How to become An ER Nurse

A trip to the emergency room is always scary. Emergency Room (ER) Nurses are licensed and registered nurses who discharge the role of first responders in medical emergencies. They use their highly specialised skills to ease the anxiety and discomfort and stabilise the condition of those admitted into the ER for any trauma, injury or acute-onset symptoms. ER Nurses deliver urgent patient care and even help sustain life while working rapidly in high-stress and fast-paced environments.

• Emergency Room Nurse
• A&E (Accident & Emergency) Nurse
• ED (Emergency Department) Nurse
• EW (Emergency Ward) Nurse 
• Casualty Department Nurse
• Trauma Nurse
• Flight Nurse
• Critical Care Nurse

What do ER Nurses do?

An ER Nurse would typically need to:

• Provide the first line of defence and treatment to patients of all ages who come to the ER due to trauma, cardiac arrests, strokes, sexual assaults, conscious sedation, allergies, or other medical, sometimes life-threatening, conditions
• Lead emergency response teams using their specialised training in ER nursing and accurate assessment skills that correspond to the patient’s age and clinical condition
• Respond to emergencies across a healthcare facility and care for patients recovering from emergency interventions
• Help identify a patient’s needs by taking part in multidisciplinary care planning aimed at optimising patient outcomes
• Take patients’ vital signs and medical histories when they arrive; gather relevant medical information from other clinical settings about the patient
• Establish patient inflow and outflow by prioritising cases and nursing interventions based on urgency and need using the method of triaging
• Work with ER staff to stabilise patients; minimise their pain and discomfort by providing immediate support that may also prevent or reduce negative long-term impact and even sustain life in some situations
• Perform CPR (cardiopulmonary resuscitation), rescue breathing, or bag-valve-mask ventilation to restore a patient’s heart and breathing functions during a cardiac arrest
• Use the IABP (intra-aortic balloon pump) and other therapies for coronary care
• Administer medications and blood products, starting and using intravenous lines (IVs) as needed
• Perform tracheostomies and intubations
• Set broken bones and give stitches and sutures as needed
• Liaise with laboratory personnel to organise testing and report findings to ER physicians on duty
• Collaborate with medical teams to decide on follow-up treatment for patients who have suffered heart attacks, strokes and traumatic injury or those with less critical issues, such as sore throats, stomach aches and sprains 
• Document patients' ongoing medical assessments, such as observation, physical examination, laboratory test results, and response to procedural intervention 
• Implement and modify the plan of care based on the patient’s evolving medical status and factoring in their physical, psychosocial and spiritual requirements 
• Create, maintain and update electronic medical records; assist patients with initiating insurance paperwork
• Organise the patient discharge process, documents and referrals to allow continuity of care post-discharge
• Share professional knowledge with colleagues, healthcare team members and other healthcare professionals
• Educate patients, their families and their caregivers about the medical issues, testing and treatment; communicate effectively with them, providing pertinent information instead of overloading them with details 
• Discharge patients with stable vitals from ER or arrange their transfer to other wings for further care and to make room for new patients
• Stay up to date with technology, legislation, policies and procedures to ensure optimal medical and ethical care for all patients and maintain the healthcare facility’s standards

Most ER Nurses work in the emergency rooms of hospitals, clinics or care facilities, where the work environment differs from other nursing specialities. However, their specific working conditions may vary according to their specialisation.

On any given day, ER Nurses tackle a large influx of patients with varied illnesses and trauma. You must think quickly, make optimal decisions and attend to patients at the earliest. The turnover is high as patients must typically be moved from the ER to the next steps for testing or treatment. ER Nurses work in a hectic, high-stress, unpredictable, and often overcrowded and noisy environment. They must calmly and efficiently manage crises amidst organised chaos and noise. Waiting lines of patients may be long, needing you to effectively communicate to them and their caregivers the estimated time of waiting and their place in the queue.

Since ER Nurses are exposed to various hazardous chemicals and infections, they wear medical scrubs and protective gear, such as gloves and masks, to prevent the transmission of infections between patients and nurses or among nurses. They may also sport clogs or other appropriate and comfortable footwear. Specific types of uniforms that ER Nurses wear may depend on their employer or speciality.

Since they attend to frequent and diverse emergency cases, they must keep their workstation immaculately sterilised and stocked with resources to clean up dripping blood or other infectious or toxic substances.

