Your Questions About Working in the ER, Answered

After I graduated from my nurse practitioner program, it took me a few years to find my niche. I always knew I wanted to work in the emergency department, however employers required experience and refused to budge. Unable to land so much as an interview in the ER, I settled for employment at a walk-in/primary care clinic and then in urgent care. With two years of experience under my belt, I was finally able to talk my way into an interview at a local emergency department. Five years later, I’m still employed by the same hospital and am enjoying life as a seasoned emergency department nurse practitioner. 

Many aspiring NPs and NP students I talk with harbor a few misconceptions about life as an ER nurse practitioner. What’s employment really like as an ER NP? Here are the answers to the most common questions I receive. 

Q: Do you work primarily with lower acuity patients?

A: In the emergency department where I work, nurse practitioners care for patients of nearly all levels of acuity. My hospital maintains written guidelines as to which types of patients NPs may treat in the ER as well as the level of physician involvement required when treating patients of various levels of acuity. These guidelines primarily apply to trauma patients. If a critical patient arrives that I am uncomfortable treating, I involve a physician in care of the patient to the extent required by the situation. 

Emergency departments vary in regards to physician and nurse practitioner staffing structures as well as how patient care responsibilities are delegated between the two groups. Unlike the hospital where I work, in some emergency departments, NPs cover primarily the ‘fast track’ section of the ER treating urgent care types of problems. In other emergency departments, nurse practitioners may serve as solo providers. 

Q: Do you run codes and/or intubate patients?

A: No. In the emergency department where I am employed, nurse practitioners do not run codes or intubate patients. This is not true of nurse practitioners in all ER settings, particularly those working in rural settings or in critical access hospitals. In remote locations, NPs may even staff an emergency department single handedly. 

Q: What is your schedule like?

A: My schedule working in the ER is all over the map. It has also changed substantially over the years to accommodate hospital expansion and increasing patient volumes. Currently, full time nurse practitioners working for my employer must work at least 140 hours/month. Shift length varies from eight to twelve hours per shift. Shift times range from early morning to midday, evening, and overnight shifts. Nurse practitioners are also expected to cover weekends and holidays on a rotating basis. The various types of shifts are divided evenly among NP coworkers making for a very fair schedule. 

Q: What does your relationship with physician coworkers look like?

A: I am constantly impressed by the support physicians where I work offer to nurse practitioners. As a new NP, they took the time to mentor me, helping me develop my clinical skill set. As a more experienced NP, my physician coworkers allow me the freedom to treat patients almost autonomously, stepping in to help as requested. 

Scope of practice laws in my state mandate physician supervision. So, for each shift I work, I am designated a physician coworker to be responsible for cosigning my charts and helping out with questions that arise.

Q: How did you get your foot in the door?

A: Persistence, experience, and professional connections, allowed me to get my foot in the door in the emergency department. As a new grad nurse practitioner, I worked in a lower acuity environment until I was comfortable. Then, I moved on to an urgent care clinic treating patients of slightly higher acuity. At the urgent care clinic, I worked alongside a former emergency department physician who connected me with the hospital where she was formerly employed. This connection along with my experience helped me land an interview during which I was hired.

Q: What is your nurse practitioner specialty?

A: I am a family nurse practitioner. The decision to become an FNP was critical to my ability to obtain employment in the emergency department. As a family nurse practitioner, I am able to treat patients of all ages, a necessity in the ER. While my education focused on primary care, this gave me a solid foundation upon which to build my ER know-how. 

Q: Were you able to do an ER clinical rotation as a nurse practitioner student?

A: Unfortunately, I did not have the opportunity to complete a clinical rotation in the emergency department as part of my nurse practitioner education. As a family nurse practitioner student, my program required that students complete all rotations in primary care. I overcame my lack of experience in a higher acuity setting through on the job training. 

What questions do you have about life as a nurse practitioner in the emergency department?

 

Comments

Nope!

Erin Tolbert

Have you ever performed an emergency tracheotomy?

Anonymous

Hi Erin

What level of experience/education would a NP need to function as a solo provider? Wouldn't the NP be taking on the role of a physician? What is the knowledge base expected of the NP by a physician in the ER, the same as another physician?

L W

Thank you for posting this. I'm in school for my FNP and working as an ED staff nurse right now, and I would love to eventually end up working ED as a Nurse Practitioner... I, too, figured family rather than acute would be a better specialty choice for ED because of the ability to see pediatric patients. Some ED's in my area (including the one I work for) do not employ FNPs - choosing only ACNPs and PAs to see patients in the fast track/main because we have a separate 8-bed pediatric unit staffed by 1 nurse and a pediatrician. I hope this is not the norm everywhere, because I'd definitely have to go back for my post-Master's in ACNP if that's the case.

Alison W