Emergency Nurse Practitioner (ENP) Autonomy

[cgBNA]

Hi everyone!

I am a soon to be BSN graduate with plans to start off in a larger trauma Emergency Department in Nashville. I will also be starting an FNP program that I will be able to complete in about two years in the fall of 2019. After that, I plan to make an attempt at an ENP (emergency NP) at Vanderbilt as a postmasters student. I know that the FNP is the foundation for NP usefulness in the ED but I feel that this program would prepare me to take on a more acute role, at least from what I have heard from former students/ ENP's in my area. After completing the FNP and ENP, I will have obtained an FNP, ENP and AG-ACNP (I believe it is part of the ENP at Vandy? and if it is not then I would also do this cert) certs. I also may do a two week Paramedic program for usefulness (there are a couple of these I have seen already.)

My biggest question is: is anyone an Emergency NP (doesn't matter what certification) and what type of acuity/ situations are you able to see in the ED. I know some are stuck back in the fast track and see very low acuity (particularly at our HCA facilities in the Nashville area) but are there ED's where they do more? I'm talking intubations, chest tubes, LP's, I&D, suturing, central line insertions, art, PA and CVP or any combination of them? I also wonder how often they are able to run codes? I work as a nurse intern in a decent size urban hospital (550 beds) and it is not uncommon for an NP to run a code on the floor but I am unsure if they intubate/ insert central lines in these situations. I understand that some flight NP's do these procedures on a regular basis?

My primary reason for asking is that I have a real interest in being able to perform these occasional invasive procedures and if that is not the case then I seriously will consider CRNA school after a couple of years in the CVICU (another offer on the table for me) as I love this part of medicine.

[Oklahoma 1]

I am curious as to their scope in ERs as well. I was looking into CRNA and ran across An article about a ENP (Emergency Nurse Practitioner) and it has perked my interest as I love the ER! Never many dull moments there. And if I went the NP route I think Emergency Medecine is where I would want to be. Especially if you get a good medical Drs, who love to teach!

[JBMmom, MSN, NP]

I work in a much smaller hospital, and our ED NPs see whoever walks through the door. Sometimes they run the codes, but usually lines and intubations are done by surgical and anesthesia respectively. Many patients that needs the really invasive stuff, though, are shipped to the closest level 2 trauma center, we're only level 3. I think much of it will depend upon the specific hospital you land at with your degree. Good luck.

[Oklahoma 1]

Thank you for the reply, I guess it will depend on where you work and the policies of the hospital. I would hope the ENP would be fully used to their training and not just seeing colds and cuts, etc, but definitely interests me if I pursue NP degree I think it would be in emergency medecine.

[Dodongo, APRN, NP]

I don't work ER, but I have a few friends who do. In my system the ICU and ER NPs do run codes and do procedures such as line insertion, intubation, I&D, suturing lacs and chest tube insertions, etc. At another facility, the one trauma NP will come to the trauma bays in the ER and she runs the trauma codes - directing the residents, nurses, respiratory, etc. It mostly depends on the facilities where you are employed. Academic centers with residencies and fellowships are not the greatest places for APRNs of any variety to work if you don't want to be relegated to the low acuity patients.

[cgBNA]

I don't work ER, but I have a few friends who do. In my system the ICU and ER NPs do run codes and do procedures such as line insertion, intubation, I&D, suturing lacs and chest tube insertions, etc. At another facility, the one trauma NP will come to the trauma bays in the ER and she runs the trauma codes - directing the residents, nurses, respiratory, etc. It mostly depends on the facilities where you are employed. Academic centers with residencies and fellowships are not the greatest places for APRNs of any variety to work if you don't want to be relegated to the low acuity patients.

I love the idea of that. I just have a real love of airway management (LAM's and intubations, etc) and performing and learning procedures but I know surgery and anesthesia would bore me as a career in the long term. I've recently found that the the ER that I scribe in supports APP's in intubations, etc so that is a positive thing I suppose.