Intensive care nurses are regularly exposed to loud sounds, but it is crucial to understand which sounds they consciously perceive during their shifts. This study, conducted in the Adult ICU at Erasmus Medical Center in the Netherlands, used a mixed-method approach to explore nurses’ auditory experiences. Over three weeks, the researchers continuously measured sound levels in patient rooms, nurse stations, and a corridor, focusing on morning shifts. Additionally, a context mapping study was conducted, by which nurses documented sound sources using portable audio recorders, arranged them on a timeline, and provided interpretations in semi-structured interviews. The findings indicate that nurses primarily hear environmental sounds and are particularly sensitive to alarm sounds during transitions. Their interpretation of ICU sounds varies based on their tasks, with both positive and negative appraisals. This suggests that ICU environments can be optimized by organizing sound events to better align with nurses’ clinical needs. Understanding the sounds nurses consciously notice and react to can help improve working conditions and patient care. By refining acoustic environments, hospitals can reduce unnecessary noise while ensuring that critical alarms remain effective, ultimately supporting both staff efficiency and patient well-being in intensive care settings.