How to Become an Emergency Nurse Practitioner? (Answered by an NP)

Written By: Kasee Wiesen DNP, APRN, FNP-C

Do you enjoy working in a fast-paced environment that is constantly changing? Do you enjoy caring for multiple patients with different illnesses, injuries, or problems? Do you like working alongside a team to better a person's or community's health? If you answered yes to any of these questions, you should consider becoming an emergency nurse practitioner.

Below, I will answer the question of how to become an emergency nurse practitioner? I will also provide information on the steps to becoming an emergency nurse practitioner, the pros and cons of the job, and the average salary.

What Does An Emergency Nurse Practitioner Do?

What exactly does an emergency nurse practitioner do? Below I will list nine duties of the emergency nurse practitioner.

1. Complete Focused Assessments:

An emergency NP must know how to perform quick and accurate focused assessments based on their patient’s complaint. They do not necessarily need to perform a head-to-toe examination on every patient but instead assess the patient appropriately based on their complaints, injuries, concerns, etc.

2. Order and interpret diagnostic tests:

The emergency NP will order and interpret diagnostic test results. This will include lab work, x-rays, and CT images. The NP must know when it is appropriate to order each test and how to apply the test results to their patient to develop an appropriate treatment plan and diagnosis.

3. Provide care to trauma patients:

The emergency NP will provide care to trauma patients, regardless of the ER they work in. Most ERs will require their providers to complete trauma education and review courses to ensure they appropriately maintain skills and knowledge to care for trauma patients.

4. Diagnose and treat critically ill patients:

Once you order the appropriate diagnostic tests, you must be able to interpret those results to diagnose a critically ill patient and develop a treatment plan. This may include admission or transfer to another hospital or close follow-up with their primary care provider at discharge.

5. Diagnose and treat acute illnesses:

In the ER, the NP will not only diagnose and treat critically ill patients but also acute conditions such as pneumonia or dehydration.

6. Wound care, including sutures:

The emergency NP will need to know how to perform wound care, including irrigation of wounds, suturing, and stapling of wounds.

7. Splint placement:

The emergency NP will place splints on the patient when appropriate. For example, they may need to apply a temporary splint to a wrist due to a fracture or dislocation. They must also know about re-usable splints/braces and when it is appropriate to use—such as a hinged knee brace.

8. Work closely with the healthcare team:

The emergency NP must work well and closely with the other staff when providing care to their patients. This may include working with the other nurses, respiratory therapists, ER physicians, ER techs, hospitalists, social workers, and even EMS personnel or police officers when they accompany or bring a patient to the ER. Working well with the team is the best way to guarantee the patient receives the care they need quickly and efficiently.

9. Educate patients:

Lastly, the ER NP must be able to effectively educate patients on their diagnosis, treatment plan, and follow-up instructions. This is critical to the patient’s recovery.

What Skills And Abilities Are Needed To Work As An Emergency NP?

Many skills are needed to work as an emergency NP. Below are eight important skills and abilities required to become an emergency nurse practitioner.

1. Time Management:

First, you must have good time management skills. This is needed due to the number and variety of patients seen throughout the shift. You must be able to manage your time to make the most of your 10-hour or 12-hour day.

2. Prioritization:

Going along with time management, you must also be strong at prioritizing your day. The emergency NP must be able to prioritize their patients and know who needs to be seen first based on acuity.

3. Knowledge to care for trauma patients:

When working as an emergency NP, you must know how to care for a trauma patient. A trauma patient’s first stop is to the emergency department to be stabilized before being transferred to the floor. The emergency NP must be confident in their assessment skills, ability to interpret results, and development treatment plans specific to the trauma patient and their injuries.

4. Knowledge to care for critically ill patients:

The emergency NP must also know about caring for critically ill patients. The emergency NP will care for and stabilize many critically ill patients diagnosed with sepsis, respiratory failure, or heart attack. Just like the trauma patient, they must know how to assess each of these patients appropriately, interpret results and develop treatment plans to stabilize the patient before transfer to another hospital or floor.

5. Knowledge to care for other acute illnesses/problems:

The emergency NP will not just care for trauma and critically ill patients but also needs to know about several acute illnesses and problems. Many people seek care in the ER for many reasons, and the emergency NP must be prepared. Some of these illnesses include vertigo, urinary tract infections, lacerations, and possible broken bones.

