuries need a highly skilled care team. 

Maybe you’ve wondered about neuro ICU nursing or considered a career in this exciting specialty. Let’s explore how neuro ICU nurses play an important role in neurointensive care. 

• What is a neuro ICU nurse?
• What do neuro ICU nurses do?
• Where do neuro ICU nurses work?
• What are specific types of neuro ICU nurses?
• How do you become a neuro ICU nurse in 3 steps?
• What are additional requirements of neuro ICU nurses?
• What are the salary and career outlook for neuro ICU nurses?

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What is a neuro ICU nurse?

Neuro ICU nurses care for critically ill patients with neurologic injuries and diseases. 

Other terms to describe a neuro ICU nurse may include:

• Neuroscience nurse
• Neurocritical care nurse
• Neuro nurse

They typically work in critical care and intensive care units (ICUs). Neurointensive care is a subspecialty of ICU nursing. 

Qualities of a successful neuro ICU nurse

Neuro ICU nurses must have special qualities. 

• Calm demeanor – able to maintain composure in critical situations.
• Strong technical nursing skills – ability to perform complex and delicate procedures such as inserting a drain at the bedside to relieve intracranial pressure.
• Ability to focus – neuro ICU nurses must be able to monitor patients closely for subtle changes. 
• Emotional intelligence – understand what patients and families might be feeling.

Another important quality for a neuro ICU nurse is a team-oriented work style. Nurses in this setting must work well with healthcare members. There are many disciplines working together in the ICU. These include:

• Neurosurgeons
• Neurologists
• Anesthesiologists
• Respiratory therapists
• Nurse practitioners
• Clinical pharmacologists
• Physical therapists
• Speech-language pathologists
• Occupational therapists
• Dieticians or nutritionists
• Social workers

What do neuro ICU nurses do?

Neuro ICU nurses perform many of the same job duties as ICU nurses. Since they work primarily with neuro patients, their jobs look a bit different. 

Some responsibilities specific to neuro ICU nurses include:

• Administering solutions and medications such as vasopressors and sedatives
• Managing airway
• Controlling body temperature
• Facilitating brain death testing
• Managing drains, including extraventricular drains (EVD) in the brain
• Administering medication
• Monitoring intracerebral pressure (ICP) levels
• Assessing neurological conscious and unconscious patients
• Overseeing organ donation and procurement
• Supporting and educating patient and family 
• Providing palliative and end-of-life care

A day in the life of a neuro ICU nurse

Neuro ICU nurses typically work 8-12 hour shifts. Neurointensive care is around-the-clock care, even on weekends and holidays. 

On the unit, a neuro ICU nurse typically has one or two patients based on acuity. They must monitor patients with neuro checks every 15 minutes to two hours. These highly skilled nurses also watch for signs of brain death. Neuro nurses must identify changes quickly and intervene when necessary. 

Another important part of the job is communicating with families about the status of loved ones.

Doctors frequently need neuro ICU nurses to assist with EVD placements, ICP monitoring, and lumbar drain placements. Neuro nurses also travel to radiology for CT or MRI scans with their patients.  

Neuro nurses must be careful to avoid work-related injuries. During their shift, they must squat, lift, and bend frequently.

Common conditions treated by neuro ICU nurses

Some of the neurological conditions commonly treated by neuro ICU nurses include:

• Brain tumors
• Encephalitis
• Falls causing brain bleeds
• Intracranial hemorrhage
• Ischemic strokes
• Meningitis or nervous system infections
• Myasthenia gravis
• Post-op craniotomies or endarterectomies
• Seizure disorders
• Sepsis
• Severe Guillain-Barre syndrome
• Subarachnoid hemorrhages
• Subdural hematomas

Because of the serious nature of these conditions, neuro ICU nurses also provide palliative care and education to patients and families.

Where do neuro ICU nurses work?

Neurocritical nurses almost exclusively work in hospital settings due to the complexity of their care.

Teaching hospitals and large facilities usually have dedicated neuro ICUs for neuro and trauma patients. In smaller facilities, neuro patients may be placed in the general ICU. 

What are specific types of neuro ICU nurses? 

Neuro ICU nurses may have sub specializations:

• Pediatric neuro ICU nurses care for babies and children with brain illnesses or injuries, such as trauma, brain malformations, tumors, or seizures.
• Trauma neuro ICU nurses may work in Level I or Level II trauma centers and specialize in high-acuity traumas such as gunshots, stabbings, and major car accidents.
• Neuro-oncology nurses specialize in treating brain cancers, including radiation and surgical interventions.

Closely related fields 

Since neuro ICU nurses are a subspecialty of intensive care or critical care nursing, several closely related nursing specialties exist. These include the following:

• General intensive care (ICU)
• Cardiac intensive care (CCU)
• Emergency and trauma nursing

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How do you become a neuro ICU nurse in 3 steps?

Step 1 – Become a registered nurse

The first step to becoming a neuro ICU nurse is to become a registered nurse.

