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How To Become an ER Nurse?

September 22, 2021 | Staff Writers

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Working as an ER nurse is a rewarding, challenging career. An emergency room nurse is a registered nurse who provides patient care in the rapidly-changing environment of the emergency department. 

ER nursing requires quick thinking and the ability to respond to a variety of situations, coping with peaks and troughs in demand and dealing with everything from minor injuries to taking care of people who have experienced severe accidents.

Most people who get into nursing do so because they want to make a difference in the lives of their patients. The emergency department is one of the best places to do this. As an ED nurse, you’ll see a wide variety of people, and have a chance to take care of them at a time when they need it the most.

The route into the emergency room is fairly standard. After qualifying as a registered nurse you have the option of working towards other specialisms, such as pediatrics or emergency nursing. Emergency nurses have proven they can remain calm under pressure, think quickly, and cope with patients who have varying, often urgent, needs.

Types of ER nurses

ER nurses work as part of an interdisciplinary team to tend to the needs of patients who come to the emergency room. Most emergency rooms have both nurse practitioners and staff nurses, as well as a handful of nurses with other specializations such as cardiac life support, pediatrics, and ICU training.

Where do emergency room nurses work?

Emergency room nurses work in the emergency departments of hospitals and clinics. This means they are in high demand. There are 6,090 hospitals in the United States and there are 130 million emergency room visits each year. The emergency department is often the busiest in the hospital, meaning it needs high-quality staff who can respond quickly, and correctly, to surges in demand.

What type of nurses do emergency rooms typically hire?

It’s possible to become a registered nurse after studying for an associate’s degree and passing the nursing exam. However, the demands placed on nurses in the emergency room mean nurses with a Bachelor’s degree (BSN) or a Master’s degree (MSN) are preferred even for standard staff nurse positions.

Nurse practitioners and certified emergency nurses undertake special training to qualify them to work with a higher degree of autonomy in the emergency room. They may also work alongside other types of nurses who are trained to support doctors in the Intensive Care Unit or who in pediatrics or neonatal care.

The demands of the emergency room can be difficult to predict, meaning everyone from an ICU nurse to a family nurse practitioner may be needed at some point. Clinical nurse specialists who have an understanding of how to triage and stabilize patients, assessing their needs and taking care of them until they can be seen by a doctor.

The responsibilities of a nurse in ER

The ER nurse is, in many ways, the frontline of medicine, especially in more rural areas where emergency rooms and urgent care facilities are frequently used as the first port of call for those seeking medical treatment.

Emergency room nurses see patients with a variety of issues ranging from injury to severe illness. According to the Agency for Healthcare Research and Quality‘s report on Trends in Emergency Visits for 2006-2014, which is their most recent full report, the most common ailments seen by emergency department nurses are:

  • Abdominal pain
  • Upper-respiratory issues
  • Strains or sprains
  • Superficial injuries
  • Chest pain

To some extent, the type of patients a nurse deals with will depend on the size of the hospital. Large metropolitan hospitals are more likely to see people with severe or extreme injuries such as stab wounds or injuries from a major traffic accident. They will also, however, have a steady flow of patients who have minor ailments and are looking for primary care.

What are the roles and duties of an emergency room nurse?

When someone reports to an emergency room, the first person they’re likely to see is a triage nurse. This is a registered nurse who is able to assess the status of a patient and determine how urgent their case is.

Triage nurses are trained to be able to pick up on signs that a person is in need of serious care. This may be obvious in the case of a person presenting with a gunshot wound but could be more difficult for someone presenting with a respiratory infection or abdominal pain.

The initial interview and triage are used to determine which patients should be seen by a doctor immediately and which cases are relatively stable and can safely wait a little longer. Nursing assistants may offer some patient care and prepare patients for diagnostics such as X-Rays, as well as handling tasks such as dressing wounds or applying casts.

The work of an emergency room nurse can be demanding and stressful, but working in ER is not always like the dramatizations we’re used to seeing on TV. In the real world, emergency rooms can be quiet on some days and very busy on others.