They may also be needed outdoors to help offload patients from vehicles and help them into the ER.

An emergency room is open 24x7 and is thus always fully staffed with medical professionals typically working on shifts. ER Nurses typically work anytime between 40 to 60 hours a week on 12-hour shifts. However, it is common for nurses, especially ER Nurses, to work longer hours. Depending on the shift you are assigned, you may work during late evenings, nights, holidays and weekends. Based on current and projected demand and ER department needs during a particular period, you may work daily for long stretches or be assigned days or weeks off every few months. You may qualify for higher pay for overtime based on your work location.

ER Nurses also typically have days off, but their frequency depends on how busy the ER is currently or expected to be during a particular period.

While at work, you spend most of your time on the ER floor in preparation for any emergency at any time.

Finding a new job might seem challenging. ER Nurses can boost their job search in the emergency rooms or emergency departments in various settings by asking their network for referrals, contacting companies directly, using job search platforms, going to job fairs, and inquiring at staffing agencies.

ER Nurses are generally employed by:

• Clinics & Hospitals 
• Ambulance Transport Teams
• Urgent Care Centres
• Standalone Emergency Centres 
• Disaster/Emergency Response Teams 
• Burn Centres
• Trauma Centres 
• Poison Control Centres
• Academic Institutions 
• Armed Forces 
• Teaching Hospitals
• Airlines 
• Cruise ships
• Prisons

Healthcare associations, such as the ENA (Emergency Nurses Association) International, provide unparalleled networking and educational opportunities. They offer all the certification courses members will need throughout their professional careers. Affiliated Nurses may attend conventions, seminars, and dinners frequented by peers, mentors, and other industry leaders. The events help them keep up with the latest breakthroughs and developments in the field, including plum jobs.

• Developing and maintaining the emotional resilience to witness tragedy, death and severe trauma in patients and anxiety in caregivers; dealing with the highly unpleasant outcomes of child abuse, accidents and violence
• Trying to stay centred and organised and not be overwhelmed by the non-stop and fast-paced work
• Coping with the unpredictability of cases, unlike the structured work of other nursing specialities
• Quickly determining the severity of a patient’s condition, whether it is just uncomfortable or life-threatening
• Implementing a triage system to decide who receives immediate care, such as heart attacks, strokes or trauma victims and who can wait longer, such as those who may need only the attention of a primary care physician
• Being knowledgeable about several areas of medicine, such as orthopaedics, paediatrics, psychiatry and more, to manage a wide range of patients, from infants to seniors, who come into the ER experiencing a wide variety of issues
• Dealing with multiple critical incidents and diverse tasks simultaneously
• Coping with the stress that comes from having to convey difficult news to patients, family members and caregivers
• Combatting violent behaviour that includes verbal or physical abuse in ER treatment or waiting rooms from patients under the influence of alcohol or drugs or those with psychiatric problems or stressed caregivers
• Dealing with the possibility of developing conditions such as post-traumatic stress disorder or finding yourselves forced to quit due to higher stress levels than other types of nursing careers
• The need for physical stamina, comfortable footwear and unwavering focus to hit the ground running at the start of each shift and continue to the end except for mandated breaks
• Keeping up with the latest developments in all nursing specialities to provide up-to-date emergency care
• Developing a solid bond with coworkers and networking with other ER professionals by joining a relevant association so that you have like-minded individuals you can rely on and share your concerns with

Although it may be possible to enter the field of ER nursing directly from nursing school, most emergency departments in hospitals prefer to hire ER Nurses with hands-on nursing experience for at least two years. You could have worked in a medical-surgical or intensive care unit that operates at a slower pace, under less pressure and with a more regular structure than within the ER environment. Experience in collaborative work on interdisciplinary or interdepartmental teams and some management and leadership experience are also helpful for aspiring ER Nurses.

Nursing experience working in various environments, from obstetrics to geriatrics and mental health, is also helpful in finding employment as an ER Nurse. ER Nurses may gain experience working with patients during placements as part of their nursing programs.

Registered nurses who wish to become ER Nurses may volunteer with local fire and emergency squads or request to float to the emergency department while working in other departments in a healthcare facility. Another excellent way to acquire the skills and experience needed for this specialisation is to work under senior ER Nurses, including helping with life support.