6. Interpretation of diagnostic tests:

Besides knowledge, the emergency NP must also be confident in their ability to interpret diagnostic tests correctly and develop treatment plans based on these results. Examples of tests that will need to be interpreted include lab work, x-rays, and CT scans—and while the radiologist may provide an interpretation of x-rays and CT scans, the emergency NP must know what that means and develop a treatment plan based on those results.

7. Critical Thinking:

The emergency NP must be able to think critically when caring for their patients. They are always looking at the entire patient and their medical history/mechanism of injury and trying to consider one or two steps ahead when providing care.

8. Teamwork:

Lastly, the emergency NP must be able to work as a team. It is impossible to deliver care to the patients in the ER by yourself. Therefore, you must work with the interdisciplinary team, which can include the nurse, respiratory therapy, phlebotomy, radiology, ER tech, ER physician, EMS, social work, etc. Teamwork is vital in providing high-quality and efficient care in the ER.

Where Do Emergency Nurse Practitioners Work?

Emergency nurse practitioners work in an emergency department located within a hospital. This environment may look different, though, based on the ER worked. For example, a rural hospital may only have 1 NP in the department, and if needed, an ER physician may be called in to assist. Or, the emergency NP could work in a level 1 trauma center where multiple ER physicians and NPs could be staffed simultaneously.

What Is The Typical Work Schedule For An Emergency NP?

The typical work schedule for an emergency department NP includes either 10-hour or 12-hour days. Typically these shifts start late morning/early afternoon and last until the night--and emergency NPs work three to four shifts a week. The ER NP will work rotating weekends and holidays. They also rarely be on-call—but if the ER is incredibly small, the NP may not need to be in “house” all the time but instead would be on-call and called in if a patient presents.

What Is The Difference Between Emergency NP And Emergency Nurse?

The difference between an emergency NP and an emergency nurse is their scope of practice. The emergency NP will have a greater scope of practice due to their education and passing the board certification exam.

First, the education requirements are different for an emergency nurse and NP. An emergency nurse requires a bachelor of science in nursing (BSN) degree. The emergency NP must have an advanced degree such as a master of science in nursing (MSN) or doctorate of nursing practice (DNP).

Obtaining licensure is also different for the emergency RN and NP. Once the RN graduates from their BSN program, they must pass the NCLEX to obtain their RN license and renew their license every two years. After graduation from their NP program, they must pass the board certification exam specific to their degree—and for the emergency NP, this will either be acute care or family practice program. Emergency NPs renew their license every five years—but keep in mind that if you work as an emergency NP, you must maintain good standing with your RN and APRN licenses.

As mentioned above, the scope of practice is different between the emergency RN and NP. The emergency NP has a much greater scope of practice when caring for their patient. The emergency NP will assess, order, and interpret diagnostic tests and create a treatment plan based on these results. The emergency NP can also order/prescribe medications, place consults, and perform technical skills such as suturing or applying a splint. The emergency RN is just as vital to the delivery of care in that they also assess the patient, implement the orders given by the NP, re-evaluate the patient and update the NP if there is a change in the patient's status.

Top 5 Pros Of Becoming An Emergency Nurse Practitioner

There are many pros to becoming an emergency nurse practitioner. Below you will find a list of five top pros of being an emergency nurse practitioner.

1. Short work week:

One pro of working in the emergency department is you will have only three or four shifts a week—depending on whether you work 12-hour or 10-hour shifts. This is nice because it allows more days home with family and friends or participating in hobbies outside work. Ultimately, it may provide a greater work-life balance.

2. Fast-Paced:

The environment in the emergency department is fast-paced—and many emergency NPs thrive in this environment. They enjoy the non-stop patient flow, caring for acutely and critically ill patients, and the excitement that comes with that.

3. Variety throughout your day:

Your day as an emergency NP is full of variety in your patient population. You may care for a patient experiencing a heart attack, another patient with a broken leg, and another patient with abdominal pain—all at the same time. You could care for 20 patients daily, and no two patients will be similar.

4. Endless learning opportunities:

Due to the variety and fast pace of the ER, the emergency NP will always have opportunities to learn. This may include learning a new or more efficient way to do a task such as suturing or applying a splint or opportunities to gain new knowledge from co-workers or CEU opportunities.

5. Rewarding career:

Lastly, working as an emergency NP is a gratifying career. You will care for patients in some of their sickest or scariest times—and your job will stabilize and help them get well. You will be a source of comfort and knowledge for your patients in times of high stress.

Top 5 Cons Of Becoming An Emergency Nurse Practitioner

Like any job, there are cons or points to consider when becoming an emergency nurse practitioner. Below, I will discuss the top five cons of being an emergency nurse practitioner.

