How to Become an Emergency Room (ER) Nurse

Nurse Types / ER Nurse

Emergency Room (ER) nurses must be quick thinking, have excellent decision-making skills, and be efficient multitaskers. They treat patients of all ages and backgrounds for a variety of issues.

These nurses are responsible for stabilizing patients before they are transferred to other hospital units. Emergency room nurses play a vital role in treating patients and ensuring they reach the unit they’re admitted to when they need further care.

Many ER patients are experiencing life-threatening situations, and the emergency department nurse and associated care team must be quick to triage, stabilize, revive, or resolve these issues before getting the patient the necessary care.  

In the article, we will explore the following:

• What is an ER nurse?
• What does an ER nurse do?
• Where do ER nurses work?
• What are specific types of ER nurses?
• How do you become an ER nurse in 3 steps?
• What are additional requirements of ER nurses?
• What are the salary and career outlooks for ER nurses? 
• FAQs

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What is an ER nurse?

An ER nurse works in the Emergency Department of hospitals and urgent care centers. They triage and provide care to patients facing medical emergencies.

Qualities of a successful ER nurse

To succeed as an ER nurse, you must be able to:

• Communicate clearly
• Cope with difficult situations
• Gain patient’s trust easily
• Remain cool under pressure
• Think and act quickly

What does an ER nurse do?

As mentioned, ER nurses must think on their feet, make decisive actions, and have strong stomachs. But it’s not all “codes and gore,” according to Alexandria Dunn, RN, an Incredible Health talent advocate. “There is a lot of social work involved, and you must know how to utilize the resources in that area.”

Duties for nurses in the ER include:

• Rapid triage and ongoing assessment
• Receive report from EMS
• Perform wound care and management
• Draw blood and start IVs 
• Coordinate care and complete insurance paperwork
• Work with social work/case management to ensure safety after discharge
• Respond to allergic reactions
• Record and report patient status
• Manage traumas and life-threatening emergencies
• Assist with orthopedic procedures (e.g., splinting or reducing fractures)
• Running codes utilizing ACLS/PALS algorithms
• Administer medications
• Assist with sterile bedside procedures (e.g., chest tube placement or central line insertion)
• Assist with conscious sedation (e.g., medication administration, consent, monitoring)
• Use and maintain medical equipment (e.g., crash carts or oxygen equipment)
• Set up for blood transfusion and administer blood products
• Discharge and care coordination (explain discharge instructions and coordinate transportation)

“ER nursing is more than just the clinical side, especially if you work the night shift with no resources. You become the nurse and the social worker depending on the area you serve,” Dunn explains. 

A day in the life of an ER nurse

Nurse Erika Harrison shares a typical 12-hour shift in a day in the life of an ER nurse.

• 05:00 – Wake up, shower, and pack a lunch to get out the door by 6:20.
• 06:45 – Pre-shift meeting to talk about admitted patients waiting on beds, a new form the facility has rolled out, and patient satisfaction scores.
• 07:00 – Receive assignments. On this shift, Erika has three patients: a 70-year-old male with chest pain, a life-long smoker with respiratory distress, and an empty room that a stroke victim will soon fill.
• 09:00 – The stroke patient arrives, and it is showtime. Within 15 minutes of arrival, the nurse started an IV, drew blood, and transported the patient to CT. 
• 09:50 – The CT results confirm that the patient had a stroke due to a blood clot. Potentially life-saving clot-busting medications are mixed and started. 
• 11:00 – The stroke patient is stable and waiting for a bed, so it’s time to check on the other patients. The respiratory patient has started to crash. Oxygen is not working, so it’s time to intervene. The doctor at the bedside is talking to the patient and family about their advanced directives and Do Not Resuscitate (DNR) status.
• Noon – Time to transport the patient who had a stroke to the Neuro ICU. Then the chest pain patient is discharged. A new patient is coming soon, an 8-year-old with a possible broken arm from a fall off the monkey bars. 
• 1:30-3:00 – Settle in the kiddo and transport the respiratory patient upstairs to an inpatient bed. A new patient is incoming. The diagnosis is chest pain. Then suddenly, over the speaker, she is called to a code. A 50-year-old, relatively healthy male was mowing his grass when he suddenly felt short of breath and sweaty. The nurse heads toward the code, and the ER team quickly and methodically works to apply oxygen, start an IV, draw blood, and administer medications. The nurse helps prepare the patient for transport to the cath lab.
• 4:30 – X-rays are back on the pediatric patient, showing a displaced fracture. The bone will have to be set, so an orthopedic doctor is called. The nurse assists with conscious sedation, and the doctor sets the bone within a few minutes. 
• 4:50 – Goes back to the skills fair and checks in with other educators; then teaches another session on PCA pump set-ups. Skills Fair for the day ends, and she stays until 7:45 grading tests. 
• 6:00 – Round on all patients: draw blood work, administer fluids, give medications, send patients for tests. 
• 7:00 – Night Shift arrives. Time to give them a report and head home.

Where do ER nurses work?

