ER/ED Nurse Practitioner

TheMindofScads · Jan 26, 2012

I am curious as to the job responsibilities of a Nurse Practitioner who works in the Emergency Department. What exactly are they able to do (aside if there are no residents in this hospital)? Is it more the fastrack stuff? Is it challenging work?

It all depends on where you work. Are there NPs that work in EDs with a fast track focus? Yes, but that isn't always the case. Where I work NPs/PAs are trained to take care of most any patients. If their patient codes that patient remains their responsibility, though a physician will likely be there to assist. This includes central lines and intubations. Yes, I believe it could be defined as challenging, but rewarding work.

In an FNP program, are you able to request to do such a clinical rotation, or even in a PNP program?

In the FNP program that I am currently in I can do a specific number of clinical hours outside of primary care in any specialty I choose.

How much ED experience do most practices/hospitals like to see (RN) nurses have before they delve into the role of NP in this setting? Are new grads hired in one with ED/ER exp?

Again, depends on the ER. Most would prefer or require experience, but some (mostly those that are desperate) will do on the job training. My hospital has a PA residency in the ER that will likely be opening up to NPs in the near future.

Do FNPs get hired in a Peds ED or do they prefer PNPs?

Again, depends though some will hire FNPs.

What about Urgent Care Centers--same as Fast Track job responsibilities?

I don't know.

What is the pay like in these settings as a new grad? Or someone with a few years experience?

My region, the midwest, I've seen the the salaries of newer grads in EDs range from as low as $84k and high as $105k. All with good benefits. The low end isn't the norm as most start in the $90s, I just know of the one that starts in the $80s.

Those of you who work in this field, do you find it challenging and enjoyable?

Right now I am working as an RN in an ED, though I'm just over 1/2 way done with my DNP-FNP. The NPs/PAs I know in EDs enjoy. I will likely go that route as the residency I referred to above is very likely my path.

danceluver · Jan 26, 2012

@TheMindofScads:

can you tell me about this residency you mentioned? Do you think there will be more in the future? Feel free to pm me if you don't want it out in the open. Something i may consider in the future too. Oh, and do you think its fine just doing an FNP program, or is it better to look into ENP programs?

:) Great response! Thank you :)

zoidberg, BSN, RN · Jan 26, 2012

I think the key is to be working as an RN in the ER, and have a supervisor who is cooperative in your training and working with you as you do clinicals. Do all of your elective clinicals in the ED. Whether or not to do an ENP program depends on if your supervisor will allow for an expanded scope if you do an ENP (which just gives you dual ACNP/FNP in most cases). A few ENP programs are just FNP with ED cliniclas and a few supplemental courses, so you should be able to tailor an FNP to fit your goals. good luck!

sandnnw, BSN, MSN, EMT-B, APRN · Jan 28, 2012

I am curious as to the job responsibilities of a Nurse Practitioner who works in the Emergency Department.
I work side by side my ED Attending and Resident. I see the same patients they do and can admit/discharge on my own. I have a PA partner and we rotate the fast track area. I do not intubate nor place central lines, not in my scope.
In an FNP program, are you able to request to do such a clinical rotation, or even in a PNP program?
I graduated from an ANP program, no ED rotations. I did work in the ED as an RN. Did not intend on working the ED after graduation, just sorta fell in my lap :-)
How much ED experience do most practices/hospitals like to see (RN) nurses have before they delve into the role of NP in this setting? Are new grads hired in one with ED/ER exp?
No, I would not hire a new grad unless they rotated in for clinicals. I had 5+ years as an ED RN and 5 years M/CCU.
Do FNPs get hired in a Peds ED or do they prefer PNPs?
I'd say both, again, depends if you rotated in and networked. FNPs have a wider scope and thus are valued more in regular EDs. I cannot comment much on Peds ED, just the children's hospital next door seems 50/50 according to my boss.
What about Urgent Care Centers--same as Fast Track job responsibilities?
Yes and no. I had far more autonomy in the Urgent Care center. A lot of sewing, interpreting films and few policies.
What is the pay like in these settings as a new grad? Or someone with a few years experience?
The previous quote seems about right. Depends upon where you live. I do not think 90-100K would be unreasonable for more urban EDs on each coast.
Those of you who work in this field, do you find it challenging and enjoyable?
To quote my favorite General, "Every G*d D$&m day!" [George S. Patton]
Thank you.

Your are most welcome, ask away!

danceluver · Mar 27, 2012

So FNPs should have no problem finding jobs in fast track or ED if they have at least some ED RN experience? Or is it really better to go FNP-ACNP to cover all?

Tinabeanrn · Mar 27, 2012

In my FNP program our director works in the ER and encouraged us to all find clinical rotations in the ER. A lot of my class mates found clinicals in the ER with FNPs or MDs and had really good experiences. Two class mates went through two clinical rotations. So try to find a NP or PA in the ER to do a few clinicals with during school. Are you in a program now?

danceluver · Mar 27, 2012

@tinabeanrn: which program did you attend if you don't mind me asking? I will be starting one next year...I know some programs don't allow FNPs to do hours in those areas because its not primary care, ...

Tinabeanrn · Mar 27, 2012

I'm in Detroit. In the ER I'm told that NPs don't see the patients that are crashing and burning so you see patients that have vag/penile complaints, symptomatic infections, kids with fevers, fractures, lacerations and etc. So thing that you could see in primary care as well.

phillycpnp-pc, MSN, RN, NP · Nov 3, 2012

I'm in a PNP program and i only have 6 years of med/surg peds experience with no ED experience and i have my first clinical rotation in a peds ED next semester, which im excited about. At one of the hospitals where i have worked i did overtime in the extended care unit in the ER (where kids aren't sick enough to go to the floor and and not well enough to go home) and the NPs managed that section and did all the orders, the chief complaints were mostly asthma, foreign body ingestion, STDs, fevers, and many of the things Tinabranrn mentioned. I think pediatric hospitals hire PNPs over FNPs for their facilities.

RN-CEN TS · Oct 15, 2013

I believe the key that most replies are missing is spelled out in your states Nurse Practice Act. Each state has different inclusions and exclusions that make up your scope of practice as a nurse practitioner. These are to include procedures, as well as differences in prescriptive authority (which schedules/classes of medications you can legally prescribe). All of these things vary by state. Many states dictate that FNP practice in clinic settings only, and you must have a nationally recognized acute care certification to practice in an acute setting. Other make no distinction. If in doubt ask your state's board of nursing. Hope this helps.

nomadcrna, DNP, CRNA, NP · Oct 15, 2013

Many states in fact DO NOT!

A few states do this, usually they have restrictive practices as well.

The states I practice in use FNPs extensively for solo ER coverage. You are it.

There are also programs coming out such as West Virginia university emergency medicine program that you can do to document education.

Accn also has a ENP certification oit that is portfolio based but another way for FNPs to document ER education and training.