1. Long hours:

There is the potential to work long hours as an emergency nurse practitioner. Typically, their shift schedule is either 10-hour, or 12 hours, but it is not uncommon for it to be longer. The shift may run longer due to the volume in the ER or charts that need to be finished.

2. Variable Schedule:

While working as an emergency NP, your schedule may vary. You will usually only work three to four days a week—but the days worked may change every week. Therefore, it may be challenging to make plans or schedule events due to the uncertainty of the schedule.

3. High-Stress Environment:

Working as an emergency NP is stressful. The acuity of patients is broad; you may have to care for a trauma patient while simultaneously caring for a dislocated joint and laceration. Depending on where you work, you may have to care for up to six or seven patients at the same time or even be the only provider in the ER. However, the staff around you will be there to support you.

4. Uncertainty of the day:

As an emergency NP, the layout for the day is based on uncertainty. There is no scheduling of the patients seen in the ER; therefore, your day is unpredictable, and you never know what you will encounter throughout the shift.

5. Potential for extensive patient list:

As I briefly mentioned above, you have the potential for a large patient list throughout the shift. Based on the overall volume of the ER on the day working, you may have five patients to chart or 25.

How Long Does It Take To Become An Emergency Nurse Practitioner?

Exactly how long does it take to become an emergency nurse practitioner? The answer--approximately 6-8 years.

First, you must complete your bachelor of science in nursing (BSN)—which you can complete in a few different ways. You can complete a traditional 4-year degree or get your associate's degree in nursing (ADN) and then complete an RN-BSN program.

After completing your BSN, I strongly encourage a minimum of one to two years of experience. This experience is optional for most programs, but the knowledge gained will be invaluable to your NP career.

Once you have your BSN, you can apply to graduate school. To become an NP, you must complete an advanced practice nurse practitioner (APRN) degree in an accredited program. And there are two pathways to take. First, you can complete your master's of science in nursing (MSN) or a doctorate of nursing practice (DNP). The MSN path will take 2-3 years to complete, and the DNP degree will take 3-4 years.

How Much Does It Cost To Become An Emergency Nurse Practitioner?

The cost of becoming an emergency nurse practitioner is dependent upon multiple factors, including the school(s) attended, degrees completed, and the overall path chosen.

First, you must complete your BSN to apply to graduate school—and the average cost of getting your BSN ranges from $40,000 to $200,000. The price is impacted by certain factors such as the school you attend, the status you attend, and if you pursue your BSN first or complete your ADN and then go on to get your BSN.

Once you have your BSN, you must graduate from a graduate program to become an emergency nurse practitioner-- you may complete your MSN or DNP. The average cost of an MSN program is $81,810 to $185,280 and a DNP program will average between $46,490 to $254,260. The same factors influence the cost of graduate school as the BSN degree.

It is important to remember that you can always get your MSN degree first and complete your DNP at a later time.

Lastly, when considering the cost of becoming an emergency NP, there are other costs. These expenses include board prep courses/resources, sitting for the board exam, and licensing fees.

What Is The Step-By-Step Process Of Becoming An Emergency Nurse Practitioner?

Below is the step-by-step process of becoming an emergency nurse practitioner.

1. Graduate from a BSN program:

First, you must graduate from an accredited BSN program. It does not matter the path you take to complete the degree; it is just needed before applying to graduate school.

2. Pass NCLEX and obtain RN License:

Once you graduate with your BSN, you must pass the NCLEX exam and get your RN license before you can practice as a nurse.

3. Gain ER experience:

This step is not required, but I strongly encourage a minimum of two years of emergency department experience as an RN before applying to an accredited graduate program. The knowledge you gain as a nurse will be invaluable to you in your practice as an emergency NP.

4. Apply to an accredited NP program:

Once you have decided to pursue graduate school, you need to apply to an accredited graduate school/NP program. If you want to become an emergency nurse practitioner, it is typically recommended you pursue an acute care (adult or pediatric) program or family nurse practitioner (FNP) program.

5. Attend and graduate from the NP program:

Once accepted, you must attend and graduate from an accredited program.

6. Pass state board exam and obtain NP license:

Once you graduate, you can apply to take the state board exam in the specialty pursued while in NP school. You must pass the board certification exam before practicing as an NP.

7. Attend a fellowship program (if desired):

It is strongly encouraged that if you are a new graduate NP wishing to work in emergency medicine to complete an emergency fellowship program. However, some ERs will allow you to start in their department right out of school.

