“Good personal coping skills are paramount to being able to function,” Proehl stresses, “because we see really terrible things in the ED.” Remaining calm in a chaotic environment is also critical to being an effective EN, she adds. However, the ED isn’t always a fast-paced environment, so the EN must be able to adjust to varying degrees of activity and intensity. Proehl explains, “You may go from delivering a baby in the parking lot to teaching a parent how to administer an antibiotic to a child.”

Although it’s more important that nurses’ personal attributes lend themselves to the ED, some types of previous nursing experience can be helpful in evaluating a nurse’s readiness for the ED – critical care, med/surg, and labor and delivery, for example. Critical care nurses have the skills for caring for extremely ill patients; med/surg nurses care for many patients and prioritize their needs simultaneously; and labor and delivery nurses have the mindset that can switch gears from a slow to a fast pace.

Getting Started

Because few basic nursing schools have courses or clinical rotations in emergency nursing, Proehl advises that new graduate nurses get other nursing experiences before trying to work in an ED. These experiences will help the new nurse become more assertive, comfortable, and grounded in the role of being a nurse. Those who have had previous nursing experiences can take the ENA course “Orientation to Emergency Nursing,” a modular program that includes didactic instruction and pairing with a clinical mentor. The program is usually purchased by institutions so that more than one nurse can be trained at a time. Proehl emphasizes that nurses seeking ED positions should look for a structured experience program (preferably several months long with a consistent preceptor) to become acclimated to the requirements and environment of emergency nursing. Nurses who are undecided about the field can observe ENs by working as a clinical volunteer in the ED.

Make a Contribution

According to Proehl, one of the classic misconceptions about emergency nursing is that it’s all “blood and guts.” In reality, only about 10% of patients in the ED require life-saving skills. As patients who would have previously been admitted directly to the hospital are sent home, ENs must increasingly use their teaching skills in a time-challenged environment. For example, patients with a diagnosis of deep vein thrombosis are being taught to inject their own low-molecular-weight heparin. If the hospital does not have a Sexual Assault Nurse Examiner, ENs often provide all of the medication information, arrange counseling and follow-up, and ensure that the legal requirements of evidence collection are met – all while giving the victim emotional support.

Through all of her different roles in the ED, Proehl has always known who she is and what she wants to do. She says, “Emergency nursing is hard work at a fast pace. We see lots of variety in age and diagnosis, seeing different patients every day and every hour. It’s rewarding to make a lifesaving contribution to a patient’s care, but nurses who work in this field cannot look to their patients for reward. You have to be satisfied with your own performance.”

For more information on emergency nursing, visit the ENA’s website at www.ena.org, call (800) 2GET-ENA, or write ENA, 915 Lee St., Des Plaines, IL 60016. ENA offers information on membership, local chapters, and educational offerings.

*“ER” does not accurately reflect the current terminology used in emergency nursing. Because ERs encompass much more than a room, the term emergency department (ED) is preferred. Nurses in the ED are now referred to as emergency nurses (ENs) or ED nurses.