Nurses may see a slow trickle of children injured after falling off their push bikes and people coming in with heatstroke or other day-to-day ailments. Weekends may see an increase in visits due to alcohol-related incidents. Extreme weather or a traffic accident may cause a stressful surge in emergency room activity.

Nurses are expected to be able to handle these tasks and stay calm and attentive under a variety of conditions. 

The duties of an emergency room nurse can include:

  • Prioritizing patients and their care based on acuity, need, and staffing levels
  • Documenting patient data and medical histories for use by other medical professionals
  • Ensuring patients receive any important interventions in time
  • Administering medications in accordance with patient needs and hospital policies
  • Documenting any change in patient conditions
  • Reporting to doctors as required
  • Recording patient care plans
  • Work with ancillary support staff, emergency teams, and other care providers to ensure a continuum of care
  • Communicate effectively with family members, patient advocates, and the patients themselves
  • Uphold the nursing professional code of ethics

Emergency room nurses are expected to fill many roles in the course of a working day, which is what makes the position so appealing to many young nurses. They deal with people from all walks of life and no two patients are the same. 

In addition, emergency room nurses are always in demand. Some smaller, rural hospitals may be limited in terms of the health-care services they provide and lack certain specialist treatment facilities, but even a small hospital is likely to have an emergency department to triage cases and provide basic emergency health care, even if complex cases are transported to a bigger city hospital for more sophisticated care.

This gives emergency room nurses a level of job security that some other, more narrowly specialized nurses may not have, especially if they’d prefer not to travel.

What are the qualities of a successful emergency nurse?

Nurses are expected to put patient care first in all aspects of their work. A good ICU or ER nurse is able to do this whether they’ve dealt with just a handful of patients that day or the department is overflowing with visitors.

Every ER nurse, from the nurse practitioners who deal with triaging and difficult cases to the nursing assistants that handle routine patient care, needs to be polite, compassionate, calm, and professional at all times.

One thing that many people forget about when considering a career in trauma nursing is the challenges of working in an environment where many of the patients are critically ill. Nurses working in a clinic or a doctor’s office may see the same patients regularly for many years. Those in pediatrics advocate for children and may become close to the families they work with.

Nurses in ER see patients who need emergency treatment. Some of those may be people looking for primary care who do not have a GP, but others could have suffered severe injury or be having a stroke, heart attack, or another serious medical episode.

This means ER nurses require a lot of resilience. They must be able to cope with the idea of a large number of their patients not surviving. They need to retain compassion and professionalism even in the face of challenging and sometimes painful losses.

ER nurses need a good level of fitness to cope with potentially long shifts and physically intensive work. Practicing good personal care, maintaining that fitness, and maintaining their mental health is not always easy.

This is why many nurses opt for ER during the mid-stages of their careers when they’re experienced enough to do a good job and truly make a difference, and are at a time in their lives when they can commit to the demands of the emergency room.

After spending a few years in ER nurses have the opportunity to move to other positions such as being a nurse educator, working in informatics, or taking a managerial role where they can apply their experience and knowledge to support younger nurses who are still learning the ropes.

Requirements for ER nurses

Some hospitals will allow a person to work as an ER nurse immediately after licensure, however in this case the nurse will receive training and mentorship on the job to help them adapt to the extra stresses and challenges of the emergency department.

It’s far more common for nurses to gain experience on a normal ward, clinic, or family practice before moving to the emergency department. Nurses with experience who have specialized in a different area, such as neonatal, anesthesia, or ICU, may be able to transition into the emergency department at their hospital with relative ease.

The same goes for those moving in the other direction. After spending time in the ER many nurses decide they’d like to move to a slower-paced department with more predictable patient loads. The experience they gained in the ER stands them in good stead to move to a family clinic or doctor’s office where they can operate as a nurse practitioner.

What certifications do nurses need for working in the ER?

