As an NP student I rotated on a hospitalist service at a large hospital. I say that I hated the role because it was very narrow and repetitive and I found waiting for a large team of docs and consults to make simple decisions extremely frustrating. Bear in mind that the way NPs were used in this hospital is not the way they are necessarily used everywhere - but basically we did scut work, managed hypertension for surgeons who couldn't be bothered, cleaned up messes when somebody got overdosed or otherwise med-error'd while on the floor, did discharge teaching for post-op patients who were newly diagnosed as diabetic, hypertensive, etc. Even the smallest and most-straightforward decisions (I'm getting a repeat head CT, I'm titrating coumadin) often required final clearance from the surgical team. They spent as much time approving and documenting these requests as they would have just managing the problems themselves ... I was also VERY unimpressed that NPs weren't allowed to do the initial hospitalist consultation for this particular service. We would go see new patients, write a note, pass it to our supervising MD, they would see the patient, and then re-write our note and sign it. What a joke!
The flip side of this experience being - I found independence and challenge in primary care. Honestly I find primary care much, much more difficult than inpatient work and I will gladly take the pay cut to stay in this setting over the relatively narrower scope, easier shifts, and better bonuses associated with a hospitalist position. But to each his own - we need good NPs in every setting !
I suspect that my experience on the hospitalist service is not necessarily comparable to work in an ER - the ER is a world unto itself. You will need a ER NP to weigh in on that one.