A Day In The Life of An ER Nurse Practitioner

Check out my guest blog post on Nurse Teeny’s blog, Makings of A Nurse.  Nurse Teeny has an excellent blog where she documents her nursing experiences.  She is planning to pursue a nurse practitioner degree in the near future.

A Day In The Life of An ER Nurse Practitioner

Working in the ER, my shifts are usually at odd hours.  Today I work from 6pm to 2am which I actually enjoy as it leaves the morning and afternoon free.  I spend an hour at the gym, return home to have breakfast and do a few chores around the house.  I write a blog entry for ThriveAP.  Then, I meet a friend for lunch, read a book on my porch and get ready for work.  Already a great day and my shift at the hospital hasn’t even started.

I arrive at work a few minutes early and immediately start seeing patients.  The ER seems to be constantly busy.  My first patient is a 40 year old male with abdominal pain.  I pick up his chart, go into the rom and observe him writhing in pain.  Kidney stones.  After two years in the ER I can usually diagnose them within seconds.  I order him pain medication along with a CT scan and some lab work to verify my initial diagnosis.

My next patient is a 25 year old female involved in a rollover MVA (Motor Vehicle Accident).  She is complaining of right wrist pain.  I remove the rudimentary splint the paramedics have placed to examen her wrist more closely.  Her wrist is swollen, bruised and deformed.  I suspect a fracture and order pain medications and an X-Ray.

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Then, I move on to my third patient, a 42 year old male who was doing construction on his home and has gotten a nail stuck in his index finger.  He was unable to remove the nail on his own and suspects it is in the bone.  I order an X-Ray to confirm his suspicions and find they are correct.  I then attempt to remove the nail by pulling it with hemostats.  It is stuck so far into the bone, I have to enlist the help of a male physician .  After successfully removing the nail, I write the patient a script for antibiotics, update his tetanus vaccine and send him home with strict instructions to return immediately if signs of infection develop.

In the ER, I never know what each day will bring.  I see patients with chest pain, abdominal pain and orthopedic problems.  I do procedures such as drain abscesses and suture lacerations.  I enjoy the variety and challenges my job provides.  I learn new things everyday.  I love my job and highly recommend the nurse practitioner career.

22 thoughts on “A Day In The Life of An ER Nurse Practitioner”

  1. Hi Lourdes,

    I am happy to help!  Where are you currently in your education?  Let me know so I can help you decide the best way to become an NP.

  2. I am a current ER nurse and have 2 and a half years of experience in this field. I am planning to go back to my masters and wondering if FNP program is a good way path to still land in the ER after finishing the program. Should I still work more years in the ER before going back to school or the said experience I have is good enough ? thanks a lot

  3. Hi Ivs,

    Great questions!  I still believe the FNP route is preferable to the Acute Care specialty for working in the ER.  In the ER you must be able to treat children and cannot do this with an ACNP.  Some schools offer dual specialty programs that prepare you as both an ACNP and FNP.  Although you will probably be more prepared to work in the ER with a dual specialty, it is certainly not necessary.  Check out my post about “How to Become an ER Nurse Practitioner“, it discusses this in a bit more detail.  

    With over 2 years of experience I think you are certainly ready to go back to school!  this is enough experience to both help you get into an NP program and be a more competitive job candidate after graduation.  That being said, ER positions are pretty competitive because they are high paying (and it’s an awesome job!).  Personally, I worked in Urgent Care for 2 years before finding an ER job.  But, I had no RN experience.

    Hope this helps!

  4. Hi! I’m currently an LPN working towards getting my bachelors in Nursing then going further to become an NP. Any advice? I’m still trying to decide which area I’ll specialize in 🙂

  5. Hi Sue!

    If you are still unsure which specialty you are interested in, my advice would be to work in a few different areas as you are getting your BSN so you can decide where you would like to ultimately practice.  While the NP profession is very flexible and you can pretty easily change work settings throughout your career it helps to have an idea of what area of medicine interests you most. 

