How to Become an ER Nurse in 2024

Nursing is a rich and diverse profession. Nurses can serve in a variety of roles, from providing day-to-day patient care on hospital wards, to working as a nurse practitioner in a clinic, providing care for children in a pediatric facility, or doing life-saving work in the rapidly changing environment of the emergency room.

The job of an emergency room nurse is a challenging one. These registered nurses provide critical care for people in a fast-paced environment and no two shifts will be alike. Sometimes, emergency nursing means dealing with minor injuries and heatstroke on a hot summer’s day. Other days cases could be much more serious or a major incident could mean there’s a rush of cases.

This means emergency care nurses need to be calm under pressure, able to adapt to rapidly-changing environments, and able to provide a high standard of care whether they’re faced with one patient or many. 

Nurses who move into this area of the field are highly respected and make an invaluable contribution to their local communities. It’s not a job for everyone, and it can be physically and emotionally demanding, but for those who have the right mindset it’s incredibly rewarding.

Benefits of becoming an ER nurse

Choosing a specialization in nursing can be a challenge. After spending two years to earn an associate’s degree or four years to earn a bachelor’s degree in nursing, and then taking the NCLEX-RN, you’re thrust into the nursing profession and are expected to decide what to focus on next.

Some nurses are happy to be a versatile registered nurse, working in clinics or providing day-to-day patient care on a ward. This job is important, rewarding, and involves helping people – which is exactly what nurses set out to do.

Some nurses want something more. Perhaps they love children and want to focus on pediatrics. Alternatively, maybe a kindly nurse made a significant impact on the quality of life of one of their grandparents, and that’s what inspired them to join the profession, so they’re looking to head into adult-gerontology.

Emergency room nursing is one of the most challenging specializations, requiring a nurse to have good decision making skills, be calm in a crisis, and be willing to tackle all kinds of critical care situations.

What are the benefits of becoming an emergency room nurse?

Working as an emergency room nurse can be incredibly rewarding and is a good option for nurses who are looking for a challenge. There are many benefits to choosing this specialization:

No two workdays will be the same

A Registered Nurse working in a clinic or on a ward will be faced with fairly similar routines every time they come to work. They’ll either have a steady flow of patients on an appointment basis, or they’ll “do their rounds” and most likely see similar cases every day.

An ER nurse will have a rather different experience. Some days may be quiet while others will be busy. Some cases will be minor injuries, others could be more critical. Every day is a new challenge.

You’ll get to treat a wide variety of patients

Registered Nurses are equipped to support patients who are dealing with a variety of health issues, and those who take on a more general nursing role could be exposed to everything from bee stings and broken bones to cancer cases or mental health conditions.

Many nursing specializations narrow the focus of nursing care. For example, neonatal nurses focus on pregnancy and childbirth. Oncology nurses support cancer patients. Certified Registered Nurse Anesthetists may deal with patients with a variety of conditions, but do so in a relatively narrow area of focus, preparing them for surgery and administering anesthetic.

ER nurses work in a dynamic environment, and the cases they’ll see on a day-to-day basis have little in common other than being “urgent”. Some patients could have broken bones, others concussions. Sometimes there’ll be a person coming in presenting with symptoms of a heart attack or a stroke. On other occasions you’ll be faced with multiple patients who have been involved in an auto accident. You’ll get to practice your skills on a wide variety of patients.

Your working environment will be fast-paced and exciting

Most nurses work a 40 hour week, with their working schedule broken into 12-hour shifts. During that time they’ll have a clear schedule and a steady flow of patients. The working arrangements of an ER nurse are different.

Some ER shifts are quiet with just a steady trickle of patients with minor ailments coming through. Some hospital emergency rooms get a lot of visits from people who don’t have a primary care physician, and those visitors will often be dealt with by a family nurse practitioner.

ER nursing’s main focus, however, is supporting the patients who are in need of critical care. On busy days, an ER nurse will need to juggle multiple patients, triaging each case, stabilizing those in the greatest need, and making sure that each and every patient gets the proper attention.

