Complete Guide to Emergency Nursing

What is an ER Nurse?

The ER nurse (also known as an Emergency Department nurse) must be one who is quick thinking, collaborative, has excellent decision-making skills, and is an efficient multitasker. They will treat patients of all ages and backgrounds for a variety of issues. Many ER patients are experiencing life-threatening situations and the ER nurse and associated care team must be quick to triage, stabilize, revive, or resolve these issues before getting the patient the further care that they need.  

Many make the claim that an ER nurse often only has time to assess, react and move on. While charting and attention to detail are always a part of the job, workflow and work environment often do not offer the chance for meticulous detail-oriented paperwork and routines.

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Roles & Duties of an Emergency Nurse

As mentioned, ER nurses need to be quick thinkers, make decisive actions, and have strong stomachs and hearts. The following is a not all-inclusive list of possible ER nurse duties.

• Rapid patient assessment
• Ability to triage
• Wound care and management
• Blood draws and IV starts
• Insurance paperwork and care coordination
• Allergic reaction management
• Assessment of patient response to interventions
• Record and report patient status
• Trauma care/management
• Code care (respiratory/cardiac responses)
• Medication management and administration
• Minor surgical procedures
• Efficient use of medical equipment (crash carts, oxygen equipment, etc.)
• Transfusion setup and administration
• Charting
• Discharge and care coordination

Associated Care Team

Though ER nurses do plenty of work independently, the workflow of an Emergency Department usually means there are physicians present much more often than other areas of a hospital. The expediency of both results and care that the ED team often needs demands excellent communication with all associated professionals. The care team may be comprised of attending physicians, anesthesiologists, lab technicians, respiratory therapists, imaging professionals, ER techs, internists, residents, social work, case managers, security and child life specialists.

Emergency Department Nurse Workplace

Nearly every hospital has an Emergency Department where patients can be triaged, stabilized, admitted, transferred, or discharged. ER nurses work in these departments. It is important to note that while nearly every facility can handle receiving or admitting patients for emergency, many smaller facilities transfer to larger, better equipped facilities or departments once a patient is stable. Should an ER nurse desire a higher level of care opportunities and experiences, they may want to pursue employment at a higher acuity facility.

Emergency Nurse Salary and Job Outlook

Though the health of the general population has shown an overall positive trend in the last few decades, there will always be demand for highly trained Emergency Department staff to respond to life’s emergency situations. Because of this, the ER nurse outlook remains (and likely will continue to remain) strong.

According to an Incredible Health study, the average ER RN makes $76,415/year. However, you can expect a range which is usually related to geography and nurse credentials, education, and experience. For example, emergency department nurses in California can expect to make more money than in other states.

Becoming an ER Nurse

In 2010, the Institute of Medicine (IOM) issued a confident goal: By 2020, their desire was that 80% of registered nurses (RN) be bachelor’s prepared professionals. This desire was related to both the complexity of nursing practice and IOM studies evidencing that bachelor’s prepared RNs have better outcomes and more competent practice. Currently, the goal has not yet been achieved, but it should affect an RN’s educational choices moving forward.   

Education Requirements for ER Nurses

Associates Degree Nurse (ADN): To practice as a professionally licensed RN, at the minimum one must achieve an ADN and pass the NCLEX-RN exam before being eligible for licensure and subsequent employment. ADN programs typically take two years to complete (after two years of the appropriate prerequisites). ADN programs are usually offered through community colleges and include coursework online, in the classroom, lab work, clinical rotations, and practicum experiences. If an RN chooses this path, they should do so understanding that they may be limited professionally, as well as be ineligible for employment in a variety of settings (particularly Magnet hospitals or hospitals seeking Magnet status).

Bachelor of Science in Nursing (BSN): To enhance their education and maintain professional advantage, most students chose to begin their education with a BSN program. BSN programs, offered at brick and mortar campuses and online, usually take four years to complete. Much like an ADN program, they are a combination of classroom work, lecture, labor work, clinical experiences, and practicums. The IOM believes that BSN programs deliver more than what is taught in ADN programs, better equipping RNs for professional practice.  

There are many “bridge” programs available, which take anywhere from 12-24 months, that allow a student to move from an ADN to a BSN or Master of Science in nursing (MSN). These programs continue to increase in popularity as the mandate continues to impact practice.

Master of Science in Nursing: A MSN is not required for professional nursing practice. However, many nurses choose a bridge program to complete their MSN, as it opens the door for teaching opportunities, higher pay, and greater responsibilities. Occasionally, some employers will reimburse or offer educational assistance for these academic pursuits (bridge programs, BSN pursuits and MSN pursuits).

Additional Credentials and Certifications for ER RNs

There are a variety of additional certifications a med-surg RN can pursue. Many of the most common are discussed below. Note that some are usually required.

Basic Life Support (BLS): This credential teaches high quality CPR and cardiovascular life support skills. It is usually required before hire or immediately after hire. It must be renewed every two years.

Advanced Cardiac Life Support (ACLS): This course builds on the basic skills of BLS. It is usually required before hire or immediately after hire. It must be renewed every two years.

Pediatric Advanced Life Support (PALS): Though many facilities may transfer these patients out, PALS is still often required for ER nurses, as they will still have to assess, treat, and stabilize. Renewal is every two years.

Trauma Nurse Core Course (TNCC): Developed by the Emergency Nurses Association, this credential is a two-day course to present core knowledge, refine skills, and strengthen the RN foundation. It must be renewed every four years. This certificate may be required.

Certified Emergency Nurse (BCEN): This credential is given by the Board of Certification for Emergency Nursing. Though the recommendation is two years of ED experience, there is actually no professional experience requirement before one can take the BCEN exam. Renewal is required every four years.

State-mandated Continuing Education: Each state has different continuing education requirements. You can learn more about your options and complete all your nursing CEUs for free on Incredible Health’s site.

A career as an ER nurse is sure to keep one on their toes mentally, physically, and emotionally. These nurses are masters of efficient assessment and response, as well as excellent communicators, leaders, and collaborators. Are you a quick thinker and excellent decision maker? ER nursing may be for you if you believe you thrive in fast-paced, unpredictable environments.