Emergency room nurses must complete a degree at a university or nursing college. It’s possible to become a registered nurse by completing an Associate’s Degree then taking the NCLEX-RN examination. However, patient outcomes are often better at hospitals with a higher percentage of BSN or postgraduate-qualified nurses, which means many hospitals prefer nurses with that higher level of education.

Nurses often study for an Associate’s Degree (ADN), earn their licensure by passing the NCLEX-RN, and then spend some time earning clinical experience while studying for a Bachelor’s Degree (BSN) part-time. In some states, an ADN holder is required to complete the BSN within a certain period of time after earning their licensure, otherwise, they will not be permitted to continue to practice.

From there, the nurse can opt to study a Master’s (MSN), or a postgraduate diploma (DPN), which takes two to four years. These higher-level qualifications allow a nurse to specialize in a specific area of nursing such as ICU or emergency nursing.

If you decide to take the route of learning ‘on the job’ it will take you longer to transition from being a nursing assistant to a more specialized role, since most nursing boards expect around 2,000 hours of clinical practice time in lieu of formal education. 

What are the continuing education requirements for emergency room nurse practitioners?

The ever-changing nature of emergency room work means nurses must strive to stay up-to-date with the latest developments in terms of patient care, best-practices, and medicine.

The exact requirements for continuing education for an emergency nurse practitioner depend on the state in which the nurse is licensed. For example, a trauma nurse at LPN level in Alabama would need to undergo four hours of continuing education provided by the state board for their first renewal, and 24 hours of other continuing education every two years.

Nurses in California at all levels from RN to LPN and Advanced Practice, are expected to complete 30 hours of continuing education every two years. Nurses can choose what to focus on with their continuing education as long as it is applicable to their areas of practice.

Many hospital emergency departments have nurse educators who offer extensive support to help nurses keep their skills current. These educators may offer help with new IT systems, training in the latest diagnostics, or guidance with treatments.

Patient care and ‘soft skills’ are often as important as diagnostics for emergency room nurses who spend time dealing with worried loved ones and advocates. In a stressful environment, clear communication about care procedures helps reduce worries and makes the triage and treatment process easier for both the staff and the patients.

What counts as continuing education?

Continuing Education is a broad term that includes a variety of forms of learning including:

  • Webinars
  • Online courses
  • Books
  • Journals
  • Seminars and conferences
  • Formal certifications

Nursing professionals typically record their continuing education efforts in a journal which should be signed off on by a superior. It’s a good idea to have a variety of sources and information in your continuing education record, to demonstrate a rounded approach to keeping your skills current.

Good sources for continuing education include publications such as the Journal of Trauma Nursing, and courses such as those provided by the American Nurses Association. Local colleges and universities may also provide short courses that are CPD approved.

Because the emergency department requires such a wide range of expertise and sees people with many different illnesses and injuries coming through it, there’s the chance for people working in that department to focus on a number of different areas.

You can focus your CPD on diagnostics, equipment, studying informatics, or learning to treat patients in a specific demographic. Whatever you choose, it’s likely to pay off at some point in your working life.

Steps to become an ER nurse

If you’re interested in becoming an ER nurse, your route into the emergency room will depend on your current level of education and experience. For those who are just investigating the idea of a career in nursing for the first time, the road to becoming an ER nurse will be a long one.

Becoming a trauma nurse or an emergency nurse follows broadly the same route as becoming a nurse who works in a ward or a clinic. The nurses who are positioned in emergency departments are trusted, qualified nurses who have some autonomy and are trusted to make decisions and work quickly in a high-pressure environment.

Choosing to train for this kind of nursing position is a major commitment, both in terms of time, work and finances. It’s possible to get scholarships or bursaries to offset some of the cost of a nursing degree or diploma, but it still requires several years of study, so it’s not something to enter into lightly.

Where can you learn more about becoming an ER nurse?

If you’d like to learn more about what it’s like to be an ER nurse, and what it takes to get qualified, you’ll find some useful resources on university websites. For example, Walden University has a master’s degree program that is tailored towards those looking to specialize in trauma nursing and explains in great detail what the program covers.

