Your Guide to Emergency Room Nursing

Emergency room (ER) nurses are often the first medical professionals a person with a health crisis sees at a hospital. They have to think fast, move fast, and work as a team to provide effective care—and possibly save lives. If you’re thinking about following this path in nursing, you’ll need those skills, plus an RN license to start.

The Emergency Nurses Association (ENA) describes the job this way: “Emergency nurses work in stressful, fast-paced, and time-constrained environments where they integrate evidence-based knowledge, make rapid assessments, make critical decisions, and perform life-saving interventions while prioritizing and multitasking.”

From caring for a rush of multiple patients at once to mending broken bones, emergency departments are a vital part of the medical response to tragedies and accidents. ER nurses are on the frontline of emergency care and must always be prepared for the unexpected. The flood of patients from the pandemic is a prime example of how emergency rooms can be pushed to their limit.

“Emergency nurses rise to the occasion at times like these,” says Mike Hastings, MSN, RN, CEN, and president of the Emergency Nurses Association.

If you thrive in challenging situations and work well under pressure, this specialty could be right for you. Learn more about what you’ll do in this fast-paced line of nursing, how much money you’ll earn, and what training you’ll need.

The Hectic Job of an ER Nurse

Emergency room nurses work as part of a team with physicians, medical assistants and technicians, and other healthcare professionals. We’ve all seen the chaotic scenes on TV dramas, but what do these nurses actually do? A lot:

Patients of all ages and socioeconomic backgrounds will be rushed through your doors with conditions ranging from broken bones to acute illnesses and heart attacks.

ER nurses most frequently work in critical-care settings like hospital emergency departments, triage centers, and trauma centers. They may also be qualified to work in poison control centers, emergency response units, flight and transport, military medical facilities, and state or federal prisons.

First Step, Get Your RN Degree

All ER nurses must be registered nurses, so you’ll need to get that designation first. There are two ways to do that: earn a Bachelor of Science in Nursing (BSN) or an associate’s degree in nursing (ADN). Each degree program has its pros and cons, so you’ll need to decide which one best meets your career goals.

If you’re looking to fast-track your path to becoming an RN, an ADN program might be best for you. You can earn your ADN in as little as 18 months at a community college or vocational school. These programs are great for students looking to save time and money, but be aware that many hospitals require RNs to have a BSN from a four-year, accredited college. BSN degrees offer more opportunities over the long run and can lead to leadership positions in administration, consulting, and medical research.

You can earn your ADN in as little as 18 months at a community college or vocational school.

If you already have an ADN and want to move up to a BSN, your employer may help pay for a four-year degree program. Many colleges also have recently started offering RN-to-BSN fast-track programs. For nurses who already have clinical experience working in a medical setting, these degrees can be completed largely in a classroom or online in as little as 18 months.

What You’ll Typically Study

Once you’ve been accepted into an ADN or BSN program, you can expect to spend 18 months to four years learning the foundational skills of nursing. Coursework will vary from program to program, but classes typically include:

You’ll also take nursing-specific courses such as:

Next, a Test and Licensing

You’ll need to answer at least 75 questions on the exam, although you may be asked as many as 265 questions to properly gauge your knowledge and competency. Many online schools offer NCLEX-RN prep courses to help you get ready for your exam.

Once you’ve passed the NCLEX-RN, you can apply for an RN license. Each state has its own license requirements and, depending on where you live, your application might include letters of recommendation and a background check.

Do I Need a Specialty Certification?

In addition to your RN license, you’ll need to earn certifications in advanced cardiac life support and pediatric advanced life support. You can find entry-level jobs in an emergency room, but some employers will require previous ER clinical rotations or an ER internship while you were in school. So, if you know you want to work in the ER, make sure hands-on experience is part of your education.

After you have at least two years of experience, you can apply for certified emergency nurse (CEN) certification from the Board of Certification for Emergency Nursing (BCEN). Although this certification is optional, it can give you an important edge in advancing your career.

What’s the Demand for this Specialty?

As the U.S. population continues to age, demand for ER nurses is expected to grow. Older adults are at greater risk for accidents such as falls and health emergencies such as heart attacks, which can land them in the ER. The Bureau of Labor Statistics (BLS) predicts job growth of 6 percent through 2031. That’s a much faster rate than the national average for other professions, the bureau says.  Demand for highly trained ER nurses remains steady, so they can expect a long career.

How Much Do ER Nurses Make?

The median salary for an RN is $77,600 per year, according to the BLS, but specialized nurses tend to earn more. Here are median annual salaries for registered nurses by state:

Your salary will depend on your education, location, experience, and the position you hold. Pursuing additional education or certifications can help you advance in your field over time and earn more.

How to Advance Your Career

You may decide to pursue further education if you want to move into management. Even if you don’t, you’ll want to stay connected after school to grow in your career. By joining professional nursing organizations, you can find a mentor, make connections, and access job boards. Here are some useful resources:

You can also follow nursing organizations and your fellow nurses on social media. Use platforms like Twitter, Instagram, Facebook, and LinkedIn to see what’s happening in ER nursing around the world in real time. Check out some nursing-specific hashtags, such as:

Is ER Nursing for You?

If you love challenging work environments, the unpredictable nature of an emergency room could be a great fit for you.

ER nurses need strong critical thinking skills to be able to assess a patient’s health quickly and act decisively to stabilize patients in medical emergencies. Strong organizational and communication skills, attention to detail, and a calm and confident attitude under pressure are qualities employers look for when they hire.

You should also excel at delivering compassionate care. If you possess these in-demand skills, you could become a key member of an emergency care team.