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I am a Nurse Manager of a very busy E.R. on Eastern Fla. coast. We use ARNPs in our main E.R.. The two ARNPs we have are, also, flight certified and fly patients to the major trauma center, if there are no other flight nurses available. They are autonomous but work under the auspices of the E.R. physician and see patients with all different complaints and injuries. My nurses have a very good working relationship with both ARNPs and having them in E.R. has been good for our unit. They truly are physician extenders in our emergency room. Hope this info. helps.