Key Responsibilities and Required Skills for ER Nurse

🎯 Role Definition

An ER Nurse (Emergency Room Nurse) provides rapid, high-quality clinical care to patients presenting with urgent, emergent, and life-threatening conditions in the Emergency Department (ED). The role requires expert patient assessment, triage, critical thinking, advanced life support skills, effective interdisciplinary communication, and precise documentation in electronic health records (EHR/EMR). ER Nurses must manage high-acuity caseloads, stabilize critically ill patients, participate in resuscitations and trauma responses, administer medications and procedures, and ensure safe patient flow from triage through disposition (admit, transfer, or discharge).

Key SEO keywords: ER Nurse, Emergency Room Nurse, Emergency Department (ED) Nurse, triage nurse, trauma nurse, ACLS, PALS, ED nursing, emergency medicine nursing, critical care nursing.

📈 Career Progression

Typical Career Path

Entry Point From:

New graduate RN transitioning into an ED residency or orientation program
Medical-surgical (Med-Surg) nurse seeking emergency care experience
Critical Care/Telemetry nurse moving into emergency medicine

Advancement To:

Charge Nurse, Emergency Department
Clinical Nurse Specialist (Emergency or Trauma)
Nurse Manager or Director, Emergency Services
Nurse Practitioner (Emergency Medicine) or Physician Assistant in ED
Trauma Program Coordinator or Flight/Transport Nurse

Lateral Moves:

Urgent Care Nurse
Intensive Care Unit (ICU) Nurse
Telemetry/Step-down Nurse

Core Responsibilities

Primary Functions

Rapidly perform focused and full patient assessments upon arrival, synthesize history and exam findings, and prioritize care using triage principles (e.g., ESI triage, rapid primary survey) to determine acuity and immediate needs.
Initiate and maintain advanced cardiac life support (ACLS) protocols during codes, perform CPR, manage airway interventions, administer emergency medications, and coordinate with code team members to achieve timely resuscitation outcomes.
Provide pediatric resuscitation and stabilization following Pediatric Advanced Life Support (PALS) and Emergency Nursing Pediatric Course (ENPC) guidelines; triage and treat a wide range of pediatric emergencies.
Manage trauma activations according to trauma protocols, complete primary and secondary surveys, apply hemorrhage control, immobilize fractures/spines, assist with emergent imaging, and coordinate rapid transfer to operating rooms or trauma services.
Establish and maintain IV access including peripheral IV placement, secure peripheral and midline catheters, administer IV fluids, IV push and infusion medications, and assist with central line care under protocol.
Administer, titrate, and document high-risk and emergent medications (e.g., vasopressors, analgesics, sedatives, antidotes) safely, calculating weights and dosages for adults and pediatrics and monitoring for adverse effects.
Perform and interpret point-of-care testing and monitoring (e.g., glucometry, bedside urinalysis, rapid antigen tests) and use cardiac monitoring/telemetry to recognize rhythm changes and intervene promptly.
Provide respiratory support including oxygen therapy, nebulized treatments, CPAP/BiPAP initiation, and coordination with respiratory therapists for intubation and ventilator management when required.
Act as primary bedside nurse during emergent procedures (e.g., chest tube insertion, lumbar puncture, paracentesis), prepare sterile supplies, assist the physician, and ensure patient safety and comfort throughout the procedure.
Conduct thorough documentation in the EHR/EMR (e.g., Epic, Cerner) including triage notes, reassessment findings, medication administration records, procedure notes, and legal/quality-required data to maintain compliance and continuity of care.
Evaluate, triage, and treat behavioral health and substance-use-related emergencies with de-escalation techniques, safety planning, and appropriate security and psychiatric consultation or transfer procedures.
Coordinate patient care and disposition with multidisciplinary teams including emergency physicians, consultants, radiology, laboratory, social work, case management, and transport services to expedite diagnostic workups and admissions.
Monitor ED patient flow and throughput metrics, identify bottlenecks, and implement bedside interventions to reduce length of stay, ensure safe dispositions, and prioritize critical patients.
Perform wound care including irrigation, debridement, suturing assistance, and complex dressing applications; educate patients and caregivers on wound instructions and infection prevention.
Recognize and initiate sepsis protocols (e.g., sepsis bundle), obtain rapid labs, start broad-spectrum antibiotics and fluid resuscitation as indicated, and communicate findings to the medical team.
Provide evidence-based patient and family education on diagnoses, medications, follow-up instructions, and red flags; complete discharge teaching with documentation and arrange outpatient care or community resources.
Participate in rapid response and disaster preparedness activities, assist with mass-casualty triage when needed, and support surge management plans while maintaining situational awareness.
Lead or participate in bedside handoffs and shift-to-shift communication using structured tools (e.g., SBAR) to ensure continuity of care and reduce errors during transitions.
Perform nursing quality improvement activities including adverse event reporting, root cause analysis participation, and implementation of practice changes to improve ED patient safety and outcomes.
Supervise and mentor nursing students, new graduate nurses, and clinical staff; provide on-the-floor education and competency assessments (e.g., cardiac monitor, medication administration, triage decisions).
Maintain and verify competency in emergency nursing certifications and procedures (e.g., ACLS, BLS, PALS, TNCC, ENPC), attend mandatory skills days, and document continuing education to meet regulatory and organizational standards.
Manage complex pain and symptom control in the ED setting, using multimodal analgesia and non-pharmacologic interventions while monitoring for opioid stewardship and safety.
Ensure accurate collection and labeling of specimens for laboratory and blood bank, coordinate urgent diagnostics (e.g., CT, X-ray, ultrasound), and facilitate stat result communication to the clinical team.
Respond to patient safety concerns and escalate issues appropriately, including suspected abuse, elder neglect, or public health reportable conditions, following institutional protocols.
Adhere to infection control standards, isolation precautions, and PPE guidelines; implement rapid isolation for suspected airborne, droplet, or contact-transmissible conditions to protect patients and staff.
Assist with patient transfers and interfacility coordination including arranging transport, completing transfer documentation, and providing verbal handoffs to receiving clinicians to ensure continuity of care.

