How Do You Become an ER Nurse Practitioner?

I have had a few readers contact me asking what specialty they should they should choose in their nurse practitioner program if they want to become an ER NP.  Other readers have asked how to find a job in the ER.  After all, the emergency nurse practitioner does top our list of highest paying nurse practitioner specialties.  Allow me share my thoughts and my story.

What Nurse Practitioner Program Specialty Should You 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 ER and the acute care specialty is that with an acute care certification you are not qualified to treat pediatric patients.  Working in the ER, you must be certified 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 NP’s for an ER position will not likely hire an NP who is not certified to treat children.  The best specialty for ER practice is the FNP.  Family nurse practitioner programs teach students to treat patients of all ages which is necessary in the ER setting.  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.  Most of what you see in the ER will fall into the primary care realm.

As nurse practitioner programs become increasingly more specialized, some schools are offering 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.

How Did I Land a Job as an Emergency Nurse Practitioner?

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Most employers and especially those dealing with higher acuity patients are looking for experience.  Upon completion of my nurse practitioner program (FNP), I applied to some emergency room job postings.  No call-backs.  I got a bit more aggressive and tried to contact medical directors of emergency departments directly.  I was able to interview with the medical director for one ER and was told I seemed like a great candidate aside from my lack of experience.  My own father who is an ER physician even told me he wouldn’t hire me!  I needed a new plan and some experience.  One week after I officially graduated I started working in an family practice/ walk-in clinic.  The clinic was poorly managed and I increasingly discovered primary care was not my calling.  After a year, I moved on to an urgent care clinic that provided a slightly higher  acuity level and allowed me to continue to learn.  I became better at procedures and working quickly and efficiently.  I learned to sort potential emergencies from run-of-the-mill illness and injury.  Finally, I was ready.

After I felt I had mastered the urgent care realm, I began to once again dream of the ER.  Fortunately, one of the physicians I worked with at the urgent care clinic had some connections at a local emergency department.  I was able to get an interview with the medical director and was hired on the spot!  The ER has given me a new challenge and a faster paced work environment.  The opportunities for learning there are endless.

What Should You Do To Start Your ER NP Career?

If you want to work in the ER, you will likely need NP experience.  Once you complete your NP degree, work in urgent care for one or two years.  Work hard and seek learning opportunities so you can get excellent recommendations.  Once you have experience, contact recruiting agencies and medical directors of emergency departments in your area.  ER physicians and nurse practitioners are often independently contracted and are not employees of hospitals themselves so hospital websites may not post these positions.  TEAMHealth is a national staffing agency that hires NP’s for ER positions across the country.  Contact agencies such as TEAM Health so check for job openings in your area.  It may seem aggressive to contact medical directors of ER’s in your area, but if they are looking for a new NP chances are you will get a call back!

29 thoughts on “How Do You Become an ER Nurse Practitioner?”

  1. Great informative post! Can you also post about a day in the life of a FNP working in family practice and urgent care? I think I will probably pursue those practice settings once I graduate next year. Thanks Erin!

  2. Erin reading your posts have motivated me more on my dream of becoming a nurse practitioner. Am still in school to get my BSN. But by the time I will be through with school, the regulations would have changed. Nurse Practioners would need to have PhD. Now my question is this: how long will this take ?

  3. Hi Riley!

    The regulations are actually going to change requiring a DNP (Doctor of Nursing Practice) not a PhD.  Both are doctorate degrees.  The PhD is more focused toward research while the DNP is geared toward clinical practice.  These programs take about three years to complete.  

  4. Thank you for the great information, I am planning on becoming a NP after I graduate and attain some experience. I would love to work in the ER and as mentioned above I heard that the regulations are changing and was wondering when that would be taking effect. Thanks!

  5. Hi Chelsea,

    I assume you are referring to the regulations requiring NP’s to have a DNP degree rather than an MSN degree?  If so, the originally proposed deadline for the requirement was 2015.  While this proposition hasn’t been officially changed, experts are saying that it will be much later than this.  There is not a firm deadline yet.  

  6. Am planning on getting into the field (2nd degree bachelors, followed by masters), and was wondering if you spent any time in the ER prior to getting your RN license, or if you were in the primary care/different setting? Would this help, or are employers looking for the experience solely at the NP level?



