How to Become an ER Nurse

Submitted by Andrew Steger on Thu, 12/23/2021 - 20:01
ER nurses rolling a patient to an operating theatre

Patients entering an emergency room are often under intense stress due to medical illness, trauma or other critical situations. They are often worried and require quick and effective treatment and emotional and psychosocial support from healthcare staff.

An emergency room (ER) nurse is essential to providing this care and often serves as a primary source of communication to emergency department patients and their families. Despite intense working conditions, many nurses find life as an ER nurse tremendously rewarding.

If you’re considering this nursing career path, it helps you better understand the required education, certification options, job outlook and how to best secure a position in the field.



What does an ER nurse do? 

ER nurses work in hospital emergency rooms, triage centers, urgent care centers and trauma centers to treat patients experiencing a variety of illnesses, including everything from mild injury to serious critical illness states like heart attack or strokes as well as trauma. 

ER nurses work in crisis conditions, so they must be able to work seamlessly with physicians and other members of the interdisciplinary team to quickly assess, identify priorities and provide quality care. Some of the most common conditions treated in the ER involve upper respiratory infections, strains and sprains, chest pain, and injuries of all types, including falls and motor vehicle accidents. 

Beyond initial injury, ER nurses are responsible for the following: 

  • Complete physical assessments to identify health issues and prioritize needed interventions 
  • Administering medications. The nurse is responsible for administering medications needed to help manage psychological illness and control pain.
  • Monitoring vital signs. Regardless of the injury, a nurse will need to continually monitor the patient’s vital signs to ensure they remain in stable condition. 
  • Assisting with minor procedures. Patients may need minor procedures, such as receiving sutures to close a wound. Nurses may be asked to assist health care providers with these types of procedures. 
  • Coordinating diagnostic tests. Many patients require diagnostic testing to further evaluate their illness or injury. Nurses play an important role in prioritizing needed diagnostic tests and often provide needed patient education about such testing.
  • Provide interventions needed for care management. Whether managing intravenous access (IVs), conducting wound care, or monitoring output with urinary catheters, nurses implement numerous interventions necessary for providing quality care.

Many of these responsibilities are similar, if not the same as, those of a registered nurse working with patients admitted to other medical settings, however, these duties are performed at a much faster pace and on a more compressed schedule in an emergency setting. In fact, ER nurses often help evaluate a patient’s condition and provide treatment at the same time. Additionally, ER nurses must routinely conduct protocols to ensure that ER equipment, space and resources are ready to go for any emergency.


Where do ER nurses work? 

Most ER nurses work at hospitals or free-standing ERs, but there are plenty of opportunities in other areas that require the skills of an ER nurse. For example, a nurse may serve on a rescue team or work for a film production crew, where access to medical care is needed in case of an emergency. An ER nurse is also commonly sought after on cruise ships because they are experienced in treating patients with many different medical issues. 

ER nurses may also serve in less serious settings, such as walk-in urgent clinics, where patients have emergencies that aren’t as serious as those that require an ER visit. Additionally, ER nurses are often qualified to work in emergency response units, state and federal prisons, and position control centers. 


Qualities required for a successful ER nurse 

ER nurses are skilled at remaining calm during stressful and demanding situations. A nurse’s ability to handle an urgent situation with a high degree of confidence can impact the quality of treatment and how comfortable the patient and their family feel. 

As an ER nurse, being interested in ongoing learning is also important. While you’ll see many of the same cases on a weekly basis, there will also be more unusual cases that arise. Additionally, life-saving and critical illness treatments are often improving based on new evidence, which makes continued learning on the job a priority for successful ER nurses.

A willingness to stay flexible is also important because an ER nurse must be able to pivot fast, adjust as a situation changes, and do so without missing a beat. But perhaps one of the most important qualities of an ER nurse is a strong sense of compassion and empathy. Patients visiting the ER are often stressed and worried and sometimes experience intense levels of pain. When an ER nurse has a high level of empathy, it can help the patient feel more comfortable and improve their experience and care. 