You’ll get to really make a difference

Anyone who goes into the medical profession does so hoping to make a difference. All medical roles form orderlies through to surgeons are vital for keeping the health care system working.

Nurses who work in more general roles such as in a clinic or doctor’s office may not always get to see the importance of their work. Taking vitals, providing counseling and administering injections are all important jobs that provide long-term benefit, but to the nurse who is doing that job the day-to-day actions may feel repetitive and insignificant.

The patients who present at an emergency room need urgent care, and ER nurses offer reassurance, support, and an immediate solution. The emotional reward that comes from this can be significant.

Which specialties are available for emergency room nurses?

It’s common for emergency room nurses to be generalists, able to handle almost any type of patient that might come into the emergency department. However, emergency room nurses can choose to specialize in specific areas such as:

• Intensive care unit nursing
• Pediatric ICU
• Neonatal ICU
• Cardiac life support
• Certified registered nurse anesthetist
• Flight nurse (providing mobile ER nursing)

A busy emergency department may have several nurses on hand, each of whom has their own area of qualification.

How might becoming an ER nurse enhance your career?

After graduating nursing school, a young registered nurse may opt to become an ER nurse so that they can gain some much-needed clinical experience and get exposure to a wide variety of medical cases.

It’s common for nurses to work for a couple of years after passing the NCLEX-RN before they enroll on a master’s degree and pursue a job as an advanced practice registered nurse or clinical nurse specialist. Time in the emergency room can be invaluable because it prepares a nurse for a variety of situations, and also helps them gain confidence when working under pressure.

If you have the long term goal of becoming a family nurse practitioner or a nurse anesthetist, you’ll need to pursue postgraduate qualifications and have several certifications. Working as an emergency room nurse gives you the opportunity to get that experience, and potentially receive training in various specialization areas via your employer.

Nursing school can teach you the theory of how to take care of certain patients, but there’s no substitute for real world experience, and the emergency department is one of the best places for a young nurse to get that experience. Time in the department will look good on your CV, and it will give you the opportunity to get exposure to many different types of patient, helping you make decisions about further specialization on the route to becoming an advanced practice nurse.

How to specialize as an emergency room nurse

If you’d like to become an emergency room nurse, the first thing you’ll need to do is become a Registered Nurse. Licensed Vocational Nurses or Licensed Practical Nurses may sometimes have a role to play in the emergency room, but the scope of practice of these nurses is more limited than that of an RN.

The process for earning an RN license differs slightly from state-to-state, but in general you’ll need a minimum of a two year associate’s degree in nursing, with many states asking for a four-year degree. You’ll also need to pass the licensing examination.

Once you’re licensed to work as a registered nurse, you can focus on earning the qualifications required to specialize in different areas, including the emergency room.

Where can you learn more about becoming an emergency nurse?

Many nurses who end up working in the emergency room simply transition from a more general position in a hospital to serving as an emergency nurse organically. They hadn’t planned a specific career move.

There is a lot of advice and support available for those who have emergency room nursing as a career goal, however. The Emergency Nurses Association offers a variety of certifications, programs and learning material for current and would-be emergency room nurses. The association also hosts regular conferences and meetings, which provide networking opportunities for those in the nursing profession.

How long does it take to become an emergency room nurse?

It takes a minimum of two years to become a registered nurse. Many states require nurses who wish to serve in more specialist roles to have a BSN degree, however, increasing the time requirement to four years.

The Board of Certification for Emergency Nursing offers a certification for ER nurses. This certification is widely accepted and is seen as one of the more common routes into the emergency room. In general, nurses are expected to have two years of clinical experience before they take this examination, although that’s not mandatory.

This means it’s possible to become an emergency room nurse in four years, although it’s more common for it to take six years to become qualified due to the BSN requirement.

How do you specialize as an emergency room nurse?

To specialize as an ER nurse, a newly qualified registered nurse would need to earn some experience in emergency nursing, working under supervision as they do so.