  7. Hi Geoff,

    Personally, I did not spend any time working as an RN.  I did, however work as a nurse practitioner in Urgent Care for 2 years before working in the ER.  Experience in the ER as an RN or experience as an NP in a related field are both helpful, I wouldn’t say one is preferred over the other. 

  8. Hello, thank you for all the great posts. I am in btw decision FNP and Acute Care NP (adults). The same as you, I want to become ER NP and there is no ER NP track in MA where I live. I feel like Acute Care prepares you more for the hospital acute situations versus FNP is more about outside of hospital practice. Am I on the right track? However I agree with your point, where you mentioned that Adult Acute NP is not certified to take care of children. From researching scholarships and loan repayment (HRSA) it seems I am more likely to get a stipend if I am in FNP. Any advice? Michaela

  9. Hi Michaela,

    One thing you could do is contact local emergency departments and ask what they prefer in your area.  The ideal situation is to get both an FNP and ACNP.  If you are choosing one over the other, I would choose FNP for the flexibility and ability to see kids. 

  10. I am in the process of completing my BSN, and looking at NP programs, and was curious, I know the ENP programs just a mix of the FNP / ACNP, do you know any that will add pediatrics acute care to this?

  11. Hi Terry,

    Unfortunately, I do not know of any programs that add pedes acute care to an Emergency NP program.  Since it is already a dual program, the curriculum is pretty packed!  Your best bet would be to either complete and FNP program then an additional specialty in pediatric acute care or complete an Emergency NP program and add pedes acute care later.  That being said, you shouldn’t need 3 specialties to find a job. 

  12. Thank you for your post! Very informative. I am currently obtaining my FNP right now, and truthfully have become discouraged in my intro classes by the health care reform and providers intake. My passion is bedside nursing, ER specifically. I have been a ER nurse for 3.5 years now, and have 1.5 years ER “travel experience.” My resume is building…my only goal is to take my career one step further and be a NP in the ER. I hold four state licenses to date. I have been researching the salaries for FNP (in various areas) and wanted to make sure there was a substantial difference than what I make as a travel nurse. I have more enthusiasm now after reading this post 🙂 Personally, where I’d love to stay is VA (my home state) but compared to other areas this is very low-paying. I am not sure where to go from here.

    I am sure now….I will finish my FNP program. Do you suggest that I practice in certain states as a travel RN and gain experience. Or certain level hospitals, ie trauma designation?

    Thank you for your input.

  13. Hi Brittney,

    Thanks for reading! It sounds like you already have a lot of experience and have been consciously seeking learning/career building opportunities. If you want to complete your FNP program and apply for jobs with your resume ‘as is’ you should be just fine. Based on what you have shared, it seems like you have a broad experience base. 

    That being said, working in/ getting experience in the state where you ultimately want to live will be to your benefit. This way you will make connections that will help you find a job. Also, companies prefer to hire employees who already reside in or have a good reason for residing in their area. 

    Hope this helps! Good luck. 

  14. Hi Erin,

    I am so happy to have found this blog/post, very informative and uplifting. Finding information that truly speaks to ones desires if hard to locate, and this is exactly what I wanted to find and “hear.” I too am completing my BSN (graduate in 5 months) and will be continuing on with an FNP program. My question is, (I think you answered a similar one,) as an RN you did not work? Did you go right into an FNP program? I intend to work, pt, while going through the NP program. To the best of your knowledge, would working as an RN in an ER qualify as Acute Care/Emergency Medicine experience toward the needed experience prior to being hired as an NP in the ER? I ask because I am no spring chicken, I will be 48 at the time of graduation and obviously am looking for the most productive way reach my goal as an ER FNP. I, like you, do not feel like I would be satisfied working in a primary care office. Any help on this subject would be greatly appreciated, I cant affor to make a mistake at this stage of the game 🙂

  15. Hi Aaron,

    I actually completed an accelerated NP program. It included both an RN and MSN degree without taking a break between the two. So, no, I have never worked as an RN. 

