Working as an emergency room nurse is one of the most demanding yet rewarding careers in the medical field. According to the Centers for Disease Control and Prevention (CDC), hospitals handle more than 130 million emergency room visits every year. This fact is just one of the many reasons why registered nurses (RNs), especially emergency nurses, are in such high demand. In fact, the Bureau of Labor Statistics (BLS) anticipates a 7% job growth for RNs over the next ten years.
ER nurses work in a fast-paced environment while often providing life-saving treatments to a wide range of patients. Although a career in emergency room nursing is not for everyone, it can be an ideal option for those who enjoy helping others and who have the ability to stay calm under stressful situations. Fortunately, emergency nurses are typically paid very well, especially when factoring in overtime and bonuses.
This guide will provide more information about the role of ER nurses, compare the salaries of these medical professionals across the country, and offer tips for how to find the highest-paid emergency room nursing jobs in the country.
Types of nurse that emergency rooms typically hire
The majority of emergency nurses work in the emergency room of a hospital or at a standalone emergency treatment center. However, these professionals can also work on an emergency transport team, including ambulances and medical helicopters as well as at professional sports arenas. No matter what type of workplace environment they work in, ER nurses can expect to treat a wide range of medical conditions, including burns, lacerations, fractures, abdominal pain, strokes, heart attacks, and various illnesses.
The day-to-day workload of an ER nurse varies greatly. One day, an emergency room nurse could see back-to-back patients with little time to rest or sit down during the day. Whereas the next day could be slower and give the nurse time to catch up on paperwork, stock medical supplies, or attend required training.
Emergency room nurses work under the direct supervision of physicians and physician assistants. They handle a wide range of duties, including:
- Monitor patients’ vital signs
- Collect and update patients’ medical history
- Provide triage care
- Administer medication
- Start IV
- Provide treatment in accordance with doctor’s orders
- Provide patient education
- Operate medical equipment
- Draw blood and submit to lab
- Arrange patient transfers as needed
- Handle the discharge process
- Arrange outpatient services
- Collaborate with the emergency team
Nurses working in the emergency room must have an excellent bedside manner and the ability to effectively communicate with patients. They must also have the stamina to work on their feet for 10 to 12 hours shifts, or longer if necessary. Additionally, ER nurses have a high level of integrity and empathy as well as decision-making and leadership skills. They should also be very detailed-oriented and have the ability to follow orders with little supervision.
Due to the vast scope of medical services ER nurses provide most hospitals prefer to hire licensed RNs (Registered Nurse). However, there may be entry-level positions available for LPNs (Licensed Practical Nurse) who are willing to pursue their RN licensure. In addition, many hospitals today prefer to hire RNs who have earned a Bachelor of Science in Nursing (BSN) degree, although an ADN (Associate Degree in Nursing) along with relevant experience is accepted by some employers. For higher-level positions, a certification as a Certified Emergency Nurse (CEN) may also be required.
Not all ER nurses specialize in a specific type of care, but the ones who do are in higher demand and are likely to find higher-paying jobs. While there are dozens of emergency medicine specialties, here’s a look at the most popular types of ER nurses.
- Triage nurse – A triage nurse is often the patient’s first point of contact. They must have an in-depth understanding of all medical conditions. These nurses access each patient’s condition and determine the level of priority of care required.
- Critical care nurse – Also referred to as ICU nurses, critical care nurses work in the intensive care unit of the hospital and treat patients facing the most critical and life-threatening illnesses and injuries. They must have many years of emergency care experience and an in-depth understanding of critical care services.
- Cardiac nurse – These specialists are called on to work with patients struggling with cardiovascular conditions and diseases, such as strokes, heart attacks, and congestive heart failure.
- Pediatric nurse – Pediatric ER nurses work with children aged 18 and under. They may also work in a subspecialty, such as neonatal, which involves caring for newborns up to 28 days old.
- Geriatric nurse – Geriatric nurses specialize in working with older patients that are over the age of 60. They must deal with a wide range of senior-related medical conditions, such as dementia, limited mobility, and incontinence care.
- Neuro nurse – These specialists work with patients dealing with neurological disorders, such as traumatic brain injuries or neurological disorders, including epilepsy, multiple sclerosis, and Parkinson’s Disease.