Depending on location, trainee placements may be mandatory to help you tackle and learn from urgent real-life situations and the pace of activities in the ER. You will receive firsthand exposure to diverse conditions and injuries, which may give you a direction for work or further research, qualifications and certification.

Read about the profession, perform community service, undertake relevant research, and interview or job shadow experts in ER nursing to prove your commitment to course providers and prospective employers. It helps document any such experiences on letters of recommendation to be submitted with nursing school applications.

Aspiring ER Nurses, just as in other nursing specialities, require at least a bachelor’s degree in nursing from an accredited institution to become registered nurses and acquire their nursing licence. Depending on your location, you may need to specialise in caring for adults, children, mental health, or learning disabilities.

Some employers may accept an associate degree in nursing from an accredited program. Coursework typically includes physiology, pharmaceuticals, family and community health, leadership, ethics, and research.

If available, you may also pursue nursing degree apprenticeships that blend classroom learning with fixed placement.

While not mandatory, you may top up your nursing qualifications with specialised emergency nursing certification.

High school courses in biology and chemistry are helpful for aspiring ER Nurses.

Although not mandatory, you may acquire certification in emergency nursing after becoming a registered nurse and obtaining the requisite experience. Certification demonstrates an ER Nurse’s competence in the standards and practices of emergency patient care and ability to apply health theories to real-life medical crises. Earning your certification fosters your decision-making skills and expertise in accurately, ethically and effectively drawing conclusions about a patient’s need and priority. It also helps you advance your career.

You would typically earn your credentials through work experience, training, and passing an examination. You may also acquire certification in flight emergency nursing, pediatric emergency nursing, trauma nursing, and critical-care ground transport nursing. 

Certifications in BLS (Basic Life Support), CPR (cardiopulmonary resuscitation and ACLR (Advanced Cardiovascular Life Support) are also highly valuable in emergency nursing.

Aspiring ER Nurses must earn their registered nurse licence and any other specific licences to practice, as their location requires. Individual government entities conduct the licensing process. It typically involves the passage of an examination and the fulfilment of eligibility requirements, such as a minimum level of education, work experience, training, or the completion of an internship, residency, or apprenticeship. Exams typically cover topics such as promoting and maintaining health, psychosocial and physiological integrity and creating a safe environment.

Performance, experience, and the acquisition of professional qualifications drive career progression. Employees with consistently high levels of performance may be eligible for promotion every two to three years. 

There is no single advancement path for ER Nurses. However, since nursing is constantly developing, higher degrees and additional certifications will help you stay current with the latest developments and keep you competitive in the employment market and progressing in your career.

 A common option is earning a master's or doctoral degree in nursing to help you qualify for the nursing jobs you wish to take up in the future.  Equipped with a master’s degree, relevant certification and experience, you may also diversify into administrative or management roles. ER Nurses may become Charge Nurses, heading a complete nursing unit within the emergency department. Doctoral programs may take three years or longer and focus on the clinical aspects of nursing. They teach you evidence-based practice, systems leadership and how to improve quality.

Earning your certification in emergency nursing and acquiring a few years of experience in the field can help you diversify into related specialities within or outside the ER. Once you obtain the relevant credentials, you may work as a Pediatric Emergency Nurse or Trauma-Certified Registered Nurse. You may also opt to certify and work as a Flight Registered Nurse or Transport Registered Nurse.

Other specialised career paths outside the ER include combat nursing to aid troops and families, sports & arena nursing to assist sudden trauma cases among large gatherings, travel nursing to go around different hospitals across the globe, legal nurse consulting, geriatric nursing, or mental health nursing.

Depending on your location and after you earn a master’s degree in nursing, you may also work as an APRN (Advanced Practice Registered Nurse) or Clinical Nurse Specialist. You may also diversify and work as a Nurse Anaesthetist, Nurse Educator, Nurse Midwife, Nurse Researcher, or Legal Nurse Consultant.

Candidates with specialised education, skills, certification and experience in emergency nursing have the best job prospects.

Continuing professional development (CPD) is essential for public wellbeing and career progression in the healthcare sector. It embraces several new learning objectives, educational methodologies, and novel technological developments, especially in education, management, and IT.

