Emergency Nursing

**Lunah**, MSN, RN

The Emergency Nurse

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!

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 (UAP) in the department, such as unit secretaries, registration associates, and Patient Care Technicians (PCTs). Other interdisciplinary team members may include radiology techs, lab techs, respiratory therapists, and/or 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 favorable 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 (not all-inclusive):

Triage Nurse
Charge Nurse (directing patient flow)
Direct patient care Nurse
Trauma Nurse

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.

Education Requirements

Graduate from accredited nursing program (RN, LPN/LVN)
Successfully pass NCLEX-RN or NCLEX-PN
Current, unencumbered RN or LPN/LVN license in U.S. state of practice

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 (NP) and/or Clinical Nurse Specialists (CNS) 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. There have been emergency nurses for decades; the Emergency Nurses Association (ENA) was founded in 1970 and was only officially recognized by the American Nurses Association (ANA) as a specialty in 2011.

Board Certification

BCEN

Two primary emergency-related board certifications for RNs are the Certified Emergency Nurse (CEN) and the Certified Pediatric Emergency Nurse (CPEN) credentials from the Board of Certification for Emergency Nursing (BCEN).

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. The certification board recommends 2 years’ experience in the specialty area however, it is not required.

A 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. A nursing certificate that is equivalent to a US RN is also acceptable. The certification board recommends you have 2 years’ experience in your specialty area, but it is not required.

There are other certifications available through the BCEN.

Additional Certifications

Additional certifications that an Emergency Nurse may be required to obtain or might want to pursue include (not all-inclusive):

Basic Life Support (BLS)
Advanced Cardiovascular Life Support (ACLS)
Pediatric Advanced Life Support (PALS)
Trauma Nursing Core Course (TNCC)
Emergency Nursing Pediatric Course (ENPC)
Advanced Burn Life Support (ABLS).

Additional courses may be required by or available at other locations; this list is not all-inclusive.

Job Outlook

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 (2020)

According to salary.com, the average annual salary for the Staff Nurse RN in the Emergency Room in the U.S. is $76,332 with a range typically falling between $68,162 and $84,782.

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

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