How long do you have to go to school to be an ER nurse?

It can take six years, sometimes longer, to become an emergency room nurse. The exact length of time depends on the route that you follow.

Earning an associate’s degree takes two years, and it’s possible to become an RN by studying for an associate’s degree, then taking the licensing exam. However, the expectation is that those who are serious about nursing will follow the Bachelor’s route (BSN). 

To go from an associate’s degree in nursing to the BSN takes two years. Doing a standalone BSN takes four years. Once someone has taken the licensing exam, they are a registered nurse and have the option of working in a variety of positions in a hospital.

A nursing assistant in the ER could be an RN with no other qualifications, although this would mean they’re limited in the roles they can fill within the emergency department. Many nurses do follow this route, however, and after earning their license simply look to engage in on-the-job training and supervised clinical practice.

Those who wish to specialize in working in the emergency room have a few options. They can take a postgraduate qualification or a master’s degree, and become a nurse practitioner, ICU nurse, or study Emergency nursing.

The Master’s degree in Nursing (MSN) is a two-year course if studied full time. A post-graduate course takes four years. These courses can often be spread out over a longer period, studied part-time while continuing to work in a health-care setting. Many elements of the courses can be studied online.

What should someone consider before becoming an ER nurse?

If you’re considering becoming an ER nurse, there are several issues that you should think about before you start nursing college.

Firstly, be aware that working in the emergency rooms is nothing like what people see in movies and TV series. There are some ‘exciting cases’, but there are many long, draining days. In addition, those cases that seem exciting when you’re watching them on TV can be stressful and harrowing when you’re a real nurse dealing with a very unwell human being in front of you.

Nursing is rewarding when things go well and you manage to help someone recover. It’s fun to be the hero, treat the sick and make people’s lives that little bit better. Losing a patient is not easy, and those who work in the ER are some of the most likely healthcare workers to find themselves dealing with loss and with bereaved loved ones.

ER nurses may be faced with people who have had horrible injuries, or with those who are drunk or on drugs, angry, violent, or distressed. It takes compassion, mental clarity, composure, and strength to be able to cope with the demands of the job.

ER nursing means working in a rapidly changing environment, and that every day you show up to the hospital you have no idea what sort of cases you’ll be dealing with. Some people relish that challenge and look forward to working in such a dynamic environment. If that sounds like you, then the emergency room could well be the perfect healthcare setting for your nursing career.

The route to nursing qualification is a slow one, however, and you’ll need to complete an academically rigorous set of qualifications before you’re let loose in the ER or even on a normal ward. 

Nurses must learn about several topics, including:

  • Ethics and codes of practice
  • Health, science and anatomy
  • Patient care
  • Leadership

It’s likely some of those areas will be more appealing to you than others, but nurses must show competency in all areas, proving they understand both the science and mechanics of the care they deliver, how that care must be documented, the processes that must be followed, and the ethics and legal requirements behind it.

Completing four to eight years of study to become an RN is a major commitment both in terms of time and in terms of finances. Fortunately, there are many scholarships available for those who are looking to embark on the pathway to becoming an ER nurse. The University of Alabama, for example, offers a number of nursing scholarships, as does Duke University.

Scholarships rarely pay for the whole qualification, so many people who are interested in pursuing a career in nursing end up taking out student loans. The Nursing Corps Loan Repayment Program repays up to 60% of those unpaid nursing loans in return for the nurse spending two years in employment with the corps. Those who then spend a third year with the corps get another 25% paid off.

There are other nursing student loan forgiveness options for those who work for a nonprofit hospital, which can make the cost of studying to become a nurse more accessible.

Nursing, overall, is a rewarding profession. Many people who choose to pursue it opt to spend a few years in the emergency department as a way of making a difference to as many people as possible, before heading to clinics, pediatrics, cancer care, or other areas that are slower-paced and more focused.

Wherever you opt to spend your career as a nurse, you can be confident that you’re pursuing a career that really matters and that will have a huge impact on the people you work with.

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