ER Nurses, just as all other nurses, must undertake CPD to renew the validity of their credentials and licence. You may opt for courses offered by professional bodies, covering clinical skills, patient care and management skills to keep up with current practices and trends in patient care, especially since the emergency room is stress intensive. You may also take courses in topics such as child abuse, narcotics and pain management since you must deal with patients of all ages and with diverse conditions. 

You may also acquire a master’s or doctoral degree in nursing, nursing practice or nursing science, which gives you a competitive edge in the job market and advances your career.

Reflective learning, interaction with peer groups, comprehensive inclusion, workshops, and professional publications also educate, influence, support, and foster lifelong enlightenment in career-grade ER Nurses.

ER vs Emergency Care

Not all emergency nurses work in emergency rooms. ER Nurses may also work in critical-care transportation, search-and-rescue teams, poison control centres, burn centres, and various branches of the armed forces. Each of these subspecialties requires specific training and skills. 

Types of ER Nurses / ER Specialisations

In accordance with diverse ER settings, ER Nurses may specialise in trauma, stroke, cardiac care, burns, neurology, disaster response, pediatric care, adult care, or geriatric care. You may also specialise in working as triage, flight or float nurses, or on cruise ships or production sets for films or TV shows. Different types of ER Nurses do share a set of common responsibilities. However, they may also be experts in certain tasks or areas and hold specific individual duties because of their particular skills or professional goals. You would typically require the relevant certification to qualify to work in your specialised field.

Triage Nurses

Emergency departments typically use a “triage” system to ensure that of all the patients present in the ER at any time, the most serious ones receive medical attention on priority. While there are real emergencies, there are also some who feel unwell and present themselves in the ER because they could not find an appointment with their primary care physician. The triage takes place as patients arrive, but a triage nurse also conducts an “across-the-room survey” to assess who must be seen immediately and who can wait longer. In addition, as patients wait in the ER, experienced triage nurses with advanced certifications and training monitor them for evident and subtle signs that their condition may be worsening.

What is the Difference Between ER, ICU and CC Nurses?

ER Nurses, ICU (intensive care unit) nurses and CC (critical care) nurses treat patients in critical condition but discharge different responsibilities. An ER Nurse treats emergency cases, stabilising a patient and taking care of the next one. However, ICU and critical care nurses provide long-term care to patients to help them recover from serious medical situations, including critical illnesses and complex surgeries. 

Skill Set Needed by ER Nurses

Along with highly specialised technical skills, ER Nurses typically possess several critical soft skills. First and foremost, they must have an intense passion for helping others, a solid work ethic, and a strong heart to deal with the physical, emotional and mental trauma they must witness and alleviate daily. Patience and empathy are also indispensable in dealing with patients and their caregivers. 

Given their fast-paced work that can include tackling life-threatening emergencies, ER Nurses must respond constructively to stress and anxiety, think quickly on their feet, be rational and decisive, and have top-notch communication and organizational skills. They must also be able to work well in teams, network and collaborate with other medical professionals, and juggle tasks skillfully in a dynamic and demanding work environment.

Potential Pros & Cons of Freelancing vs Full-Time Employment

Freelancing ER Nurses have more flexible work schedules and locations. They have full ownership of the business and can select their projects and clients. However, they experience inconsistent work and cash flow, which means more responsibility, effort and risk.

On the other hand, a full-time ER Nurse has company-sponsored health benefits, insurance, and retirement plans. They have job security with a fixed, reliable source of income and guidance from their bosses. Yet, they may experience boredom due to a lack of flexibility, ownership, and variety.

When deciding between freelancing or being a full-time employee, consider the pros and cons to see what works best for you. 

Mobile apps now allow paramedics to alert ERs before patients arrive. Receiving the estimated time of arrival via GPS and some of the patient’s  crucial details helps ER staff be better prepared.

Whether you choose to work in the ER in a hospital or a more specialised setting, being an ER Nurse is a challenging career. However, if you are someone who yearns to save lives and thrives on the adrenaline rush it generates, then emergency nursing may be the right choice for you.

A career in emergency nursing is for those with emotional stability, mental alertness, physical stamina, willpower, and the willingness to learn constantly. As an ER Nurse, you will face something new daily and must always be ready to face it. Do not run from tragedy. Instead, channelise your grit and empathy to impact others’ lives positively.