- Transport nurse – Transport nurses provide ambulatory care or work as flight nurses onboard medical planes and helicopters. They provide immediate care to patients as they are transported to the hospital.
- Burn unit nurse – These medical professionals often work in the burn unit of the emergency room. They work with patients suffering from severe burns and who require immediate care.
- Travel nurse – Travel ER nurses are in very high demand. These nurses travel from location to location based on need. For example, a travel nurse may be called to a specific location to treat patients after a natural disaster or called to work in areas that have are in high demand for ER nurses. These professionals must have the ability to relocate with little notice for months or even years at a time.
- Psychiatric nurse – Psychiatric nurses who work in the emergency room are called in to work with patients facing a mental illness or suffering from a psychotic episode. These nurses must have special training in mental health care.
States with highest-paid emergency room nurse
According to recent studies, the average ER nurse earns between $68,638 and $85,372 annually. While experience, education, and specialty play a vital role in emergency room nursing salaries, so does location. In fact, the difference between the state the pays the highest annual ER nursing salaries (Massachusetts- $95,375) and the lowest paying state (Florida – $66,733) is more than $28,500. There are several reasons for these wide discrepancies in salaries, including:
Cost of living
The cost of living is the amount of money it costs to maintain a standard quality of living. The states with the highest cost of living, such as Hawaii, Oregon, and Massachusetts also offer the highest salaries to ER nurses. A higher salary may look tempting at first glance, but once you factor in housing and transportation costs, the higher pay may not leave you with more money. When comparing salaries in different locations, it’s always important to factor in the cost of living.
Demand for ER nurses
Another factor driving salaries is demand. Some states of an overabundance of ER nurses, which makes not only finding a job harder but also makes annual salaries lower. However, states with a high demand for ER nurses tend to pay higher wages. For example, Alaska, South Dakota, and North Dakota all have a high demand for qualified nursing in their states. It’s not surprising that these states are among the highest paying in the country.
State’s credentialing requirements
Each state also has its own set of credentialing requirements for ER nurses. States with higher requirements tend to offer higher salaries. While this is based on experience and education level, which affects all salaries, it still plays a role in state ER nursing salaries as a whole.
Local competition
Finally, local competition can help to drive salaries up. For example, in a rural area with only one hospital, the number of applicants may be so high for these jobs that they can offer lower salaries. However, in cities, such as New York City, where multiple hospitals are located, nursing salaries may be higher as each hospital competes to recruit the most qualified ER nurses.
State-by-state comparison
There are 12 states that offer average ER nursing salaries that are higher than the national average. These states include:
- Massachusetts: $95,375
- Hawaii: $95,099
- Rhode Island: $91,746
- North Dakota: $90,078
- Alaska: $89,670
- Nevada: $88,963
- Washington: $88,887
- South Dakota: $88,447
- New York: $87,069
- Oregon: 86,459
- Maryland: $85,750
- Kansas: $85,730
Florida is the only state the fell below the national average. This fact is primarily due to the overabundance of ER nurses in the state, perhaps due to its year-round sunny weather. The other 37 states all fall within the average range for ER nursing salaries.
Metro vs rural areas
ER nursing salaries also vary based on location within any given state. Generally, cities in large metropolitan areas tend to pay higher salaries than smaller cities and rural areas. For example, here’s a look at the highest paying cities in the country.
- Brooklyn: $90.32 / hour
- New York City: $44.66 / hour
- Houston: $42.54 / hour
- Phoenix: $38.94 / hour
- Miami: $38.29/ hour
- Chicago: $38.14 / hour
- Atlanta: $38.07 / hour
- Dallas: $37.97 / hour
As you can see, all of the highest paying cities are located in metropolitan areas. Even cities in the state of Texas, which overall offers only average salaries, offers higher wages in their major cities.
While it’s not always the case, rural areas and smaller cities tend to pay less, in part because they have fewer resources available to them and lower demand for ER nurses as a whole. However, there are exceptions to this rule. For example, a specialty hospital, such as a cancer center and a children’s hospital may be willing to pay higher salaries for the specialized services ER nurses can provide.
When searching for a job as an ER nurse, it’s important to compare nursing salaries to the cost of living. However, you also want to compare benefits. For example, an employer that offers tuition reimbursement or more career advancement opportunities, such as a mentorship program, may be worth taking a lower-paying position for better career advancement.
