ER Nurse in the hospital

Emergency Room (ER) Nurses are critical care or trauma nurses. ER Nurses have a license to work in the emergency department of a healthcare facility.

ER Nurses assist with stabilizing patients before they go to the medical-surgical unit, operating room, or intensive care unit. They play a vital role in many people’s lives, intervening at the most critical times. 

ER Nurses work with patients of all ages, with various medical histories and diverse needs. These nurses need to excel at multitasking, decision-making, and quick thinking. 

In the emergency room, every day comes with different unforeseen challenges. As an ER Nurse, you must be willing to adapt based on the current situation and be quick on your feet. 

As you consider a nursing career in the ER, it’s essential to understand what it involves and the steps to take. 

Recommended Reading - What is an ER Nurse?

What Are the Steps to Becoming a Qualified ER Nurse?

The primary requirements of a career as an emergency nurse are relatively simple. With a degree in nursing, the next step should be getting a job in the ER.

However, realistically speaking, you’ll need to fulfill additional requirements such as practical experience to work in the ER.

Attend Nursing School

Before you work as an ER Nurse, you'll need to become a registered nurse (RN). You can achieve this in two main ways: Earning an associate’s degree in nursing (ADN) or a Bachelor of Science in Nursing (BSN).

The fastest way to become a registered nurse is through the ADN program. It will take about 18 months to earn an associate’s degree at a vocational institute or community college.

However, most healthcare facilities require registered nurses to have a four-year BSN from an accredited institution. Earning a BSN ensures more job opportunities, better salary, and access to leadership positions in fields such as medical research, administration, and consultation. 

If you have an ADN, it’s best to consider upgrading your education level to a BSN. Most colleges offer RN-to-BSN programs to fast-track your career. If you have clinical experience working at a medical facility, some institutions allow you to attend online classes based on your schedule.

After joining an ADN or BSN program, some courses you’ll take are such as

Study and Pass the NCLEX-RN Exam

Once you complete your degree program, you’ll have to sit for and pass the National Council Licensure Examination (NCLEX-RN). It’s a standardized exam that tests all aspects involved in nursing.

The exam may have up to 265 questions to assess your competency and knowledge. You'll have to answer 75 questions and above on this exam, but there are online NCLEX-RN prep courses you can take to prepare well.

If you pass the NCLEX-RN, you qualify for an RN license to start the application process. 

Obtain a State Registered Nurse License

The nursing profession requires state licensing to protect public health. As an RN, you need a nursing license to practice legally in any state in the US. 

Every US district, state, and jurisdiction has a Board of Nursing (BON). This board determines the standards of safe nursing care and provides nursing licenses based on the Nursing Practice Act (NPA) legislation in that region. 

Every state has a different:

  • Continued education units (CEU)

  • Renewal period and requirements

  • Clinical hours served

  • Temporary practice permits

  • Length of the application process

  • License application fees

Some states require the nursing education program you join to be nationally accredited, but some allow state board-approved programs.

Due to the different licensing requirements, the application procedure will depend on the state you intend to practice. For instance, some states require documentation that proves physical and mental health, good moral character, no felony convictions, and proficiency in English.

Gain Bedside Experience in the Emergency Room

Some hospitals hire ER Nurses after acquiring a license to practice. The hospital then takes the responsibility of providing specific training based on the types of services they offer.

Although getting a job in the ER right after school is possible, most new nurses find it challenging. New nurses require clinical experience in a general medical-surgical unit or any less specialized department.

If you have previous nursing experience before working in the ER, it will be easier to adjust or transition and manage your time. You'll also be a better candidate for open positions in the ER.

Consider Taking and Passing an Emergency Room Nursing Certification.

Once you get your license to practice, you'll need to participate in continuing professional education to maintain it. Some approved providers offer this continuing education through online or in-person sessions.

Certification is not a legal requirement to practice as an ER Nurse, unlike the license. However, most employers require specific certifications, and it's an excellent way to boost your career.

All ER nursing certifications are about the techniques and knowledge of emergency treatment. The credentials required can vary depending on the specific workplace. For example, the flight and transportation ER Nurse certification is specific to patients on emergency transportation.

Popular certifications are such as

  • Certified Emergency Nurse (CEN)

  • Certified Transport Registered Nurse (CTRN)

  • Trauma Certified Registered Nurse (TCRN)

  • Certified Flight Registered Nurse (CFRN)

  • Certified Pediatric Emergency Nurse (CPEN)

Are the Steps to Becoming an ER Nurse Different in All States?

The steps of becoming an ER Nurse are similar to education and passing the NCLEX-RN. However, every state has unique licensing requirements, so ensure you confirm with the right board.

If you wish to practice in multiple states or a border area, you’ll need a license from every state. The only exception is where the particular states recognize permits from other jurisdictions.

Can You Become an ER Nurse Online?