8. Apply to emergency nurse practitioner jobs:

This step can start before graduation—which is applying to emergency NP jobs.

9. Accept the job:

Accept the job and enjoy your new career!

10. If desired, complete your DNP:

This step is not required, but if you wish to complete a terminal degree, it may be an excellent option. Also, if you want to teach, you will need a terminal degree such as a DNP.

Top Emergency Nurse Practitioner Programs

There are no specific emergency nurse practitioner programs—but there are fellowship/residency programs that I will discuss below.

If you desire to become an emergency NP, it is strongly encouraged you pursue an acute care NP degree. However, please note that some ERs will hire an NP who is board certified in family practice—especially if they have experience as an ER nurse.

Recommended Certifications To Enhance Your Job Role As An Emergency NP

Certifications are a way for NPS to demonstrate competency in their specialty. Below, I will discuss two certifications specific to emergency nurse practitioners.

Emergency Nurse Practitioner (ENP):

The ENP is geared towards family practice NPs with knowledge and experience in emergency medicine. The ENP supports the FNP's expertise by demonstrating their competence in the delivery of emergency medicine. This exam is through the American Academy of Nurse Practitioners.

Certified Emergency Nurse (CEN):

The CEN is a certification for emergency nurses that includes nurse practitioners. Obtaining this certification demonstrates competency and a passion for emergency medicine. The exam is through the Board of Certification of Emergency Nursing—and this organization also provides specific certifications for super-specialized emergency nurses, including pediatric emergency nursing, flight nursing, and transport nursing.

List Of Fellowships And Residency Programs For Emergency Nurse Practitioners

Emergency nurse practitioners have numerous fellowship/residency programs to choose from. This provides an excellent opportunity for emergency NPs to develop their skills further and solidify their knowledge before starting their career. Below, I will provide information on two of these programs.

Mayo Clinic College of Medicine and Science:

The Mayo Clinic College of Medicine and Science offers an 18-month postgraduate fellowship for NPs or physician assistants (PAs) at their campus in Rochester, MN. This program will better prepare NPs and PAs for a career in emergency medicine through furthering knowledge and skill development. Completing this program demonstrates competency and passion for emergency medicine—making the NP or PA more marketable.

New York-Presbyterian Hospital - Weill Cornell Medical Center (NYPH-WCMC):

The New York Presbyterian Hospital-Weill Cornell Medical Center offers a 15-month post-graduate residency program in emergency medicine for nurse practitioners. This program consists of didactic and clinical hours, preparing the NP to deliver high-quality emergency medicine to their patients.

Continuing Education Requirements For Emergency Nurse Practitioners

Continuing education units (CEUs) are a must continue to practice as an NP. For an emergency NP, you will have to complete CEUs for your RN license, NP license, and any certifications you hold.

The state where you hold your RN and NP license determines the CEU requirements needed to maintain licensure. In most states, your RN license is renewed every two years and your NP license every five years—and you will have to complete a specified number and type of CEUs for each license determined by your state of practice. It is not uncommon to have to complete a specific number of pharmacology and opioid prescribing CEUs for your NP license. For more detailed information regarding CEU requirements for your NP and RN license, visit your state board of nursing.

You will also have to complete a specified number of CEUs for any certifications you may hold. For example, if you are a certified emergency nurse practitioner (ENP), there are specifics regarding CEU requirements for re-certification--visit the American Academy of Nurse Practitioners for more information.

What Is The Starting Salary Of An Emergency Nurse Practitioner?

The starting emergency nurse practitioner salary is $76,930 a year. The emergency NP's starting salary is impacted by multiple factors, including their state and whether they work in a rural or urban community. The size of the ER, status worked, and years of experience as a nurse will also impact their starting wage.

Per Hour$36.99
Per Month$6,410
Per Year$76,930

What Is The Average Salary Of An Emergency Nurse Practitioner?

What is the average salary of an emergency nurse practitioner? The average emergency nurse practitioner salary is $114,266. This number is influenced by multiple factors, including where you live, the size of the emergency department, and if you work full-time or part-time. Years of experience as an emergency nurse, nurse practitioner, and emergency NP will also influence your salary.

Per Hour$54.94
Per Month$9,520
Per Year$114,266
(Source: Ziprecruiter.Com)

What Is The Average Salary Of An Emergency Nurse Practitioner In Your State?

Now that I have talked about the average starting and average salary of an emergency nurse practitioner. You may be wondering what is the average wage in my state of practice. Below, you will find each state's average salary for an emergency NP.