They’d also need to study for, and pass, the BCEN certification. Many hospitals also ask emergency room nurses to earn other certifications, such as:

• Advanced Cardiac Life Support
• Pediatric Advanced Life Support
• Newborn Advanced Life Support

Nurses who want to work in a more specialized area of emergency room nursing, such as flight nursing or trauma nursing will need to earn certifications in those areas as well. Before a nurse can sit certification examinations in those areas they’ll need to have extensive clinical experience. 

Most flight nursing employers are happy to provide training in aircraft-specific procedures and general flight safety, but expect that any applicants will have the skills required to cover the health care aspects of the job. Providing critical care on a mobile platform is not an easy task, and the medical emergencies that transport nurses are likely to attend will be challenging ones.

Responsibilities of a nurse in the emergency room

Emergency room nurses deal with patients who are in urgent need of care. They’re required to be calm under pressure, able to make decisions quickly, and able to respond to rapidly changing situations.

Emergency nursing is some of the most challenging work that a registered nurse can do.

What type of nurses do emergency rooms typically hire?

Emergency room nurses can fill a variety of roles, including:

• Triage nurses
• Charge nurses
• Emergency department nurses
• Certified trauma nurses
• Certified registered nurse anesthetists
• Cardiac / ICU nurses

Each of these nurses fills a specific role in the department, and they’re all required to work together effectively and efficiently to keep the department running smoothly and ensure each patient gets the care and support required.

What are the responsibilities of a nurse in the emergency room?

Emergency room nurses are responsible for most of the ‘pathway’ that a patient will take when they visit an emergency room. Nurses are responsible for each step through the stay, including:

• Triage
• Taking vitals
• Administering medications or providing treatment
• Monitoring and charting
• Discharge

Emergency room nurses don’t have prescriptive authority, so they aren’t able to prescribe medications themselves, but they can triage patients when they come to the emergency room, take any required readings, and make sure the visiting patients are seen by doctors or specialists in order of need.

Once a doctor has seen a patient and decided what the best course of treatment is, a nurse can then deliver that treatment.

Complex cases may need to spend some time in the hospital, and nurses will be responsible for monitoring the recovery of the patient, providing ongoing treatment, and keeping the patient’s chart up to date.

Once a patient is well enough to leave the hospital, a nurse will be the one that completes any required discharge paperwork and provides advice to the patient and any caregivers about any aftercare required.

Depending on the level of experience of any one individual nurse, they may focus on a specific job such as taking vitals, monitoring and charting, or they may have the responsibility of triage or discharge.

All of these roles can be quite demanding in the emergency room, because of the diversity of patients who are admitted, and the possibility that some of them may be in a critical state. 

Newly qualified nurses may have the opportunity to work in an emergency department, administering treatments as directed by doctors and supporting more experienced nurses who are qualified to make decisions about patient care, and who have a wider scope of practice.

Clinical nurse specialists, certified registered nurse anesthetists, and nurse practitioners all have an important role to play in the day-to-day operation of the emergency room, as do nurses with expertise in critical care and ICU.

These nurses need to have the support of other nurses who provide more practical, hands-on support, so that they can focus on the highly specialized areas of their respective jobs. As with so many other parts of the health care profession, nurses who work in emergency rooms are required to work as a part of a team so they can provide the best possible patient outcomes.

Which qualities are important to have to be an ER nurse?

ER nurses deal with a wide variety of medical issues, people of all ages, and people from all walks of life. This means they need strong ‘soft skills’ as well as a detailed understanding of evidence-based practice.

Nurses working in the emergency room should:

• Possess good communication skills
• Be able to deal with people of all age-groups
• Be calm under pressure
• Give every patient the same high standard of care
• Be capable of dealing with potentially traumatic incidents
• Be willing to work long shifts in an emergency, if required
• Be able to respond to rapidly changing situations
• Have good physical fitness

Working in an emergency room isn’t for everyone. Many early-career registered nurses choose to try the emergency department for the experience and because it’s often glamorized as being where the “interesting cases” are seen.

However, the reality of the job is that nurses in this department are expected to be ready to respond to rapidly changing levels of demand. On some shifts, there may be little to do except treat occasional walk-ins.

Other shifts may be incredibly busy, for example if there’s been a severe weather incident or traffic accident causing a sudden surge in the number of cases.

