Emergency Nursing

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    Emergency nursing is a specialty in which situations change and evolve from minute to minute. Emergency nurses must be able to create order from chaos. This article gives an overview of the specialty, discusses education requirements, outlines some possible associated board certifications, and provides resources for further exploration.

    Emergency Nursing

    What is Emergency Nursing?

    Emergency nurses specialize in caring for patients in potentially emergent or critical condition, be it from illness or injury. Because this specialty is unique in that patients do not necessarily arrive with a diagnosis, emergency nurses must be able to rapidly recognize impending threats. Patients will range in age from neonates to centenarians, and will arrive in all conditions. Care of these patients is typically intended to be short-term in duration; however, with hospital crowding, lack of beds for admission, and lack of access, some patients become very familiar to staff. And no, it's nothing like on TV!

    Education Requirements

    An Emergency Department (ED) may employ a variety of types of nurses, including LPNs, ADN-prepared RNs, BSN-prepared RNs, MSN-prepared RNs (often in department management or education), and even Nurse Practitioners in a mid-level provider role. Not all types of nurses will be present in all EDs as hiring preferences vary by location.

    Additional certifications that an emergency nurse may be required to obtain or might want to pursue include: Basic Life Support (BLS), Advanced Cardiovascular Life Support (ACLS), Pediatric Advanced Life Support (PALS), Trauma Nursing Core Course (TNCC), Emergency Nursing Pediatric Course (ENPC), and Advanced Burn Life Support (ABLS). Additional courses may be required by or available at other locations; this list is not all-inclusive.

    Emergency Nursing as a Specialty

    As the "Emergency Room" (ER) has morphed into the full-fledged "Emergency Department" (ED), so has the emergency nursing specialty grown in prominence. Though there have been emergency nurses for decades (after all, the Emergency Nurses Association [ENA]) was founded in 1970), it was only officially recognized by the American Nurses Association (ANA) as a specialty in 2011.

    Board Certification

    Two primary emergency-related board certifications for RNs are the Certified Emergency Nurse (CEN) credential and the Certified Pediatric Emergency Nurse (CPEN) credential. To qualify for the CEN, one must be an RN with an unrestricted license in the US or its territories, and there is no minimum practice requirement, though two years is recommended. To qualify for the CPEN, a candidate must hold a current unrestricted RN license in the United States or Canada and have practiced at least 1,000 hours in pediatric emergency nursing practice as an RN in the preceding 24 months. Links to the Board of Certification for Emergency Nursing (BCEN) are available in the "Resources" section below.

    A new trauma-specific board certification is the BCEN's Trauma Certified Registered Nurse (TCRN) credential. To sit for the exam, one must hold a current unrestricted RN license in the United States or its Territories, and a nursing certificate that is equivalent to a US RN is also acceptable. Two years of trauma experience is recommended with 1,000 hours per year across the trauma continuum, and 20-30 hours of trauma-specific coursework. A link to more information about the TCRN is below.

    Work Environment

    Emergency nurses most commonly work in the hospital-based ED setting, though they are also employed at freestanding EDs, urgent care centers, and in prehospital environments in some areas. Typically an emergency nurse can expect to have unlicensed assistive personnel resident in the department, such as unit secretaries, registration associates, and Patient Care Technicians (PCTs). The broader interdisciplinary team also includes radiology techs, lab techs, respiratory therapists, and other specialists who participate in caring for patients. The entire team, including providers, works closely to care for patients and arrive at a diagnosis and disposition.

    Skills/Qualities of Emergency Nurses

    Emergency nurses should possess excellent assessment skills to ensure that their patients are not experiencing an immediate or potential life threat. Often emergency nurses are the first to see patients, before the providers; as such, rapid recognition and identification of health issues is essential. Communication is also key to elucidating a patient's reason for visiting the ED, which may provide clues to a current or potential health issue. The environment is fast-paced and constantly changing.

    Duties of the Emergency Nurse

    The emergency nurse may fill many roles in the ED: triage, charge (directing patient flow), direct patient care, trauma nurse, and so forth. The emergency nurse constantly communicates with patients, often acting as the patient's advocate. He or she must be attuned to any changes in patient condition that require a change in treatment or intervention, and must keep the rest of the team apprised of any such changes. Emergency nurses often make arrangements for admission or transfer of patients, which can be a complex and time-consuming task requiring close communication with the accepting facility staff, the patient, any family, and the transport team.

    Job Outlook and Salary

    Though the downturn in hiring has certainly affected nursing across the board, this is a specialty that has been relatively stable for experienced nurses. New graduate nurses may have more difficulty with direct entry into emergency nursing practice, but emergency nursing opportunities remain available and desirable.

    Salary will vary by education and location. Emergency nurses typically work in shifts, which results in shift differential and other benefits.


    Emergency Nurses Association

    Board of Certification for Emergency Nursing - Certified Emergency Nurse (CEN)

    Board of Certification for Emergency Nursing - Certified Pediatric Emergency Nurse (CPEN)

    Board of Certification for Emergency Nursing - Trauma Certified Registered Nurse (TCRN)
    Last edit by Pixie.RN on Apr 5, '16 : Reason: Adding TCRN Information
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    Pixie.RN: a short green-eyed redhead, very tattooed, Emergency/Trauma Nurse, former CPT/66T (Army). Avid reader, addicted to good shoes, allnurses, and her Android smartphone.

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  3. by   NGYSUN
    Very enlightening post Pixie. I guess that success in the ED boils down to many including GOOD assessment skills..Thank you for sharing..
  4. by   Pixie.RN
    Updated the article to add TCRN information.