Starting salaries for emergency room nurses
Nursing students interested in pursuing a career as an ER nurse should look for opportunities to gain clinical experience in an emergency room setting as early as possible. This hands-on experience can improve your chances of obtaining an ER nursing job upon graduation. Even without this experience, it’s important to try to find a job at a hospital or emergency care unit as soon as you earn your license to be a registered nurse.
As an entry-level nurse, you can expect to start at the base pay. According to recent studies, the average annual base pay for entry-level ER nurses is $53,665. Naturally, your salary should increase with experience. For example, mid-level ER nurses earn an average annual salary of $65,580 and higher-level ER nurse earn an average annual salary of $79,000.8
There are, however, several other factors that can impact how much an emergency nurse is paid, such as:
Education
A nurse’s education level can affect salaries, even for an entry-level position. For example, an ER nurse with a BSN (Bachelor of Science in Nursing) degree is likely to earn a higher salary than a nurse with only an ADN (Associate Degree in Nursing) degree. Additionally, nursing who move forward to earn an MSN (Master of Science in Nursing) degree earn even more, on average, than those with a ADN or BSN.
If you currently have an RN license, but only have a nursing school diploma or an ADN, you should consider enrolling in an RN-to-BSN program. This type of program can help you earn your bachelor’s degree in nursing as quickly as possible and increase your salary potential. On the other hand, if you already have a BSN, you might want to consider entering a BSN-to-MSN program to advance your career.
There are many online nursing programs that offer the flexibility to complete a portion of the coursework from the comfort of your own home and at a time that is most convenient for you. It’s important to realize that most of these online programs still require in-person lab and clinical work to be completed. Some universities and colleges, however, allow nursing students to complete this required work at an approved local hospital or medical facility. It recommended to obtain some clinical work in an emergency room setting if possible.
Location
Nursing salaries vary greatly based on location. As mentioned early, the highest paying nursing jobs are typically found in metropolitan areas. Additionally, some states, such as Massachusetts, Hawaii, and Rhode Island offer some of the highest ER nursing wages in the country.
Moving to one of these locations can improve your chances of obtaining a higher-paying salary. Before making this decision, however, you should also consider several related factors, such as the cost of living in the area, commuter expenses, and the cost of moving. You may find that the higher salary doesn’t compensate for the costs associated with moving.
Certification
Nursing certification can also greatly affect salary even at the starting level. Nursing with specialized credentials, such as an Advanced Cardiac Life Support (ACLS) certificate or certification as a Trauma Certified Registered Nurse (TCRN) can increase a nurse’s salary level. After two years of work experience in an emergency room setting, RNs can obtain their certification as Certified Emergency Nurse (CEN). This certification not only increase job opportunities for ER nurse but it can help them land higher-paying jobs.
There are several things that nurses can do to increase their salary potential, including:
Update employer: Don’t assume that your employer knows what types of training and credentialling you’re doing to advance your career. Even if your direct supervisor knows, always update your employer as soon as you earn a new certificate or certification as well as any specialized training you received. Be sure to provide your employer with a copy of all relevant documents. Just earning a certification or a new degree can instantly increase your salary.
Apply for hire positions: Emergency rooms are chaotic and hectic by nature. Don’t expect your supervisor to let you know every time a new position is available in the ER. Instead, be proactive by continuously checking the hospital job site for new employment opportunities. Apply to any position that matches your interests and future career goals.
Career development program: If your employer offers a mentorship program or some other type of career development program, be sure to request more information and stay active. Additionally, if you’re employer offers a tuition reimbursement program be sure to take advantage of this benefit and advance your training. After all, an employer is more likely to promote an employee that they are investing in.
Networking: Networking with other nursing professionals and former professors is a great way to learn about new job opportunities. Additionally, consider joining a professional membership, such as the American Academy of Emergency Medicine (AAEM) to hear about even more job opportunities in your career field.
Highest salaries for emergency room nurses
Emergency nursing is of the most popular career options in the medical field. Currently, there are about 90,000 ER nurses working in the United States. The majority of these nurses follow the same basic career path the includes:
Undergraduate degree
The first step to becoming an ER nurse is to earn your undergraduate degree, such as a nursing diploma, associate degree, or bachelor’s degree.