Potential pay scale and job opportunities 

The average pay of an ER nurse is $31.97 an hour, or $51,000 to $97,000 annually, according to A 2019 study found that the median salary for emergency, trauma, and transport nurses was roughly $77,500. Job growth as a whole for the nursing industry is expected to be faster than average through 2029, which will provide many potential career opportunities. This is especially true for ER nurses. With an aging population, many people require urgent care and visit ERs or urgent care facilities for unexpected medical issues. 

The amount you earn will vary based on where you live, your employer, and your prior nursing experience. For example, California and Hawaii are the highest-paying states for registered nurses, with the District of Columbia also paying well. 


How to Prepare to be an ER Nurse

If you're interested in learning how to become an ER nurse, you’ve come to the right place. 

The amount of education needed will vary based on your current education level and future career ambitions. Nurses must receive their RN accreditation to apply for state licensure.


Step #1: Earn your nursing degree

Earning your nursing degree from an accredited nursing program is the first step to becoming an ER nurse. You can earn your associate degree in nursing (ADN), a Bachelor of Science in Nursing (BSN) or complete a direct-entry Master’s in Nursing program.

The ADN is a popular path for students who want to complete a nursing degree quickly and enter the workforce, with these programs taking as little as 18 months to finish. A bachelor’s degree can take about four years to complete; however, completing a bachelor’s program can better prepare you for your role and future career success as well as support positive patient outcomes.

Additionally, distance BSN programs are a popular option for students who want to complete their nursing degree and maintain existing personal commitments. These programs typically are completed asynchronously without mandatory login times and allow most work to be completed online. Accelerated BSN programs are also an option for individuals who already hold bachelor’s degrees in a different field and want to change careers.


Step #2: Seek licensure in your state

After completing your nursing degree program, you must take the licensing test required to become a registered nurse in your state. The National Council Licensure Examination (NCLEX-RN) is a test covering various nursing topics. There are at least 75 questions on the exam, but you could be asked over 200 (depending on your answers) to ensure entry-level competency in the nursing profession. Many schools offer preparation courses to help you get ready to take the exam.

You must first apply to your state’s licensing agency to initiate this process. From there, you’ll be authorized to take the NCLEX-RN exam. It’s important to note that some states may have requirements in addition to passing the exam, such as completing a background check or providing letters of recommendation.


Step #3: Explore certification opportunities

Emergency rooms are often willing to hire ER nurses after graduating from an accredited nursing program and earning their licenses. Hospitals offer new graduate nurses robust residency (or orientation) programs to offer further training and education in the area of nursing in which the individual will be working under the mentorship of nurse educators and RN preceptors. Alternatively, a nurse may work in a different department within the hospital system and apply for a transfer to an emergency nursing position. Such transition would also include the support of an extensive ER orientation program.

In addition to being a licensed RN, you may become a certified emergency nurse (CEN) by taking and passing the CEN exam. This certification, which is nationally recognized, is for nurses in emergency settings who are looking to improve their knowledge, career and patient care. It requires you to obtain a certain level of expertise in emergency patient care, and you must have at least two years of RN experience to take the exam.


Charting your path forward 

The ER nurse position may be a good fit if you enjoy working in a fast-paced, challenging environment. ER nurses should possess the ability to think fast, have strong critical thinking skills, and be able to act decisively about a patient’s course of treatment. They need collaborative skills to work seamlessly with other care team members, such as doctors, medical assistants, and other healthcare professionals. 

If you possess these skills and mindset, consider getting started today with an online ABSN program. The rewards of this career path are worth the effort as you provide care and comfort to patients during difficult times. ER nurses can also expect career opportunities and compensation to remain strong into the future, with many opportunities to choose how and where they work. 



The content published on our blog is reviewed by credentialed healthcare professionals to give you the most up-to-date and professionally accurate information. This particular article was professionally reviewed by Colleen Sanders, RN, FNP-BC on December 22, 2021.