Although emergency nursing courses are available online, most programs require in-person participation. Most online courses are only available to distance-learning students with an RN license and some work experience.

You'll need extensive in-person practicum to finish the degree for the classes available fully or partially online.

What Is the Difference Between an ER Nurse and an ICU Nurse?

ER Nurses and ICU Nurses are Registered Nurses but with different care goals. 

ICU nurses operate in intensive care units and ensure continuous 24/7 care for patients. 

These nurses monitor patients' treatments and vital signs and handle unexpected life-threatening emergencies. ICU nurses consider the long-term goals of the patients as they recover from critical illness.

ER Nurses operate in emergency departments and provide immediate care and quick action to patients. They use short-term interventions to ensure the patient gets long-term care. Once the patient is stable, they move to the next patient. 

ER Nurses rarely interact with and educate patients or families on patient care. On the other hand, ICU nurses often build rapport and educate patients and their families on patient care.

What Positions Can You Progress to From Being an ER Nurse?

There is no particular path to advancing your career as an ER registered nurse. Earning a Master's Degree in Nursing (MSN) helps you qualify for leadership positions such as nurse administrators or team leaders. 

You can also use the MSN for a career as a certified emergency nurse practitioner or teach nursing. 

Do Your ER Nurse Exam Qualifications Expire?

ER Nurse Exam qualifications do not expire, provided you remain a practicing nurse. As long as your license is active, there’s no need to retake the exam. 

However, if you fail to practice for an extended duration, you may need to attend remedial classes or retake the NCLEX-RN for your license to become active.

You'll also need to finish several continuing education units (CEU) hours.

Since every state has individual requirements, ensure you confirm with the right board of nursing. 

How Much Do ER Nurses Make?

The ER Nurse salaries differ based on location and the industry or setting you work in. 

On average, ER Nurses in the US earn $78,451.61 annually or $37.72 per hour. The highest-paying states are the District of Columbia, Hawaii, New York, California, and Rhode Island.

ER Nurses earn the lowest in Iowa, Oklahoma, Kansas, Indiana, Colorado, and Utah.

Recommended Reading - How much do Emergency Room Nurses (ER Nurses) make?

How Long Does It Take to Become an ER Nurse?

It generally takes five to six years to become an ER Nurse. A Bachelor of Science in Nursing degree takes four years, while an associate’s degree in nursing (ADN) takes two years.

Once you get your nursing degree, you’ll have to work for two more years in the ER to become certified. 

Types of ER Registered Nurses

As an ER Nurse, you can work in other places besides the emergency room. You can choose a specialized career path such as

  • Travel Nursing – You can work in various hospitals on a contract or freelance basis, and you'll get to travel while offering emergency medicine to multiple communities. 

  • Combat Nursing – Combat nurses or The Army Nurse Corps attend to troops and their family members while on active duty or reserve.

  • Sports and Arena Events – Your background in trauma can be an asset in large-crowd events.

What are the Duties and Responsibilities of an ER Nurse?

ER Nurses work in challenging environments where they constantly deal with new patients. These patients have varying ailments or injuries, and the nurses have a limited time frame.

ER Nurses can work in various settings such as inpatient units, operating rooms, emergency departments, and labor and delivery units. 

Typical duties and responsibilities include: 

  • Identifying patient issues and swiftly implementing the proper intervention

  • Administering vaccinations and blood products

  • Evaluating each patient's response to intervention such as treatment or medication

  • Administering and documenting medicines based on the hospital policy

  • Assisting with cases of trauma, conscious sedation, strokes, and cardiac arrests

  • Attending to wounds, critical injuries, and adverse allergic reactions

  • Administering bag-valve-mask ventilation, cardiopulmonary resuscitation, or rescue breathing

  • Performing intubations and tracheotomies

  • Prioritizing patient care based on staffing, understanding, and need

  • Recording changes in the patient status and reporting accordingly

  • Guiding and communicating with patients' family members in a respectful manner

What Skills Must ER Nurses Have?

The ER environment requires a particular skill set to thrive. As an ER Nurse, some essential skills you need include:

Remaining Calm under Pressure

Emergency rooms are often high-stakes and high-stress environments. ER Nurses must be able to triage patients and act fast while remaining calm under immense pressure. Patients are more likely to keep calm if they have confidence in the person attending to them.


In the ER, situations can change in seconds, so ER Nurses must be able to adapt swiftly. These nurses then evaluate and treat multiple patients without overlooking or forgetting any essential aspect.

Emotional Strength to Manage Loss 

ER Nurses handle many traumatic cases and lose some patients despite their best efforts. As an ER Nurse, you'll need the emotional strength to bear the loss and treat the next patient to the best of your ability. 


Although ER Nurses often work under pressure and multitask, they must also remain compassionate and empathetic towards the patients. They need to reassure traumatized patients and their families.