  6. Hello Erin,
    I do not have ER experience, but my dream is to be an ER NP. I have been a registered nurse for two years, and I worked on med/surg/tele floor since graduation. Recently, I got accepted to an FNP program at a local private university, it would start this coming fall semester. However, I have many mixed-feelings about this next career move; the brand name of the university, cost, and the ability to find a job graduation. Should I continue my work and attend the FNP program in August? Or should I apply to bigger name Universities and quit my job to do full-time? I am confused.

  7. Hi TN,

    This is a big decision and one that will require a lot of thought and analysis. You are right to question if paying more for your education is worth it- many schools offer affordable options for getting a nurse practitioner degree. 

    The first step I would take in making your decision is to make 2 sample budgets- the first if you attend the private, more expensive school and the second if you attend a less costly, public university. Do this not only for your time in school but also post-graduation assuming you will be paying off student loans. This way you can see what sacrifices you would need to make to pay for a costlier program. You can assume an average NP salary of about $90,000. Then, based on your budget you can choose the program that is the best option for you.

    The good news is, that regardless of which program you attend, you will graduate as a nurse practitioner. 

  8. Hi Erin,

    I am trying to decide whether or not to take the job in the ER. I am a FNP and working PT at a specialty clinic. I am 1 yr post grad and havent really worked as a NP in a clinic setting yet. I have been hired in the ER but don’t know if the ER stress will be too much for me. What was your experiences as a new NP in the ED? Do you think passing up a job in the ED is a mistake? Any insight would greatly be appreciated.

  9. Hi Lisa.

    I’ll be honest. Even with 2 years of FNP urgent care experience under my belt, I felt like I was going to vomit on the way to work in the ER everyday for the first few months! It is a stressful transition, especially if you have limited or no RN experience. You will have a lot of questions. For me, the stress was totally worth it. Once those first few months went by things were much better. I love the work I do and my non-traditional schedule. 

    ER jobs are hard to come by for NPs so if this has been a goal of yours, go for it! Work hard, ask questions, and learn as quickly as you can. Knowing it is normal to be stressed at first will help. 

  10. Good Morning, I graduate in June with my associates degree in nursing, the school that I am attending is offering a BSN / MSN dual degree program, I have already made plans to enroll in that program. my ultimate goal is to become a Nurse Practitioner, I am a retired New York City Fire Department Paramedic, I also have worked, inside of a emergency room at a level 1 trauma center , my total time spent inside of a emergency room is at least 5 years, as a Paramedic only. I only plan on working part time inside of the emergency room as a registered nurse when I graduate in June, because I wanted to devote a good portion of my time towards studying towards my dual degree, my question to you is this, upon completion of the duel degree, will I have a difficult time finding a school that will offer a certification program for me to work inside of the ER ? and what will the certification curriculum class consist of ? and how long will it take ? … and not that it should matter but I am a African American male will that put me in even more of a demand ? thank you so much congratulations on your accomplishments and have a wonderful day.

  11. Hi Matthew,

    It can be difficult to get a job in the ER as a new graduate but it is certainly possible. Given your experience as a paramedic, you have a great chance of getting a job. If you can’t get a job in the ER immediately after school, you may need to work elsewhere for a year or so to build your resume up a bit. For example, I worked in urgent care as a new grad nurse practitioner before I was able to get a job in the emergency department. 

    There is not a special ER certification you will need. Once you graduate, you will simply need to apply for jobs in the ER. Make sure, however, that when you choose a nurse practitioner program you choose the family specialty rather than the adult or acute care specialty. ERs treat children and with an adult or acute care specialty you are not allowed to do so. 

    Hope this helps!

