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Emergency Room Nursing Specialty: The Ultimate ER Jobs Guide

According to the Centers for Disease Control and Prevention (CDC), in 2018, there were 130 million visits to the emergency room (ER) in the United States, which is equivalent to 40.4 visits per one hundred people. In other words, nearly half of the entire US population visited the ER that year. Who treats all those patients requiring urgent care? You guessed it: primarily ER nurses.

Would you like to become one of these indispensable frontline workers? Read on for the ultimate guide to ER nursing. Learn what emergency room nursing is like, how to become an ER nurse, what salary ER nurses can expect, and much more. 

Table of Contents

What Does ER Stand for, and What Does It Mean in Medical Terms?

emergency room

The abbreviation ER stands for emergency room. The medical definition of emergency room is an area prepared to receive and treat people requiring immediate medical care. 

According to the Emergency Nurses Association (ENA), emergency rooms or departments can actually be found in many different settings aside from major urban hospitals, which is the type of ER that most readily comes to mind. Other emergency department settings include the following:

  • Teaching hospitals: These are large facilities with ample resources associated with one or more universities. 
  • Stand-alone emergency departments: These emergency departments are not connected to a hospital and are only available in some states. 
  • Community settings: These are found in mid-sized cities and have a moderate amount of resources.
  • Rural areas: These ERs are in moderately remote areas and have more resources within a few hours’ travel. 
  • Critical access: ERs in these areas have very few resources since they are located in remote settings.
  • Disaster settings: These ERs are usually associated with federal or military responses to disasters and often have few resources.

Furthermore, emergency rooms can also have subspecialties, catering to specific populations with particular medical needs. Emergency medicine can focus on trauma, stroke, cardiac, burn, or neuro. It can also cater specifically to pediatric, adult, geriatric, or military populations.

What Is an Emergency Room Unit in a Hospital?

A unique characteristic of an emergency room is that patients do not require an appointment to receive medical attention, which also implies that many people may be at an ER at once awaiting treatment. ER staff does their best to determine which patients require attention most urgently.

Unless patients’ conditions are severe, the first person patients usually see in an emergency room is an ER nurse. This nurse asks patients about their problems and checks their temperature, pulse, and blood pressure. While patients wait, they may have lab work or X-rays done. Depending on each patient’s condition, the ER healthcare team may treat a patient in the ER, ask them to stay for observation, or decide that the patient needs to be admitted to the hospital. Before being discharged, patients receive instructions on caring for themselves at home and may be given prescriptions for medications.

What Does an ER Nurse Do?

ER nurses often treat patients suffering from severe and even life-threatening conditions. The main responsibility of an ER nurse is to identify the patient's medical needs and the severity of their condition. As one of the first responders when patients enter an emergency room, an ER nurse’s responsibilities also include providing basic life support to stabilize patients. They also must assess situations quickly to make the best decisions regarding which patients need attention most urgently.

Other typical ER nurse duties include the following:

  • Assessing, planning, implementing, and evaluating patient care 
  • Prioritizing interventions based on patients' needs
  • Documenting observations, physical examinations, test results, and patients’ responses to treatment
  • Taking vital signs
  • Administering medications and assisting physicians with procedures 
  • Collaborating with members of the interdisciplinary team to identify patients’ needs
  • Revising care plans based on patients’ needs
  • Coordinating patient care through the continuum of care, including educating patients and their families regarding their health conditions and care after discharge

What Is the Role of an ER Nurse?

emergency room

What ER nurses do also depends on their specific roles. Even within the ER, nurses may work in different positions. According to the ENA, here are some ER nurse roles:

  • Trauma nurses: These nurses work in trauma centers and take over when patients arrive at the ER.
  • Triage nurses: These nurses determine which patients will be treated first based on the severity of their conditions. 
  • Code nurses: These ER nurses provide emergency care for the sickest patients during code situations.
  • Disaster response or emergency preparedness nurses: Any emergency room can receive victims of natural or man-made disasters, which is why all ER nurses should receive this training. Nevertheless, some nurses specialize in this area and ensure that their departments prepare to meet these needs. These nurses may also work for special disaster response teams and be called in in moments of need. 
  • Critical-care transport nurses (CCT): CCT nurses care for critical care patients while they are transported by ambulance from one facility to another.
  • Flight nurses: These nurses care for critically ill or injured patients while they are being transported by plane or helicopter from one facility to another. 
  • Pediatric ER nurses: These ER nurses usually work in pediatric hospitals caring for newborns, children, and adolescents. 
  • Burn center nurses: These ER nurses are specially trained to resuscitate and care for burn victims.
  • Geriatric ER nurses: These nurses are specialized in elderly patient care.
  • Military ER nurses: If nurses enlist in one of the military branches, they may work in military hospitals, clinics, or even combat zones. 
  • Charge nurses: These nurses basically run the ER: They handle staffing, patient assignments, and communication within the ER, among many other duties.

How to Become an ER Nurse?

Emergency room nurses are registered nurses (RNs). In other words, nurses who work in ERs have either completed associate’s or bachelor’s degrees in nursing. Furthermore, nurses can pursue certifications to specialize in emergency room care. 

ER Nurse Certifications?

Many RN jobs require Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ACLS) certifications, but these credentials are indispensable in the ER setting. Furthermore, nurses who work with pediatric populations should also obtain Pediatric Advanced Life Support (PALS) certifications. All of these certifications are available through the American Heart Association

Moreover, the Board of Certification for Emergency Nursing (BCEN) offers five different certifications for ER nurses:

  • Certified Emergency Nurse (CEN)
  • Certified Pediatric Emergency Nurse (CPEN)
  • Trauma Certified Registered Nurse (TCRN)
  • Certified Flight Registered Nurse (CFRN)
  • Certified Transport Registered Nurse (CTRN)

To be eligible for any of these certifications, nurses must hold a current RN license. In addition, BCEN recommends that applicants have at least two years of previous nursing work experience.