In big cities, weekends in the emergency room may involve dealing with a lot of people who are drunk or who have been injured in an altercation. The stress and emotional trauma associated with treating patients who are in need of critical care can be difficult to deal with.

Emergency room nurses may need to maneuver or manipulate patients in the course of administering treatments. Depending on the condition of the patient and the urgency of the treatment required, movements may need to be performed manually. This means the day-to-day work of an ER nurse can include lots of standing over patients and lots of moving heavy people or objects.

For this reason, nurses are expected to be physically fit. The toll that long shifts can place on a nurse’s body means that it’s not uncommon for a nurse to retire from the emergency department after a few years, moving into a narrower (but potentially related) specialization when they’re ready for advanced practice work.

Training requirements for ER nurses

There is room for nurses with a variety of different levels of experience in the emergency room. This means hospitals will often hire nurses to work in this department immediately after licensure. A registered nurse can take on a lot of the work that is required in the emergency room.

However, certified emergency nurses have a lot of value because of the experience and training they have in critical care, ICU, and trauma care.

What type of training is required for a registered ER nurse?

A BCEN-certified ER nurse is expected to have around two years of experience in their chosen area of nursing, and to have an understanding of a variety of aspects of emergency care.

The BCEN examination covers an extensive list of medical emergencies, including:

• Cardiac emergencies
• Respiratory emergencies
• Gastrointestinal emergencies
• Gynecology and obstetrics
• Neurological emergencies
• Psychosocial emergencies

Nurses are not doctors, and a registered nurse working in an emergency department would not be expected to diagnose, prescribe, or decide on full treatment plans. They are, however, expected to be able to provide a basic standard of care to a patient to stabilize them, monitor their status, and communicate effectively with other medical professionals who are also involved in the patient’s care.

Nurses who have experience in a specific area such as pediatrics, mental health, or adult-gerontology can use that experience in the emergency department to offer more focused care to patients who are in their area of expertise.

It’s common for an emergency room to have a nurse practitioner, who is a nurse that is educated to the post-graduate level and who may (in some states) have prescriptive authority. Nurse practitioners are educated to at least master’s degree level, with some holding a doctor of nursing practice.

Nurse practitioners have the expertise required to triage patients and can fill many of the roles of a general practitioner. This means they’re uniquely equipped to offer the kind of judgement and advice required in a fast-moving emergency room.

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

Emergency room nurses work in a high pressure environment and are expected to deal with a wide variety of medical conditions. This means it’s vital their skills are up-to-date and that they show a commitment to continuing education.

All registered nurses are expected to undergo a program of continuing education. The exact number of hours required, and the breakdown of what should be covered in those hours, varies from state-to-state.

Not all nurses who work in an emergency room are nurse practitioners or even certified emergency nurses. Those who are certified will have higher continuing education requirements than those who are not.

For example, to maintain CEN status in some states a nurse is expected to undergo 100 hours of continuing education per recertification period, and the same is true for nurse practitioners. Most nursing-related certifications have a five year revalidation requirement.

In general, those 100 hours will need to be spread out across topics such as ethics, evidence-based practice, life support, pharmacology, and other nursing-related subjects. Continuing education credits can be accrued for online courses, taking nursing-related certifications, self-guided study, teaching, research, attending conferences or talks.

Most nurses should find it easy to meet the 100 hour requirement, as they’ll likely want to pursue training in the use of various medical devices, learn about new drugs, or explore other areas of nursing in the course of their career.

It’s common for hospitals to offer a continuing education budget to support nurses, and many clinics may even have a nurse educator on staff who can help nurses identify areas for improvement, recommend courses, and support a young registered nurse as they work towards a master’s degree or even pursue a DNP so they can become an emergency department nurse practitioner.

In rare cases, a nurse who works on an emergency room may be a registered nurse with just an associate’s degree. The best thing such a nurse could do is pursue their BSN, so that they can offer a higher standard of care, and also advance their career by opening up the option of working towards more specialist nursing qualifications. Simply earning that bachelor’s degree can make a huge difference to a nurse’s employment prospects.