Nursing diploma
Some students begin their nursing career by earning their nursing diploma from an accredited nursing school. These programs typically take an average of 1 to 2 years of intensive, full-time studies to complete.
ASN/AND
Other nursing students choose to attend an accredited college or university to attain their Associate of Science in Nursing (ASN) degree or an Associate Degree in Nursing (AND) degree. Both programs take an average of two years of full-time studies to complete.
BSN
With more and more employees seeking nursing with a bachelor’s degree, many students today start their career by earning a Bachelor of Science in Nursing (BSN) degree from an accredited school. These programs take an average of four years of full-time studies to complete.
No matter which undergraduate program you select, you can expect to take a variety of medical-related courses, such as anatomy, biology, and psychology as well as clinical work. If possible, it’s recommended to gain some clinical experience in an emergency room setting during your undergraduate program. This experience cannot only increase your job opportunities upon graduation, but it can help to ensure that a career as an ER nurse is the right option for you.
RN licensure
Once you have earned an undergraduate degree from an accredited nursing program, you can sit for your RN licensure exam, the NCLEX-RN. This exam is developed by the National Council of State Boards of Nursing and is graded on a pass-fail basis. Due to the importance of this exam, it’s recommended to take time to study or take a test prep course if possible. Once you have your RN license you can start to apply for jobs in an emergency room setting.
Clinical experience
The next step in your career as an ER nurse is to obtain a minimum of two years of experience providing emergency care. Take this time to learn as much as you can about emergency care and practices. This is also a good time to consider if you would like to specialize in a type of emergency room care.
CEN certification
Many nurses who are committed to advancing their career as an ER nurse move forward to become certified as a Certified Emergency Nurse (CEN). This certification is offered through the Board of Certification for Emergency Nursing. You must hold a current RN license, complete a minimum of two years of emergency room clinical experience, and pass the CEN examination to earn this certification. While obtaining is CEN certification is not required by many hospitals and other emergency medicine employers, it can improve your chance of landing the job your want.
Additional certifications
ER nurses who want to specialize in a specific type of emergency care often choose to earn additional certification. The Board of Certification for Emergency Nursing offer a variety of specialty certification, such as CPEN (Certified Pediatric Emergency Nurse), CFRN (Certified Flight Registered Nurse), and TCRN (Trauma Certified Registered Nurse). While each certification has its own eligibility requirements, many can be accomplished with just a current RN license.
Graduate degree
Those wishing to advance their career even further can move forward to earn a Master of Science in Nursing (MSN) degree or a Doctorate of Nurse Practices (DNP). Completion of a graduate program in nursing may allow you to earn your license as a Nurse Practitioner (NP) and expand your job opportunities and increase your salary.
Nurse practitioners tend to earn the highest paying salaries of all emergency room nurses despite their specialty. This higher salary is based on the fact that licensed nurse practitioners can handle a wider range of services. While NPs still work under the supervision of a medical doctor, they are able to prescribe medication, diagnose patients, and develop treatment plans for patients.
In addition to NPs, some of the highest paying ER nurses are:
- Anesthetist nurse
- Clinical Nurse Specialist
- Psychiatric nurse
- Certified Nurse-Midwives
- Neonatal ICU nurse
- Nurse administrator
ER nurses who have also earned additional credentialing in a specific field, such as a CTRN (Certified Transport Registered Nurse) certification as well as those who have obtained specialized training, including a certificate in Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS), often have higher salaries than nurses without these advance certifications.
Another major factor determining salary is demand. For example, a children’s hospital likely has a high demand for neonatal ICU nurses, so they may be willing to pay higher salaries to recruit the most experienced ER nurses. On the other hand, an area with a high percentage of senior citizens may be willing to pay higher salaries for geriatric ER nurses because they are in higher demand.
In addition to high-paying salaries, ER nurses can expect to receive a wide range of benefits, such as paid time off, sick pay, and medical insurance. Since ER nursing is considered a long-term position, many employers also offer retirement plans, such as 401(k) to their employees.
You may also be eligible for continuing education training as well as tuition reimbursement to further your career. Most importantly, many hospitals and medical centers have an excellent career advancement program that allows employees to advance their careers by applying for higher-level positions within the hospital.