Other certification options for RNs are available through the ENA, which offers the following courses:

  • Trauma Nursing Core Course (TNCC)
  • Emergency Nursing Pediatric Course (ENPC)
  • Geriatric Emergency Nursing Education (GENE) Course
  • Triage First
  • Emergency Severity Index

How Long Does It Take to Become an Emergency Room Nurse?

Since ER nurses are RNs, becoming an ER nurse takes a minimum of two to four years: approximately two years for an associate’s degree or four years for a bachelor’s. After licensure, RNs can immediately pursue an emergency room certification, although both the BCEN and the ENA recommend acquiring work experience before certification. Therefore, in total, becoming a certified ER nurse could take anywhere from two to six years or more.

How Much Do ER Nurses Make?

According to the US Bureau of Labor Statistics, on average, RNs in the United States make $82,750 per year or $39.78 per hour. In the hospital setting—where most ER nurses work—nurses earn, on average, $85,020 annually or $40.88 per hour. Although this average salary gives nurses an idea of the income they can aspire to as ER RNs, this income can vary widely across state lines and from one industry to another. For example, RNs who work in nonscheduled air transportation earn $112,630 annually or $54.15 hourly. ER nurses can also obtain higher hourly rates through travel nursing gigs or per diem work

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What Is ER Nursing Like?

ER nurses are a special breed; it takes a specific personality profile to thrive in this fast-paced, highly stressful, and unpredictable environment. However, many nurses who choose this nursing specialty enjoy the spontaneity of their jobs. Some even describe themselves as adrenaline junkies since they are energized by the excitement of constantly changing patients and priorities and enjoy having to be constantly on their toes making decisions on the go. Here is what ER nurses say about their jobs:

“ER nursing is not for everyone…That being said, ER nursing is so fun! One minute you’re drawing labs on your tenth abdominal pain, the next you’re dragging someone out of a car and starting CPR in the parking lot! And you’re gonna work with a smart, crazy, fun group of people…” Redditu/erinkca

“I think that in the ED the docs and nurses have the most overlap in our mindsets, skillsets, attitudes, and personalities of any practice environment. ED nurses are exceptionally independent in their thinking, evaluation of patients, and personal agency towards treatment.” Redditu/borgborygmi

Is ER Nursing Hard?

emergency room

Like all nursing specialties, ER nursing has its challenges. Here are some of the difficulties that ER nurses face:

“ER nurses have no control over what walks through the doors. They make messes, are also very smart, but are trained to put out fire after fire after fire throughout the shift. All while caring for 6 acute patients; 1 who's demented…, 2 are drunk and yelling at each other, 1 is of suicidal and upset about all the noise, all while squeezing a unit of blood in to the poor guy with a variceal bleed. No cnas or techs, typically.” Redditu/amybpdx

“There are of course many drawbacks. People who misuse the emergency department, frequent flyers, the pysch stuff, etc... And covid has burned me out so very bad.” Redditu/berekah7

Why Choose ER Nursing?

Nurses should choose to work in the ER if they can deal with chaos—or, better yet, if they thrive on it. Nurses who are detail-oriented and methodical should run in the opposite direction. ER nurses don’t have time to be detail-oriented; they must quickly assess situations, make decisions, and move on to the next patient. Despite this chaotic and stressful environment, ER nurses remain calm and can adapt easily to constantly evolving situations. Does this sound like you?

“...I love the ED. I am also at a large inner city level 1. Been doing it for almost a decade now, used to work floor before that. I love the atmosphere, how anything can come in at the drop of a hat. I love the staff camaraderie, we really are our own ‘family’ unit from the attendings to the residents to the nurses to the techs to the unit clerks with the teamwork, the experiences (good and bad.) I find I mesh well with most ED people personality wise. I love the autonomy, the wide scope, the criticality of our patient population…I’ll never leave. I’m a lifer.” Redditu/VNR00

“I like it because you have a lot of autonomy, you have to assess/triage the patient and know what to do, many times before the doc sees them…I have tried other nursing, but I always come back to the ER” Redditu/krisiepoo

What Makes a Good ER Nurse: Tips for New Nurses?

Based on the nature of ER nursing, the following are some skills and qualities that new ER nurses should strive to develop: 

  • Quick critical thinking 
  • High flexibility and adaptability
  • Ability to stay calm and focused in a chaotic environment
  • Effective communication and interpersonal skills
  • Autonomy
  • Compassion for patients and their families

In addition, here are some tips from ER nurses themselves:

“...the ED can teach nursing but it cant teach attitude, so always go in to learn. Work with your techs because they’ll teach ya stuff just as often as the docs.” Redditu/Dornishsand

“It's fast and unpredictable, exciting and emotional. You learn a lot and fast, you'll feel overwhelmed but you mature quickly. Years 1&2 are novice years, and they're hard. You need to be a sponge, malleable and absorbent, willing to learn and take criticism. Years 3-5 are where you hit your stride…if you apply yourself. After that, you've earned your stripes and can make a good long career out of it if you love it, or until burnout sets in.” Redditu/pushdose 

Final Thoughts on ER Nursing

ER nurses love their jobs and wouldn’t change them for any other, but is ER nursing for you? Choosing a nursing specialty depends on a lot more than demand and potential salary. Each nurse must evaluate their unique characteristics to decide which specialty will be the best fit for them. 
Furthermore, an excellent way to test the waters before a significant career move is to pick up per diem shifts in different settings and roles. No amount of information can beat hands-on experience, so pick up a per diem nursing shift today!

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