Nearly every hospital has an Emergency Department where patients can be triaged, stabilized, admitted, transferred, or discharged. It is important to note that while nearly every facility can handle receiving or admitting patients for an emergency, many smaller facilities transfer to larger, better-equipped facilities or other departments once a patient is stable.

There are also stand-alone ERs not attached to a hospital that will stabilize and transfer patients. If an ED nurse desires higher care opportunities and experiences, they may want to pursue employment at a higher acuity facility.

What are the specific types of ER nurses?

Within the field of emergency medicine, each of these have specialized training to care for different types of patients that may come through the ER:

• Burn Center ER Nurse
• Flight Nurse 
• Pediatric ER Nurse
• Sexual Abuse Nurse Examiner (SANE) 
• Trauma Nurse

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How do you become an ER nurse in 3 steps?

Step 1 – Become a registered nurse

Earn a nursing degree

To become an ER nurse, you must have a nursing degree. 

Associate Degree in Nurse (ADN): To practice as a professionally licensed RN, the minimum you must achieve is an ADN. This program associate’s program typically takes two years to complete (after two years of the appropriate prerequisites).

Bachelor of Science in Nursing (BSN): To maintain a professional advantage, you may choose to begin your education with a BSN degree program. This program usually takes four years to complete. Much like an ADN program, they combine classroom work, lectures, labor work, clinical experiences, and practicums. In general, bachelor’s programs deliver more than what is taught in ADN programs, better equipping RNs for professional practice.  

Many “bridge” programs allow students to move from an ADN to BSN or a BSN to MSN. 

If you already have your RN licensure, there are also the RN to BSN and the RN to MSN programs. 

Another option is accelerated programs which allow you to pursue a nursing degree if you have a bachelor’s in another field.

Pass the NCLEX exam

To become a registered nurse, you must pass the NCLEX-RN for Registered Nursing. Passing this exam will grant you eligibility as a registered nurse and allow you to continue on the path toward emergency nursing. 

Step 2 – Accumulate experience

To become an ER nurse, you must gain relevant experience in the hospital. Some examples include:

• Working as a tech or CNA in the ER
• Work on an acute care/Med Surg floor to get the nursing basics
• Spend time as a unit clerk 

Other options include volunteering in an ER, shadowing nurses, or working as a psych sitter. Having this kind of relevant experience will help you during the hiring process.

Step 3 – Obtain certifications

ER nurses can become certified in their fields. Specialty certifications they can earn include:

• Trauma Nurse Core Course (TNCC) Developed by the Emergency Nurses Association, this credential is a two-day course to present core knowledge, refine skills, and strengthen the RN foundation. This course teaches how to treat trauma patients, including triage, assessment, and interventions, and respond to mass casualty events. Nurses must renew their certification every four years. 
• Certified Emergency Nurse (BCEN) This credential is given by the Board of Certification for Emergency Nursing. Though the recommendation is two years of ED experience, there is no professional experience requirement before one can take the BCEN exam. Renewal is every four years.
• State-mandated continuing education (CEUs) Each state has different continuing education requirements. You can learn more about your options and complete all your nursing CEUs free on Incredible Health’s site.

What are additional requirements of ER nurses? 

There may be additional requirements for some nursing educator jobs. For example, medical device companies or pharmaceutical companies that use nurse educators may require travel. 

Nurses who work in the ER will likely be required to maintain the following certifications:

• BLS – This credential teaches high-quality CPR and cardiovascular life support skills. It is usually required before hire or immediately after hire. Nurses must renew it every two years.
• ACLS – This course builds on the basic skills of BLS and trains nurses on how to run a code. In ACLS, you learn algorithms to help treat lethal rhythms. It is much more intense than BLS, and you must understand cardiac rhythms and medications. It is usually required before hire or immediately after hire. Nurses must renew it every two years.
• PALS – Though many facilities may transfer these patients out, PALS is still often required for ER nurses, as they will still have to assess, treat, and stabilize. Renewal is every two years.

What are the salary and career outlooks for nurse educators? 

There will always be a demand for highly trained Emergency Department staff to respond to life’s emergencies. Because of this, the ER nurse outlook remains strong. The Bureau of Labor Statistics estimates the average growth for registered nurse jobs to be around 6% between 2021 and 2031.

According to data from Incredible Health, the average salary for ER nurses is $91,071. However, you can expect a range based on geography, nursing credentials, education, and experience.

Find out the highest paying states and cities for nurses.

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Job satisfaction

The majority of ER nurses love their jobs. According to a survey by the Emergency Nurses Association, 64% of respondents reported being very or extremely satisfied with their job.

Next Steps

A Master of Science in Nursing (MSN) is not required for professional nursing practice. However, you may choose to obtain a master’s degree. With this degree you can become an Emergency Nurse Practitioner. This opens the door to teaching opportunities, higher pay, and greater responsibilities.

A career as an ER nurse is sure to keep one on their toes mentally, physically, and emotionally. These nurses are masters of efficient assessment and response and excellent communicators, leaders, and collaborators. Are you a quick thinker and an excellent decision-maker? ER nursing may be for you if you thrive in fast-paced, unpredictable environments.

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