Secondary Functions

Participate in department-driven performance improvement projects to reduce wait times, decrease readmissions, and improve patient satisfaction and ED throughput metrics.
Serve on multidisciplinary committees (e.g., sepsis committee, trauma PI, ED quality council) and contribute frontline insights to protocol development and policy updates.
Maintain inventory control for emergency supplies, crash carts, medications, and procedural kits; perform daily equipment checks and report deficits for restocking.
Provide community and patient education outreach activities including public health initiatives (e.g., overdose prevention, seasonal illness education) and contribute to staff training modules.
Document and track clinical indicators and operational metrics for regulatory reporting and support data collection for departmental analytics.
Assist with orientation and competency sign-off for new hires, act as preceptor or clinical coach, and provide structured feedback and evaluations to nurture clinical growth.
Support telemedicine triage or virtual ED initiatives as directed, providing remote assessment and disposition guidance when organizational resources require telehealth integration.
Participate in mock codes, trauma simulations, and emergency drills to maintain readiness for high-acuity events and to improve interprofessional communication and response times.

Required Skills & Competencies

Hard Skills (Technical)

Emergency triage and acuity scoring (e.g., Emergency Severity Index - ESI) for rapid patient prioritization.
Advanced Cardiac Life Support (ACLS) certification and demonstrated experience leading or participating in adult code responses.
Pediatric Advanced Life Support (PALS) and Emergency Nursing Pediatric Course (ENPC) skills for pediatric emergency care and resuscitation.
Proficiency in IV therapy, peripheral IV insertion, midline/catheters support, and central line assistance and maintenance.
Medication administration in emergency settings including IV push, weight-based dosing, rapid titration, and controlled substances handling.
Wound management skills: suturing assistance, wound irrigation, dressing application, and minor procedures in the ED.
Airway management and respiratory support: oxygen therapy, nebulizers, CPAP/BiPAP initiation, and coordination for intubation/ventilator support.
Trauma nursing skills and familiarity with trauma activation protocols and immobilization techniques.
Competence with EHR/EMR systems (e.g., Epic, Cerner, Meditech) for documentation, order entry, and clinical communication.
Point-of-care testing and cardiac monitoring interpretation, including recognition of acute arrhythmias, ST-elevation changes, and ischemic patterns.
Sepsis recognition and initiation of sepsis bundles including timely labs, fluid resuscitation, and antibiotics.
Infection control practices and PPE use, including isolation procedures for airborne, droplet, and contact precautions.
Basic Life Support (BLS) certification and proven CPR skills across patient populations.
Familiarity with emergency department throughput metrics, patient flow management, and disposition planning.
Experience with behavioral health crisis management, de-escalation techniques, and security coordination for agitated or violent patients.

Soft Skills

Exceptional clinical judgment and rapid decision-making under pressure in high-acuity environments.
Excellent verbal and written communication skills for clear interdisciplinary handoffs and patient/family education.
Strong teamwork and collaboration with physicians, advanced practice providers, therapists, techs, and ancillary services.
High emotional resilience, stress tolerance, and ability to prioritize tasks in a fast-paced, unpredictable environment.
Empathy and patient-centered bedside manner while maintaining professional boundaries during crises.
Leadership and accountability in guiding code teams, mentoring peers, and coordinating care during peak times.
Time management and organizational skills to manage multiple simultaneous patients and competing priorities.
Cultural sensitivity and ability to work with diverse patient populations and families with varied health literacy.
Conflict resolution and negotiation skills for managing family concerns, resource limitations, and interdepartmental tensions.
Continuous learner mindset with commitment to maintaining current certifications and adopting evidence-based practices.

Education & Experience

Educational Background

Minimum Education:

Current, unrestricted Registered Nurse (RN) license in the state of practice (or compact RN license where applicable).
Associate Degree in Nursing (ADN) or Diploma in Nursing.

Preferred Education:

Bachelor of Science in Nursing (BSN) preferred for many facilities and leadership/advanced practice pathways.
Certifications such as Trauma Nursing Core Course (TNCC), Emergency Nursing Pediatric Course (ENPC), or Certified Emergency Nurse (CEN) are highly desirable.

Relevant Fields of Study:

Nursing (ADN, BSN)
Emergency Nursing
Critical Care Nursing
Trauma Nursing

Experience Requirements

Typical Experience Range:

1–5 years of professional nursing experience; many hospitals prefer 1–3 years of acute care (ED, ICU, telemetry) experience for new ED hires.

Preferred:

2+ years of Emergency Department (ED) or critical care experience.
Demonstrated experience in high-volume, high-acuity emergency settings, trauma centers, or similar acute care environments.
Prior experience with EHR systems, resuscitation team participation, and documented competencies in emergency procedures.

Certifications often required or strongly recommended: BLS, ACLS, PALS, TNCC or ENPC, and optionally CEN.