Your Guide to Emergency Room Nursing

nurses wheel patient in critical condition down hallway
emergency room staff wheeling patient down hallway in gurney

ER Nurse at a glance

Where you’ll work: Hospital emergency departments, triage centers and trauma centers.

What you’ll do: ER Nurses are often the first person someone sees when they are admitted to the ER. They have to quickly and efficiently treat a patients’ health issue, and possibly perform life-saving interventions.

Minimum degree required: ASN or BSN, though many employers (especially hospitals) prefer or require nurses to have a BSN or higher.

Who it’s a good fit for: ER nurses must be able to think and act quickly in a stressful environment. An ER nurse should prefer a job that is fast and unpredictable.

Job perks: Every day as an ER nurse is always going to bring variety. You will have the chance to learn about a lot of different specialties because you treat such a wide array of health problems that bring people to an ER.

Opportunities if you pursue a higher degree or certification: You can earn a Certified Emergency Nurse (CEN) certification from the Board of Certification for Emergency Nursing (BCEN), which could lead to more career advancement opportunities and higher pay. This certification, and/or earning an advanced degree to be an APRN could lead to nurse leader or nurse manager positions within an ER.

Median annual salary: $77,600

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:

  • Administer medicine
  • Monitor vital signs
  • Perform minor operations
  • Advise patients and their families
  • Transfuse blood
  • Perform diagnostic tests
  • Start IV lines

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.

What’s the difference between an ER nurse and a trauma nurse?

ER nurses work with seriously ill patients in the emergency department.

Trauma nurses treat patients who have serious injuries from accidents and other events.

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.

Can you take classes online?

If you’re an aspiring nurse and working on an ADN or BSN, chances are you’ll be able to take classes online instead of in a campus setting. But you’ll need to attend hands-on training courses at a hospital or clinic.

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:

  • Biology
  • Chemistry
  • Nutrition
  • Anatomy

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

  • Emergency care
  • Fundamentals of nursing
  • Surgical nursing
  • Healthcare ethics

Next, a Test and Licensing

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After finishing your degree program, you’ll need to pass the National Council Licensure Examination (NCLEX-RN), a standardized test that covers all aspects of nursing.

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:

Registered Nurses

National data

Median Salary: $77,600

Projected job growth: 6.2%

10th Percentile: $59,450

25th Percentile: $61,790

75th Percentile: $97,580

90th Percentile: $120,250

Projected job growth: 6.2%

State data

State Median Salary Bottom 10% Top 10%
Alabama $60,510 $47,390 $78,670
Alaska $99,110 $77,450 $127,020
Arizona $78,260 $60,750 $100,200
Arkansas $61,530 $47,510 $79,440
California $125,340 $78,070 $165,620
Colorado $78,070 $60,550 $100,870
Connecticut $83,860 $61,470 $110,580
Delaware $75,380 $59,900 $99,780
District of Columbia $95,220 $62,700 $129,670
Florida $75,000 $49,680 $95,630
Georgia $75,040 $58,400 $98,410
Hawaii $111,070 $75,380 $129,670
Idaho $75,560 $59,640 $98,030
Illinois $77,580 $59,640 $100,650
Indiana $62,400 $48,400 $90,260
Iowa $61,790 $48,290 $79,260
Kansas $61,790 $47,630 $79,360
Kentucky $62,480 $48,000 $82,410
Louisiana $64,450 $48,920 $94,360
Maine $75,040 $59,640 $98,780
Maryland $78,350 $60,420 $101,650
Massachusetts $94,960 $61,180 $151,310
Michigan $76,710 $60,120 $98,510
Minnesota $79,100 $60,850 $101,610
Mississippi $60,790 $47,210 $78,670
Missouri $61,920 $47,350 $94,690
Montana $75,000 $60,320 $97,260
Nebraska $64,000 $55,040 $84,910
Nevada $79,360 $61,790 $119,530
New Hampshire $77,230 $59,900 $99,580
New Jersey $94,690 $70,920 $117,990
New Mexico $78,340 $60,320 $98,660
New York $96,170 $61,260 $127,080
North Carolina $72,220 $51,420 $95,360
North Dakota $73,250 $59,810 $95,360
Ohio $74,080 $59,540 $94,690
Oklahoma $62,170 $47,960 $79,940
Oregon $99,410 $76,180 $127,680
Pennsylvania $76,940 $59,640 $98,680
Rhode Island $78,900 $61,340 $101,650
South Carolina $72,650 $47,860 $86,820
South Dakota $60,550 $47,470 $77,360
Tennessee $62,390 $48,190 $81,950
Texas $77,320 $59,780 $99,070
Utah $75,000 $59,640 $95,160
Vermont $75,380 $59,640 $98,030
Virginia $76,900 $59,170 $100,990
Washington $96,980 $74,070 $127,320
West Virginia $62,390 $47,450 $87,440
Wisconsin $76,560 $60,060 $98,970
Wyoming $75,000 $59,650 $98,140

Source: U.S. Bureau of Labor Statistics (BLS) 2021 median salary; projected job growth through 2031. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

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:

American Nurse Today

This journal is published by the American Nurses Association and provides valuable information to help nurses advance their careers.

The Emergency Nurse Association

This group provides ER nurses with educational, networking, and advancement opportunities.

The Board of Certification for Emergency Nursing

The board offers specialty certifications and educational opportunities to help ER nurses advance in their careers.

The Journal of Emergency Nursing

The Emergency Nurses Association publishes this journal, which focuses on new research in the field and challenges unique to ER nurses.

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:

  • #nurselife
  • #nurse
  • #nursing
  • #instanursing
  • #nursesrock
  • #nurselife
  • #healthcare
  • #ptsafety
  • #nursecollab
  • #nurseproblems
  • #ernurse
  • #emergencynurse

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.

Written and reported by:

Stephanie Behring

Contributing Writer

With professional insight from:

Mike Hastings, MSN, RN, CEN

President of the Emergency Nurses Association.