F.A.Q.s About Becoming an Emergency Nurse Practitioner

As a nurse practitioner in the emergency department I get asked a lot of questions about my job and my career path because, well, my job is pretty sweet. Yes, it is a job. But, when it comes to working, life as an ER NP is a pretty good gig. There is a lot of confusion in the nurse practitioner community about how to land a position working in the emergency department and what this process looks like. So, today I’ll address some frequently asked questions to help clarify the confusion. 

Starting Out…

What specialty should aspiring emergency nurse practitioners 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 emergency department and the acute care specialty is that with an acute care certification NPs are not certified to treat pediatric patients. Working in the ER, you must be qualified 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 NPs for an ER position will not likely hire a nurse practitioner who cannot treat children. The best specialty for ER practice is the FNP. Family nurse practitioner programs teach students to treat patients of all ages. 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. Much of what you see in the emergency department will fall into the primary care realm. 

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As nurse practitioner programs become increasingly more specialized, some schools have started to offer 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.

What kind of work experience is important in landing a job as an ER NP?

Experience working as an RN in the emergency department is of course helpful in finding a job in the ER at the nurse practitioner level. If you don’t have an emergency nursing background or are a new grad NP, you may need to work your way up gaining some experience before landing a position as an ER NP. Emergency nurse practitioner opportunities often require experience given the setting’s high acuity level and reliance on procedural know-how. Working for a year or two in the urgent care setting helps new nurse practitioners learn the basic skills they will need to succeed in the emergency department. 

If you aren’t hired for an emergency department position right out of your NP program, don’t be discouraged. Accept another position that will help you grow as a nurse practitioner for your job search the next time around. 

Landing a Job…

Who do prospective emergency nurse practitioners interview with for a job?

Hospitals vary in how their emergency departments are set up. Most often, applicants interview with the emergency department director, or medical director of the department. In the ER setting, this is typically an emergency medicine physician who works primarily in an administrative capacity. Larger ER groups may also have a ‘midlevel’ director responsible for hiring and managing nurse practitioners and physician assistants. During the interview process for emergency nurse practitioner positions also expect to meet nursing administrators, emergency physicians and other NPs working in the department. 

Who do emergency department NPs report to on a daily basis?

Emergency department provider staffing may be set up in one of two ways:

  1. Contracted through an outside staffing organization
  2. Managed by the hospital itself

If you work in a hospital that outsource’s emergency department staffing to an outside organization, as a nurse practitioner you will report to the medical director as well as administrators working for the staffing agency. The structure is similar for NPs working in hospitals managing their own ER staff except that administrators will be internal hospital employees. 

Mastering the Skill Set…

What skills are most important to work on during NP program clinicals to secure a job as an ER NP?

Procedural skills are a must in the life of an emergency nurse practitioner. Suturing, casting, splinting and I&D of abscesses are daily occurrences. Seek out experience with procedures in your nurse practitioner program clinicals. 

What skills prove valuable as a more experienced nurse practitioner?

Even experienced nurse practitioners working in the emergency department have room to improve their skill sets. Advanced suturing skills prove helpful in many clinical situations. Ultrasound is becoming increasingly popular among providers in the emergency department. Taking a course in ultrasound technique will be useful. Advanced procedural skills and knowledge of ultrasound isn’t essential for nurse practitioners in many ERs, but focusing continuing education on these areas is worth considering. 

Are there any continuing education courses directed specifically toward ER nurse practitioners?

Yes! There are a wealth of continuing education options available to aspiring and practicing emergency nurse practitioners. Check out these 7 continuing education conferences for ER NPs and these skills workshops for increasing your procedure arsenal. 


You Might Also Like: 5 Steps to Becoming an Emergency Department Nurse Practitioner


4 thoughts on “F.A.Q.s About Becoming an Emergency Nurse Practitioner”

  1. I am currently a RN in the ER and plan to return to nurse practitioner school this summer. I work in an ER currently where we see a lot of pediatric patents, but I plan on working as a ER NP in a large city once I graduate with pediatric hospitals nearby. I am contemplating ACNP vs FNP. I noticed in this post that you recommended FNP. If I plan to eventually maybe work with a Cardiologist later in my career should I do ACNP? So many decisions!

  2. Hi Ellie, 

    I would choose FNP initially. This gives you more flexibility as you can teat children. There is also a new Emergency NP Certification you can get which can only be taken with an FNP degree.

    You may also consider getting a dual FNP/ACNP degree. This will add some time to your education but will give you the greatest number of options for your career. You can always complete an additional post-masters ACNP degree online while working at a later time.  

    There are a lot of options, however, if you are looking for the most foundational place to start and aren’t 100% sure where you want to take your career, start with the FNP.

  3. Erin—I have some questions for you but I have had a devil of a time signing up and logging in. I can’t find where to ask you a question so I’ll just paste it here:

    I am having a very difficult time getting data regarding physician/NP collaboration. Do you know where I could find out how a doctor can supervise? Are the guidelines for how much a physician receives? What is to keep an unscrupulous physician from contracting with 20 nurse practitioners? What is to keep him from pushing for unethical things like sexual favors. New nurse practitioners are vulnerable due to the weight of their student loans and other expenses associated with NP school and family?

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