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newborn. Nurses working on a psychiatric unit mustknow psychiatric assessment and interventions, includ-

ing appropriate medications. In order to work effec-tively in the emergency department, the nurse needs toknow all of the above and much more. In a typical day(if there is such a thing!) the emergency nurse may welltreat patients with everything from severe respiratorydistress, to chest pain, overdose incidences, seizures,pulmonary edema, and countless other scenarios. Asimilar list could be created for the nurse working in

the surgical areaof the EmergencyDepartment,including: fractures,lacerations, trau-

matic injuries, orectopic pregnancies.You never knowwhat your patientssituation will be,yet you need toprovide the bestpossible nursingcare no matter what.

Emergencynursing is, bynature, sporadicand unpredictable.

Unplanned situa-tions and undiag-nosed healthproblems require

prompt and accurate assessment and interventions.Motor vehicle crashes, heart attacks, strokes, falls, andhundreds of other emergency situations can happen toanyone. The sporadic nature of emergency care, how-ever, contributes to what I believe is one of its greatestdisadvantagesthere is usually no opportunity tofollow the patients progress. As one of my colleaguesdescribed it recently, its like reading half a book orseeing half a movie. Emergency patients range in age

from minutes old to over 100 years

features

Is emergency nursing really like the television pro-

gram ER? I am frequently asked. My answer is

yes and no. Yes, in that it is unpredictable, dramatic,

challenging, and requires a team effort. Emergency

nursing is notliketelevision in thatthe numerous life-threatening and

dramatic events por-trayed do not occurin rapid successionin a neat, one-hourtime frame. In addi-tion, the role of theemergency nurse inproviding patientcare is much moresignificant than isevident in the madefor TV script.

As appealing as

emergency nursingis for some of us,it is clearly not foreveryone. The advantages are many. As an emergencynurse, I face a variety of challenges every day, whichmakes the work exciting. I feel privileged to helpothers during what is often the most difficult time oftheir lives. Emergency nurses are elegant generalists;that is, they must know a great deal about virtually allaspects of nursing. For example, nurses who work ina coronary care unit (CCU) must have a good knowl-edge base about cardiac disease. Nurses working in amaternal-newborn setting must be proficient in laborand delivery, pregnancy complications, and care of the

EMERGENCY

NURSING

23NSNA/Imprint

By Anne Manton

Emergency nurses are elegant generaliststhey must

know a great deal about virtually all aspects of nursing

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25NSNA/Imprint

There are many opportunities fornurses with an interest in emergencycare outside the EmergencyDepartment setting, such as flightnursing and ground transport orprehospital care. Nurse educator,nurse manager, emergency nurse

practitioner, psychiatric-mentalhealth nurse practitioner, and pre-hospital care coordinator are otherpossible choices within the hospitalsetting. Some hospitals are develop-ing roles for nurses in disaster plan-ning and management, mass casualtyplanning, and bioterrorism. Forensicsand sexual assault nurse examiners(SANE) are other areas of interest,as are injury prevention educationand community outreach roles.

As with most specialty areas of

nursing, there are numerous positionsavailable in emergency departmentsacross the U.S., and predictions arethat the need is likely to continuefor years to come. As the health caresystem and technology advance,there will always be a need for emer-gency care and emergency nurses.Emergency nurses are heroes andheroines who make a positive differ-ence in peoples lives every day!

4. Criticalthinking andsharp decision-making are essen-tial in emergencynursing, as inother nursing spe-

cialties. The dif-ference in emer-gency nursing isthat the patientsillness or injurystate is frequently

undiagnosed. This presents anadditional challenge in the care ofemergency patients.

5. Good communication skillsare imperative. Emergency patientsand their families are often in acrisis situation, and the emergencynurse must have the ability to com-fort, educate, and listen to patientsand families in a caring, nonjudg-mental manner. Other importantattributes for success in the emer-gency nursing role are compassion,humor, good organizational skills,and being a team player.

Employers often expect emergencynurses to have completed coursessuch as Advanced Cardiac LifeSupport (ACLS), Trauma Nursing

Core Course (TNCC), EmergencyNurses Pediatric Course (ENPC),as well as certification in emergencynursing (CEN). In some cases,this education should have beencompleted prior to working in thedepartment, while in other cases thecourses can be completed over time.

I am frequently asked whethernew graduates can and should behired to work in the EmergencyDepartment. As a general rule, Iadvise new graduates to gain experi-

ence in the medical/surgical settingfirst, to give them some solid experi-ence. However, this is not necessarilythe case for everyone. If the newgraduate has worked previously inthe emergency setting, as an emer-gency medical technician (EMT), oras a paramedic, they may be betterprepared to jump into emergencynursing sooner. If the employeroffers an extensive preceptor experi-ence for the new graduate, this canalso prove quite successful.

old. Socioeconomic status variesfrom the richest to the poorest insociety. While most patients arecooperative and grateful for theircare, it is not unusual to experienceangry and even combative behaviors.It is important that the emergency

nurse be prepared for this vastvariety of scenarios.

How does one prepare for acareer in emergency care?

Consider the following factors:

1. First, know yourself. Can youthink on your feet and prioritizequickly? Do you have the flexibilityto continually restructure your day,sometime by the minute? Thenemergency nursing might be a good

career choice for you. On the otherhand, if you dislike multitasking, areuneasy in a high pressure environ-ment, or if you prefer to focus on afew patients for the entire shift, thenemergency nursing is probably NOTfor you.

2. An emergency nurse musthave good assessment skills, both inobtaining a health history as well asin physical assessment. In additionto recognizing abnormal findings,emergency nurses must be able to

understand the significance of thosedeviations from the norm in order todetermine urgency levels.

3. Emergency nurses need astrong knowledge base in every areaof nursing, from pathophysiology topsychology, pharmacology, policiesand procedures, and everything inbetween. But it is also important toknow your limitations, and how andwhen to use resources appropriately.

www.ENA.orgweb site of the Emergency NursesAssociation

www.elsevier.nl/locate/jenThe Journal of Emergency Nursing

Official publication of the Emergency

Nurses Association. Published sixtimes per year, it includes clinical

articles, research articles, governmentupdates, and more.

r e s o u r c e s

Anne Manton,PhD, RN, FAAN,

is an associateprofessor at Fairfield

University, Fairfield,CT, and past

president of theEmergency Nurses

Association (ENA) and the Board ofCertification in Emergency Nursing.

She can be contacted at:

amanton@mail. fairfield.edu.

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