State Average Salary
Hourly Monthly Annual
Alabama $47.66 $8,260 $99,140
Alaska $52.97 $9,180 $110,180
Arizona $55.81 $9,670 $116,080
Arkansas $49.84 $8,640 $103,660
California $70.66 $12,250 $146,980
Colorado $52.39 $9,080 $108,980
Connecticut $56.06 $9,720 $116,600
Delaware $54.09 $9,380 $112,510
Florida $48.79 $8,460 $101,480
Georgia $50.99 $8,840 $106,060
Hawaii $59.33 $10,280 $123,410
Idaho $49.00 $8,490 $101,920
Illinois $56.07 $9,720 $116,620
Indiana $52.82 $9,160 $109,860
Iowa $56.49 $9,790 $117,490
Kansas $50.59 $8,770 $105,230
Kentucky $49.37 $8,560 $102,690
Louisiana $52.43 $9,090 $109,050
Maine $54.16 $9,390 $112,650
Maryland $53.85 $9,330 $112,000
Massachusetts $60.29 $10,450 $125,400
Michigan $50.62 $8,770 $105,290
Minnesota $59.11 $10,250 $122,950
Mississippi $52.01 $9,020 $108,180
Missouri $48.16 $8,350 $100,180
Montana $53.85 $9,330 $112,010
Nebraska $52.44 $9,090 $109,070
Nevada $57.56 $9,980 $119,730
New Hampshire $56.19 $9,740 $116,870
New Jersey $63.76 $11,050 $132,630
New Mexico $55.14 $9,560 $114,690
New York $62.34 $10,810 $129,660
North Carolina $52.47 $9,090 $109,130
North Dakota $52.46 $9,090 $109,120
Ohio $52.35 $9,070 $108,890
Oklahoma $54.29 $9,410 $112,920
Oregon $59.66 $10,340 $124,090
Pennsylvania $54.57 $9,460 $113,510
Rhode Island $59.00 $10,230 $122,710
South Carolina $47.87 $8,300 $99,560
South Dakota $52.27 $9,060 $108,730
Tennessee $44.27 $7,670 $92,080
Texas $54.87 $9,510 $114,120
Utah $52.55 $9,110 $109,310
Vermont $52.38 $9,080 $108,940
Virginia $52.27 $9,060 $108,730
Washington $60.89 $10,560 $126,660
West Virginia $48.75 $8,450 $101,400
Wisconsin $54.45 $9,440 $113,250
Wyoming $53.30 $9,240 $110,870

Job Outlook For Emergency Nurse Practitioners

The job outlook for emergency nurse practitioners is very promising. First, the U.S. Bureau of Labor Statistics (BLS) predicts a 45% job growth between 2020-2030 for nurse practitioners, nurse midwives, and certified registered nurse anesthetists. This rate of job growth is significantly greater than a lot of occupations.

Specific to ERs, the number of patients seeking care in the emergency department has increased. This may be due to Covid-19 or the aging population--regardless of the cause, more people seek care in the ER. Therefore, the demand for nurse practitioners is excellent. Emergency nurse practitioners can work directly alongside the ER physician in treating patients of all ages and problems, helping meet the population's needs.

Useful Organizations And Associations

Organizations are an excellent resource for nurse practitioners. Below I will provide information and links to two organizations specific to emergency NPs.

Emergency Nurses Association:

The Emergency Nurses Association (ENA) is an excellent organization for emergency nurses. It provides education and network opportunities, access to publications, and practice resources. It is a great organization to join if you are an emergency nurse or nurse practitioner to demonstrate competence and passion for emergency nursing further.

American Academy of Emergency Nurse Practitioners:

The American Academy of Nurse Practitioners is an organization directed toward emergency NPs. They provide educational opportunities and CEUs, access to publications, and research and networking opportunities.

Finally, Is Emergency Nursing The Right NP Specialty For You?

I hope the information above answered the question, how to become an emergency nurse practitioner? Emergency NPs are needed and play an essential role in meeting the healthcare needs of their community. Above, I discussed information regarding the steps to becoming an emergency nurse practitioner, the pros and cons of becoming an emergency NP and their salary.

Kasee Wiesen DNP, APRN, FNP-C
Kasee Wiesen is a practicing family nurse practitioner. Her nursing background includes emergency medicine, pediatrics and peri-op. Education is a passion of Kasee’s, and she has taught BSN, RN-BSN and DNP students, and has enjoyed every moment of it!