Complete Guide to an Emergency Room Nursing Career
By Katelynne Shepard, Contributor
The emergency room may be the setting of many a TV drama, but the reality of actually working there is quite different. ER nurses have to be self-sufficient and able to make decisions confidently and quickly to ensure patients are assessed and treated properly. If you've been wondering if a career in the ER may be right for you, here's everything you need to know about what emergency room nurses do and how to become one.
What do emergency room nurses do?
Emergency room nurses are responsible for providing care to all patients who come through the ER doors, and this can range from babies all the way up to the elderly and include every age between. A day in the ER could have you start with assessing a patient who came in complaining of their heart racing and feeling short of breath and end with administering pain medication to a trauma victim.
Emergency room nursing is unpredictable, and you can never be exactly sure what you're dealing with, even if the EMTs have called ahead to give a briefing. Cases in the ER can change quickly, and it's important for nurses to be ready to move or change responsibilities at a moment's notice. ER nurses must be able to react quickly to the patient and directions from the doctor. Some other standard responsibilities of emergency room nurses include:
Being able to multitask. One of the biggest differences in ER nursing compared to other specialties is that everything is done much more quickly. This means that you may need to be taking vital signs while simultaneously looking for the source of bleeding or keeping a broken limb stable. Assessment and treatment often overlap in the ER, and you'll need to be able to handle both at the same time.
Being firm and direct. While a lot of nursing is about being able to comfort patients, the ER is often more about assessing the situation and next steps quickly. You will be dealing with patients who are in a lot of pain and may be confused about where they are or what happened. ER nurses need to be able to handle patients firmly while still providing compassionate care.
Having a collaborative approach. The ER has a lot of moving parts, and that includes personnel. As a nurse, you must be able to work seamlessly with the rest of the team to provide patient care under high-stress situations that have very little margin for error or hesitation.
All nurses have to assess and monitor patients, record vital signs, administer medications and start IVs, and ER nurses are no different. However, all of these tasks must be completed under pressure and with speed in mind as the goal of the ER is to move patients through, either by deeming that they need to be admitted to the hospital or stabilizing them and sending them home. Common duties of an ER nurse include:
- Checking medical equipment to ensure it's functioning properly
- Keeping supplies stocked between patients so they're ready when needed
- Performing or assisting with tests such as EKGs, electrocardiograms and blood draws
- Asking questions to get an accurate idea of the patient's condition and symptoms
- Keeping accurate charting notes to ensure continuity of care if the patient is moved to another department
Emergency room nursing by definition takes place in the nursing room, but there are still different areas you may work in depending on the day, shift or changing staffing needs. Here are a few common nursing areas in the ER:
Registration. This is where patients go when they first present in the ER, and while the actual registration process may not be completed by an RN, it's common for a nurse to be stationed at registration so they can immediately start assessing and treating any critical patients who come in.
Triage. This area is one of the most important in the ER. The triage nurse is responsible for deciding who gets care in what order when there are multiple patients coming in. For example, head injuries, possible heart attacks and difficulty breathing typically take precedence over a broken limb or cut in a patient who is otherwise stable.
Observation. It's common for patients to be watched and vital signs evaluated for a few hours before a determination can be made on whether they need ongoing care in the hospital or can be released back home. Nurses working in the observation area will monitor patients for any change in status, either good or bad. They may also administer IV fluids and medications and respond to patients' calls.
Surge. When the ER starts getting close to full capacity, surge procedures may be implemented. This is where makeshift beds may have to be set up in hallways and other flex spaces. While this may not occur very often in ERs — usually only occurring when there's an illness outbreak or a mass casualty event — it's a time when it's easier for details to get lost in the shuffle. Nurses assigned to the surge area will need to be extra careful about properly documenting patients' info and treatment details.
It's also possible for emergency room nurses to work in urgent care centers, sports arenas and helicopters (in the case of flight nurses).
Rewards and benefits of emergency room nursing
One of the main reasons nurses are drawn to the emergency room is the fast pace and the fact that no two shifts are ever alike. In the ER, you never know what's coming through the door next. One shift could cover everything from a car accident and gun shot wound to a deep laceration to the hand and a child with a high temperature. The constantly changing atmosphere is a big plus for nurses who love the hustle and bustle of the profession and would rather be on their toes dealing with the next incoming case than doing rounds on a regular unit.
When it comes to monetary benefits, working as an ER nurse can be a lucrative opportunity, particularly for travel nurses. The Bureau of Labor Statistics reports that registered nurses can expect to receive an average salary of around $71,000. However, this depends largely on experience, specialization and location.
According to PayScale, ER nurses make an average of $30.80 an hour as of July 2019. When you factor in mandatory overtime and bonuses, some nurses could make upwards of $90,000 in high-paying locations like California.
