How Do You Become an ER Nurse Practitioner?

I have had a few readers contact me asking what specialty they should they should choose in their nurse practitioner program if they want to become an ER NP.  Other readers have asked how to find a job in the ER.  After all, the emergency nurse practitioner does top our list of highest paying nurse practitioner specialties.  Allow me share my thoughts and my story.

What Nurse Practitioner Program Specialty Should You Choose?

Naturally, if you want to practice in the ER you may assume you should specialize as an acute care nurse practitioner.  The problem with the ER and the acute care specialty is that with an acute care certification you are not qualified to treat pediatric patients.  Working in the ER, you must be certified to treat patients of all ages (one exception to this rule would be if you work at a hospital that is affiliated with a nearby children's hospital).  Employers seeking NP's for an ER position will not likely hire an NP who is not certified to treat children.  The best specialty for ER practice is the FNP.  Family nurse practitioner programs teach students to treat patients of all ages which is necessary in the ER setting.  It may seem counterintuitive to study primary care for a career in emergency medicine, but the reality is primary care is the foundation for all other specialties.  Most of what you see in the ER will fall into the primary care realm. 

As nurse practitioner programs become increasingly more specialized, some schools are offering an emergency nurse practitioner specialty.  These programs are simply dual ACNP/ FNP or FNP/ ANP programs that focus on clinical experiences in the ER.  Completing these programs may give you an edge in the job market over candidates with an FNP degree alone, however an FNP degree is sufficient.

How Did I Land a Job as an Emergency Nurse Practitioner?

Most employers and especially those dealing with higher acuity patients are looking for experience.  Upon completion of my nurse practitioner program (FNP), I applied to some emergency room job postings.  No call-backs.  I got a bit more aggressive and tried to contact medical directors of emergency departments directly.  I was able to interview with the medical director for one ER and was told I seemed like a great candidate aside from my lack of experience.  My own father who is an ER physician even told me he wouldn't hire me!  I needed a new plan and some experience.  One week after I officially graduated I started working in an family practice/ walk-in clinic.  The clinic was poorly managed and I increasingly discovered primary care was not my calling.  After a year, I moved on to an urgent care clinic that provided a slightly higher  acuity level and allowed me to continue to learn.  I became better at procedures and working quickly and efficiently.  I learned to sort potential emergencies from run-of-the-mill illness and injury.  Finally, I was ready.

After I felt I had mastered the urgent care realm, I began to once again dream of the ER.  Fortunately, one of the physicians I worked with at the urgent care clinic had some connections at a local emergency department.  I was able to get an interview with the medical director and was hired on the spot!  The ER has given me a new challenge and a faster paced work environment.  The opportunities for learning there are endless.

What Should You Do To Start Your ER NP Career?

If you want to work in the ER, you will likely need NP experience.  Once you complete your NP degree, work in urgent care for one or two years.  Work hard and seek learning opportunities so you can get excellent recommendations.  Once you have experience, contact recruiting agencies and medical directors of emergency departments in your area.  ER physicians and nurse practitioners are often independently contracted and are not employees of hospitals themselves so hospital websites may not post these positions.  TEAMHealth is a national staffing agency that hires NP's for ER positions across the country.  Contact agencies such as TEAM Health so check for job openings in your area.  It may seem aggressive to contact medical directors of ER's in your area, but if they are looking for a new NP chances are you will get a call back!


I graduate in 4 months with my AGACNP and keep reading about getting a certification in ER. How is that possible? Do you just go back to do your hours in pediatrics and OB/Gyn that were not covered in the curriculum? Have you ever heard of AGACNP's treating only adults in the ED?


Hi Misty, 

You will most likely not be able to work in the ER with an ACNP certification alone since you will not be able to treat children. You must either have a dual ACNP/FNP certification, or an FNP certification. 

Erin Tolbert

I'm set to start the ACNP program at Grand Canyon University next month. My counselor has been adamant that I should do the acute care track vs. the NP track to work in an ER. She told me she has many FNPs who return for their ACNP because their hospital insists on it. It's been pretty confusing trying to work through all this conflicting information. Anybody know of any ACNP who work in an ER?


I am a FNP in the emergency setting and love my job! The ANCC along with the ENA have a certification option by portfolio, however, the AANP and the AANEP have a certification via testing coming soon -


Hi Haley,

Thanks for reading!

If there is ever anything you feel would be helpful for me to cover on MidlevelU as you start your journey to becoming an NP, let me know!

Erin Tolbert


Thanks so much for the informative (and motivating) post! I am currently a sophomore in college & am in the process of applying to the nursing program! I am excited to receive my BSN but my dream is to become an NP.

I have really been thinking about a career as an ER NP and your posts make me very excited to see what is in store for the future!


Hi Stephanie,

I would say that generally I see more acute care NPs in trauma units although it's not unheard of to find a family nurse practitioner working in trauma, particularly if he/she has RN experience in critical care. 

Interesting question about why there is not an acute care specialty that covers the lifespan...I don't know why this is the case! It certainly would make things easier if there was. 

Erin Tolbert

Thank you so much for this article! I'm currently two months into in a entry to practice/MSN combined program with an FNP speciatly. I'm realizing that I tend to prefer higher energy environments and I was starting to worry that I'm in the wrong program. I have an interest in ER work or trauma work. Would you say that this guidance applies to trauma units as well? Also, given that there are specialties for geriatric primary care, pediatric primary care, or primary care across age groups, what is your take on why there isn't a specialty for acute care across age groups?

Stephanie L



If at all possible, take an ECG reading course, an X-ray reading course, or any procedural courses you can find. EM Boot Camp, for example, is a good resource. If that isn't possible, setting up a few days to job shadow before you officially start working would be helpful. 

Erin Tolbert

I have as far as I know, just landed my first NP job and it is in the ED! What are some resources I can use to help me prepare while I wait to start. I have the ESI severity index and the ENA NP competencies printed...Thanks

Amanda D