Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients with medical emergencies, that is, those who require prompt medical attention to avoid long-term disability or death. Emergency nurses are most frequently employed in hospital emergency departments (EDs), although they may also work in urgent care centers, sports arenas, and on medical transport helicopters and ambulances.
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ED nurse role
In addition to addressing these "true emergencies," emergency nurses increasingly care for people who are unwilling or unable to get primary medical care elsewhere and come to emergency departments for help.
Besides heart attacks, strokes, gunshot wounds and car accidents, emergency nurses also tend to patients with acute alcohol and/or drug intoxication, psychiatric and behavioral problems and those who have been raped.
They must be adept at working with patients of many different backgrounds, cultures, religions, ages and types of disabilities. Emergency nurses must also have a good working knowledge of the many legal issues impacting health care such as consent, handling of evidence, mandatory reporting of child and elder abuse and involuntary psychiatric holds.
In their role as patient educators, they must have a thorough knowledge of anatomy, physiology, pharmacology and psychology and be able to communicate effectively with patients and their families.
An emergency nurse is typically assigned to triage patients as they arrive in the emergency department and as such are the first professional patients see. Therefore, the emergency nurse must be skilled at rapid, accurate physical examination, early recognition of life-threatening conditions. In some cases, emergency nurses may order certain tests and medications following "collaborative practice guidelines" or "standing orders" set out by the hospital's emergency physician staff.
CEN®
The Certified Emergency Nurse (CEN)® designation is granted to a registered nurse who has demonstrated expertise in emergency nursing by passing a computer-administered examination given by the Board of Certification for Emergency Nursing (BCEN). The certification exam first became available in July 1980, was accredited by ABSNC in February 2002, and was reaccredited in 2007 and 2012. The certification is valid for four years, and can be renewed either by passing another examination, by completing 100 continuing education units (CEUs) in the specialty, or by completing an online 150 question "open book exam."
As of 2015, the BCEN has designated over 30,500 active CENs in the United States and Canada. The CEN exam has 175 questions; 150 are used for testing purposes (25 are sample questions). The passing score is 70% and the candidate has three hours to take the exam. The test is administered internationally in Pearson Vue testing centers.
CPEN®
The Certified Pediatric Emergency Nurse (CPEN)® designation is applied to a registered nurse who has demonstrated expertise in pediatric emergency nursing by passing a computer-administered examination given jointly by the Board of Certification for Emergency Nursing (BCEN) and the Pediatric Nursing Certification Board (PNCB). The certification exam first became available on January 21, 2009, and was accredited by ABSNC in May 2015. The certification is valid for four years, and can be renewed either by passing another examination, by completing 100 contact hours (continuing education) in the specialty, or by completing 1,000 clinical practice hours and 40 contact hours in the specialty. The CPEN exam has 175 questions; 25 are unscored sample questions.
As of 2015, the BCEN and the PNCB have designated over 3,900 active CPENs. The CPEN exam has 175 questions; 150 are used for testing purposes (25 are sample questions). The passing score is 87% and the candidate has three hours to take the exam. The test is administered in AMP testing centers internationally.
In the United Kingdom
A specialist nurse will independently assess, diagnose, investigate, and treat a wide range of common accidents and injuries working autonomously without reference to medical staff. They primarily treat a wide range of musculoskeletal problems, skin problems and minor illnesses. They are trained in advanced nursing skills. Under the National Health Service grading system, ENPs are typically graded Band 6 or 7.
Additionally, some specialized nurses perform as [emergency care practitioner]s. They generally work in the pre-hospital setting dealing with a wide range of medical or emergency problems. Their primary function is to assess, diagnose and treat a patient in the home in an emergency setting.
In the United States
An advanced practice nurse assesses, diagnoses, and treats a variety of common illnesses, injuries and disease processes in emergency care settings. ENPs are trained in advanced nursing and medical skills such as x-ray interpretation, ophthalmic slit lamp examination, suturing, local and regional anesthesia, abscess incision and drainage, advanced airway techniques, fracture reduction, and casting and splinting.
In Australia
Australian nurse practitioners follow the clinical practice guidelines developed by the Victorian Emergency Nurse Practitioner Collaborative (VENPC), who have supported nurse practitioner development in Victoria. This includes attending to minor head injuries, burns, open wounds, joint pain (Haemophilia), blood and fluid exposure, PV bleeding, suspected UTI, abdominal pain, cellulitis and more.
Challenges of emergency nursing
Emergency nursing is a demanding job and can be unpredictable. Emergency nurses need to have basic knowledge of most specialty areas, to be able to work under pressure, communicate effectively with many types of patients, collaborate with a variety of health care providers and prioritize the tasks that must be performed.
It can be quite draining both physically and mentally for many nurses. Australian emergency department treat over 7 million patients each year. They spend much of their time on their feet and ready for unexpected changes in patients' conditions as well as sudden influxes of patients to the emergency department. ED (emergency department) nurses may be exposed to traumatic situations such as heavy bleeding, dismemberment and even death.
Violence is a growing challenge for many nurses in the ED. Emergency nurses too often receive both physical and verbal abuse from patients and visitors.
Emergency nurses in Africa
Emergency nurses work in various places, many of which are understaffed as there are nursing shortages across Africa. There is also a shortage of doctors, leaving many tasks for nurses with limited guidelines or standards to deal with, and for many emergency nurses the scope of practice is quite undefined. Nurses may be forced to work outside their scope causing frustration and increasing the opportunities for occupational health hazards. It can be speculated that triage protocols are either lacking or not being followed. The limited basic knowledge and skill of emergency nursing included in undergraduate nurse training programs, and the limited number of nurse trainers, provide difficulty for many pending nurses to acquire the skills needed to work in emergency settings.
The history of emergency nursing
Around the 1800s hospitals became more popular and there was a growth in emergency care. The first development of an emergency room was originally called "The First Aid Room". Originally, nurses only dressed wounds, applied eye ointments, treated minor burns with salves and bandages, and attended patients with minor illnesses like colds and sore throats. The rule of thumb was first in, first served, but there were many cases where some people were in more need of emergency care than others and as the situation became more intolerable, one of the greatest medical developments came into perspective: triage.
For centuries triage had been used in war but was not yet established in the emergency department. The first time triage was referred to during a non-disaster issue was at Yale, Newhaven Hospital, United States, in 1963, and since then has become developed and more defined.