  12. Hello, my name is Matthew and I have enjoyed reading this blog. I have a passion for emergency medicine, and I only a Freshman in College. I have had the opportunity to do New Visions Medical Professions my senior year of high school and the opportunities were wonderful, I spent almost every rotation in the ER. I also volunteer at a hospital near my school between 6-8 hrs a week. I am interested in becoming an ER FNP, however how do I get these credentials ? My college does have an FNP program as well as a DNP program. I am very strong academically, as well as through community service. What books would you recommend I read on being an ER FNP. I have a room full of medical books and I just love to read up on anything pertaining to medicine !.

  13. Hi Matthew,

    Thanks for reaching out!

    Your first step to becoming an FNP is to get your bachelor’s degree in nursing. Then, you can enroll in an FNP program where you will get you master’s degree in nursing. Some schools have programs that roll these two degrees into one. 

    Once you graduate from your nurse practitioner program, you will take a certification exam allowing you to practice as a nurse practitioner. Then you will be ready to start working!

  14. I found your blog to be very informative and passionate about your profession. I will be graduating with a BSN in March 2016. I’m applying to graduate school to pursue a NP/MPH dual degree after working a year in ICU. The program allows students to specialize in two areas; I would like to I’ve read through some of your advice about preparing for ER. Would you recommend to work in ICU as well as get some experience in Urgent Care before pursuing the dual specialty NP?

  15. Hi Javier, 

    Congratulations on your upcoming graduation!

    Yes, urgent care and ICU would both be great experience for a dual NP degree. This would allow you to work in both inpatient and outpatient settings so you get the skill sets of each. 

  16. I have found that may sights give information about our salary, but these numbers seem incorrect to me… Can u help me find some real numbers?

  17. The salary of an ER nurse practitioner varies based on region. The best way to get an accurate read on the salary for your specific specialty in your area is to ask other NPs working in the same or similar settings.

    The U.S. Bureau of Labor Statistics gives salary information for nurse practitioners but it is not specialty specific. Salary.com gives specialty specific information but based on my experience I haven’t found it to be highly accurate. Either of these resources can, however serve as a point of reference at very least. 

  18. Hi Erin,
    I am interested in becoming a nurse practitioner. I have a lot of questions, and I hope you do not mind answering them 🙂
    I am a rising sophomore in college, majoring in Health Sciences.
    If I continue the next 3 years in college majoring in Health Science, would I have to find a bridge/another path after I graduate to connect back to nursing in order to become a registered nurse ? Or would Health Science be enough to connect me to a nursing path?
    Also, what ways can I get experience in while in college to benefit me before graduating? I currently volunteer in the hospital, any specific departments I should take into consideration? And, am I allowed to shadow nurse practitioners?
    What schools in the New York area have a NP program ?

    Thank you very much!!


  19. Hi Linda, 

    Thanks for reaching out!

    You will need to get an RN or BSN degree to enter a nurse practitioner program. This blog post, How to Become a Nurse Practitioner Without Nursing Experience, outlines your three options for doing so with a health sciences degree. Once you select the best path for you, this will help you narrow down your options as far as schools. 

    Volunteering in the hospital is a great way to get healthcare experience before graduating. You could also consider getting your CNA certificate, or completing another type of healthcare certificate to get more direct patient care experience. 

    As far as job shadowing, most facilities will allow you to job shadow an NP. Reach out to any NPs you know to see if they are up for hosting you for a few hours. Most will be more than willing. 

    Good luck!

  20. Hello,

    I’m curious about the scope of an Emergency room nurse practitioner. What can you do and what can you not do as a ER nurse practitioner. I’ve scoured all over the internet, and I can’t find the limitations? Can you do sutures, intubate, place chest tubes etc?

  21. The scope of practice for NPs in the emergency department depends on state laws and the rules of your facility. 

    Overall, provided that the NP is trained, nurse practitioners are permitted to intubate and place chest tubes. Suturing is a very basic skill and nurse practitioners are permitted to do this in all settings that I am aware of, provided they have appropriate training. 

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