    Working as an RN in the ER will be attractive on our resume when you apply for ER NP jobs. As far as if it counts as enough experience, it depends on the employer. Someone has to be the one to give you your first NP position!

  16. I am about to graduate next year with a non-nursing degree, and have the pre-reqs completed to enter either a one-year accelerated BSN program or a 21 month accelerated MSN-NP program directly after graduation at the school I already attend. My school also has a Post-MSN NP Certification available for afterwards. Could you please shed some light on the newer qualification requirements or recommendations for being an NP in the ER? Would one of these programs over the other be better or is MSN an outdated track now?

  17. Hi Annelise, 

    The MSN is not an outdated track. To become an NP in the ER, you need to complete a family nurse practitioner program. You could enroll in the accelerated BSN program followed by working as a nurse while you complete an NP program simultaneously. To land a job in the ER once you graduate, having some nursing experience would be helpful.

    A direct entry MSN program would help you become a nurse practitioner more quickly but you will graduate without nursing experience. You may need to work in an urgent care setting for a few years to get some experience before you can work in the ER as an NP with this route. 

    Ultimately, either path will get you there. I would look closely at cost in this decision as well. How does tuition for each program compare?

  18. I found theses comments/ posts very interesting. I am a Family Nurse Practitioner and also Director of our Fast Tracks in the ED. I do the interviewing and hiring of the FNP s, which is a requirement to apply. One thing I would add is that if you are interested in Emergency Practice is to get one of your clinical rotations in the ED. You will learn suturing, X-rays, EKG interpretations, etc and also will find if you like that environment. You also will meet people who can help you land a job. I also have all my new hires take the EM BootCamp. You can find it on the internet and it is a great starting point for those interested in Emergency Nurse Practitioner. Good Luck!

  19. Erin,…
    I have as far as I know, just landed my first NP job and it is in the ED! What are some resources I can use to help me prepare while I wait to start. I have the ESI severity index and the ENA NP competencies printed…Thanks

  20. Amanda,


    If at all possible, take an ECG reading course, an X-ray reading course, or any procedural courses you can find. EM Boot Camp, for example, is a good resource. If that isn’t possible, setting up a few days to job shadow before you officially start working would be helpful. 

  21. Thank you so much for this article! I’m currently two months into in a entry to practice/MSN combined program with an FNP speciatly. I’m realizing that I tend to prefer higher energy environments and I was starting to worry that I’m in the wrong program. I have an interest in ER work or trauma work. Would you say that this guidance applies to trauma units as well? Also, given that there are specialties for geriatric primary care, pediatric primary care, or primary care across age groups, what is your take on why there isn’t a specialty for acute care across age groups?

  22. Hi Stephanie,

    I would say that generally I see more acute care NPs in trauma units although it’s not unheard of to find a family nurse practitioner working in trauma, particularly if he/she has RN experience in critical care. 

    Interesting question about why there is not an acute care specialty that covers the lifespan…I don’t know why this is the case! It certainly would make things easier if there was. 

  23. Erin,

    Thanks so much for the informative (and motivating) post! I am currently a sophomore in college & am in the process of applying to the nursing program! I am excited to receive my BSN but my dream is to become an NP.

    I have really been thinking about a career as an ER NP and your posts make me very excited to see what is in store for the future!

  24. Hi Haley,

    Thanks for reading!

    If there is ever anything you feel would be helpful for me to cover on ThriveAP as you start your journey to becoming an NP, let me know!

  25. I’m set to start the ACNP program at Grand Canyon University next month. My counselor has been adamant that I should do the acute care track vs. the NP track to work in an ER. She told me she has many FNPs who return for their ACNP because their hospital insists on it. It’s been pretty confusing trying to work through all this conflicting information. Anybody know of any ACNP who work in an ER?

  26. Hi Misty, 

    You will most likely not be able to work in the ER with an ACNP certification alone since you will not be able to treat children. You must either have a dual ACNP/FNP certification, or an FNP certification. 

  27. Hi
    I graduate in 4 months with my AGACNP and keep reading about getting a certification in ER. How is that possible? Do you just go back to do your hours in pediatrics and OB/Gyn that were not covered in the curriculum? Have you ever heard of AGACNP’s treating only adults in the ED?

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