Potential cons of working as an emergency room nurse
The fast pace of the ER that's a draw for many is also a double-edged sword in that it can contribute to a more stressful working environment and, for nurses who work in the ER over the long-term, burnout. For travel nurses in particular, it can be difficult to have to start making split-second decisions and working as part of a cohesive treatment team when you're still getting used to where supplies are kept and don't have an existing working relationship with the other nurses and doctors.
While ERs are rarely as action-packed as the TV shows would have you think, they do have to deal with traumatic cases, and ER nurses will experience patient loss. It can be difficult to have to notify family and next of kin of a loved one passing, but you can also take solace in the fact that you were able to do everything you could to save the person.
Outlook for emergency room nursing jobs
Overall, the Bureau of Labor Statistics reports a project job growth rate of 15 percent for registered nurses from 2016 to 2026, which is classified as "much faster than average." Emergency room nurses should also enjoy good job security as a large portion of patients who are admitted in hospitals have to come through the ER before they get there. The continued need for urgent care centers in places that are far from larger hospitals also helps boost the number of open positions for emergency room nurses, and travel nurses are especially in demand to help ease the burden on staff nurses who are working mandatory overtime due to geographic nursing shortages.
How to become an emergency room nurse
To become an emergency room nurse, you'll need to get the proper education and then start taking your nursing skills and knowledge into direct patient care. Advanced education, such as a master's in nursing, and certifications can also be helpful if you're looking for higher paying jobs or are interested in eventually moving on to a nurse practitioner or supervisory position.
Becoming an emergency room nurse starts with getting either your associate degree in nursing or a bachelor's degree in nursing. While it may be tempting to go with just the associate degree, when you want to work in a specialty such as emergency room nursing, a BSN opens up more opportunities and helps set you apart from the other applications.
Once you've graduated, you're eligible to sit for the NCLEX exam. After successfully passing, you'll be granted your RN license and be able to start getting real-world experience.
Training and work experience
After you get your RN license, you'll be ready to start applying to open nursing positions, but it may be difficult to get an ER job right away. Because of the high-stress, split-second pace of the ER, many employers want to see nurses who have already demonstrated an ability to handle patients and work with other medical professionals before upping the ante in the emergency room. Because the ER deals with a little bit of everything, it's a good idea to try to get experience with a variety of environments during clinicals. You may want to try a float position as an RN so you can work in different departments.
Getting certified as an emergency nurse shows that you take your career seriously and allows you to demonstrate to employers that you have the skills, knowledge and experience that emergency nursing takes. There are several certifications nurses interested in working in the ER may want to consider, all accredited by the Board of Certification for Emergency Nursing:
Certified Emergency Nurse (CEN). This is the general certification for emergency room nurses and should be the first step for those looking to add something extra to their resumes.
Certified Flight Registered Nurse (CFRN). This certification verifies your experience working in flight nursing, including Life Flight operations and caring for patients on helicopters.
Certified Pediatric Emergency Nurse (CPEN). Getting certified in pediatric emergency nursing is ideal for nurses who want to work in children's hospitals.
Trauma Certified Registered Nurse (TCRN). The emergency room often involves trauma cases such as those from auto accidents or gun shot victims, and having this certification shows employers you're ready to handle these serious cases.
Certified Transport Registered Nurse (CTRN). This certification is for nurses who provide care to patients being transported, usually by ambulance, to other hospitals and health care facilities.
What travel nurses need to know about emergency room nursing
Travel nurse positions in the emergency room are in high demand because it's a high-stress environment that not all nurses are suited for or enjoy. It's also an area that can have increased rates of burnout, and travel nurses can help provide some relief for staff nurses who have been working overtime due to high patient volume. As a travel nurse working in the ER, you will have to be able to familiarize yourself quickly with the policies and procedures of the different facilities and be ready to take charge of your patients in a new environment.
If you're someone who thrives in a high-energy environment that requires multitasking and quick decision-making skills, it may be time to take your knowledge and experience on the road as a travel emergency room nurse. TravelNursing.com has the resources you need to pursue this career path, including a list of open ER nurse jobs around the country.
Johnson and Johnson Nursing. Emergency Nurse.
India Ogazi. A Day in the Life of an ER Nurse.
Rasmussen College. Emergency Nursing: Everything You Need to Know About Being an ER Nurse.
Colorado Technical University. How to Become an ER Nurse.
US Acute Care Solutions. Hospital Capacity Management II: The Surge.
Bureau of Labor Statistics. Registered Nurses.
PayScale. Average Registered Nurse (RN), Emergency Room Hourly Pay.
Board of Certification for Emergency Nursing. CEN.
Board of Certification for Emergency Nursing. CFRN.
Board of Certification for Emergency Nursing. CPEN.
Board of Certification for Emergency Nursing. TCRN.
Board of Certification for Emergency Nursing. CTRN.