Earn a BSN degree 

Neuro ICU nurses need a Bachelor of Science in Nursing (BSN). A BSN is a four-year degree program that includes coursework on leadership and management, research, and public health. 

Large and well-known hospitals that are Magnet®/Pathways® Accredited may only hire BSN nurses, or RNs enrolled in BSN programs.

RNs with an Associate Degree in Nursing (ADN) who want to be neuro nurses can explore RN-to-BSN degree options. These programs typically take 12-18 months to obtain a BSN. 

Non-nursing bachelor’s degree holders who want to become neuro ICU nurses should consider an Accelerated Bachelor of Science in Nursing (ABSN). Most last 12-18 months and prepare students for the nursing board exam.

Pass the NCLEX exam

After earning your BSN degree, the next step to becoming a neuro ICU nurse is taking the NCLEX exam. 

The NCLEX-RN exam covers foundational knowledge new nurses need to work in the ICU. You will be tested on pharmacology, assessment, and neurological pathophysiology.

When you pass, you will be eligible for an RN license.

Step 2 – Accumulate experience

Most neuro ICU nurse jobs require two years of clinical practice experience. Many employers also prefer leadership and management experience. To find the right experience for your dream job, look at Incredible Health’s career resources.

Helpful Skills and experience

Experience in another ICU or critical care setting can help you get a job as a neuro ICU nurse. Nurses who have worked with neurologists in private practice or outpatient clinics will be more knowledgeable about the pathophysiology of neuro patients and, therefore, more hireable.

Nurses with experience in neuro testing and procedures will be ahead of the game when they start as neuro ICU nurses. Special skills that benefit neuro nurses include:

• Brain oxygen monitoring
• Neuroimaging
• Understanding EEGs
• Monitoring cerebral blood flow
• Monitoring intracranial pressure

Changing specialty to a neuro ICU nurse 

If you want to change specialties and become a neuro ICU nurse, here are some considerations to keep in mind.

In the neuro ICU, the patients are high acuity. The typical nurse-to-patient ratio is 1:1-2. Caring for the neuro patient requires constant monitoring and assessment and thinking through complications that arise. That can be very different from a general med-surg unit, where you are juggling 5-6 patients. 

Another difference in the ICU setting is brain injuries often impair the ability to communicate effectively. If you look forward to talking to your patients and getting to know them and their families each shift, you may miss that when you transition to the neuro unit.

If you are seriously considering a career move, you can ask questions or talk to other nurses in Incredible Health’s community for nursing questions and advice.

Step 3 – Obtain certifications

There are many certifications for neuro ICU nurses. Since they care for complex patients, the more certifications and skills a neuro nurse has, the better!

Required certifications include:

• Basic life support (BLS) – basic CPR certification required for healthcare providers
• Advanced cardiac life support (ACLS) – for RNs in the critical care setting
• Pediatric advanced life support (PALS) – for RNs in the pediatric critical care setting

Additional certifications include:

• Certified neuroscience registered nurse (CNRN) – certification for neuro nurses.
• Certified critical care RN (CCRN) – certification for nurses working in a critical care setting.
• Certified perioperative nurse (CNOR) – certification for nurses caring for patients before, during, and after surgical procedures.
• Fundamental critical care support (FCCS) – training to manage critically ill patients for the first 24 hours. 
• NIH stroke scale (NIHSS) – certification for stroke providers.
• Trauma care after resuscitation (TCAR) – for acute care, critical care, perioperative, and rehab nurses.

What are additional requirements of neuro ICU nurses? 

In addition to education and professional requirements, neuro ICU nurses typically complete a unit orientation or nurse residency program. These usually last around 3–6 months for new grads or 1–2 months for experienced nurses. 

Neuro nurses must also stay current on practice standards and evidence-based practice by earning continuing education hours (CEUs) each year. Check with your state board for the number of hours required for license renewal. 

What are the salary and career outlooks for neuro ICU nurses?

The salary for neuro ICU nurses ranges from $99,111 ($47.65 per hour) to $164,231 ($78.96 per hour). Salaries may vary widely by state. 

Currently, Washington state reports the highest wages for neuro ICU nurses. Like many other nursing specialties, the coastal regions in the Pacific Northwest pay higher. 

The job outlook is also promising for nurses in the neuro ICU field. Employment for RNs is expected to grow 6% between 2021 and 2031.

Job satisfaction

A career as a neuro ICU nurse is extremely fulfilling. Imagine helping your patient recover from major brain trauma to have them write a thank you note to you one day. How rewarding!

Next steps 

Neuro ICU nurses can grow in their careers over the long term. Nurses who love the field of neurology can go on to pursue master’s or doctoral degrees in neuroscience or neuro-critical care. 

As a nurse practitioner in the neuro ICU, nurses can perform H&P’s, put lines in (central lines, arterial lines, dialysis caths), or even intubate patients depending on state practice acts and facility guidelines. 

With passion and dedication, your career in the neuro ICU can take you as far as you want!

For more information about neuro ICU nursing, here are a few more resources.

• AACN Neuro Resources
• Neurocritical Care Society