Do you dream of a nursing position that offers constant variety, instead of treating the same types of patients and medical conditions day in and day out? Do you long for a work environment where physicians regard you as a key player on the team, rather than making you feel subservient? Have you always wanted to work in a field where the patients come from so many different walks of life that a racially, ethnically and culturally diverse nursing staff is nothing short of an absolute necessity?
A career in emergency nursing offers you all this and much more.
“I enjoy the variety,” enthuses Julie Moses, RN, a native of Trinidad who is a clinical resource nurse in the emergency department at Washington Hospital Center in Washington, D.C. “Any medical problem can turn up in the emergency room. You get to do so many different types of nursing—from med/surg, OB and orthopedic to cardiac care and ICU. You see it all, from birth to dying, and everything in between. I just love it!”
Thelma Kuska, BSN, RN, a Filipino-American CEN (Certified Emergency Nurse) who worked for 20 years in the ER at Christ Hospital in Oak Lawn, Ill., believes emergency nursing is an ideal career for minority nurses because it is so empowering. “I’ve worked in other areas, such as surgery and pediatrics,” she says, “but the ER is the most rewarding, because the doctors treat you as a colleague. They value your input. If you say, ‘I need you here in this room, NOW,’ they run. And they show you everything—they’ll say, ‘Come look at the x-ray!’ instead of treating you like someone who’s just there to follow orders.”
Because life-threatening emergencies cut across all categories of age, gender, race, ethnicity and socioeconomic status, emergency nursing is virtually synonymous with diversity. And because the nurse is usually the first person that patients encounter when they are brought into the ER, minority nurses can play a unique and highly visible role in providing culturally sensitive emergency care.
“We’re really right there on the front lines,” notes Cherrlyn Jones, MSN, RN, an African-American clinical resource nurse at Howard University Hospital in Washington, D.C., and president of the Metropolitan Washington Chapter of the Emergency Nurses Association (ENA). “The way the patients see us shapes the way they will view the rest of their treatment.”
“There’s always anxiety in the ER, because patients don’t come there unless something is really wrong,” adds emergency nurse practitioner Elda Ramirez, MSN, RN, CEN, FNP, who is also an assistant professor of clinical nursing at the University of Texas-Houston School of Nursing. “It’s important to give them some sense of relief and comfort. I think that when minority patients see a caregiver from their same culture, it gives them that relief. They think, ‘This person will understand me. They will know what my problem is.’”
Best of all, job opportunities for emergency nurses are everywhere, because the demand for these professionals has risen to unprecedented levels in recent years. While America is currently suffering from an acute nursing shortage in virtually every area of the profession, RNs with specialized emergency-care training, skills and experience have become particularly scarce.
If your knowledge of emergency nursing is based on watching the TV show “ER,” it’s time to switch to the reality channel. “I think the words ‘ER’ may scare some potential nurses away,” Moses believes. “They say, ‘I don’t want to work [in an environment] like that!’ But emergency nursing is simply another type of nursing, another way to care for people. It’s not like the TV show, where everybody is constantly rushing around.”
In fact, the term “emergency room” no longer truly reflects reality. The Emergency Nurses Association, along with a growing number of hospitals, prefers the more all-encompassing term “emergency department (ED).” Today’s emergency nurses can be found practicing in an impressively wide array of settings beyond the traditional ER—from trauma centers, urgent care clinics and prehospital services to such enterprising new areas as in-flight nursing, forensics, amusement park nursing and emergency prevention education. The ENA’s membership ranges from staff nurses, ED nurse managers, administrators and clinical nurse specialists to prehospital coordinators, nurse practitioners and educators.
Kuska now works as an injury control and prevention educator for the National Highway Traffic Safety Administration, providing outreach to communities in a six-state region. She teaches the importance of seatbelt and airbag use, bicycle safety and drunk-driving prevention. “I did a lot of soul-searching about whether I was ready to give up ER nursing,” she says. “But I finally decided that with this position, I could use my expertise to make a much broader impact than I could treating just one patient at a time.”
Still other emergency nurses are expanding their careers into corporate settings. “Many big oil and gas companies now have teams of emergency medical technicians and nurses who are on call in case of accidents or disasters at their refineries,” Ramirez reports. “In fact, a lot of people who have done emergency care in the past end up becoming consultants for corporations in areas like disaster management. I even see emergency nurses going into the business field—there are a lot of companies that contract emergency services to hospitals and corporations.”
Gloria Salazar, MA, BSN, RN, CEN, a 20-year veteran of the ER who is now a trauma education and injury prevention manager at Thomason Hospital in El Paso, Texas, feels that “emergency nursing is a stepping stone. Most emergency nurses have plans to continue their education or their professional development, and they eventually move on to something else.”
Meanwhile, back in the ED, there’s no denying that the pace is fast. Because every emergency case is different and the volume of patients is high, emergency nurses must have a finely honed ability to quickly assess what’s wrong with the patient and take immediate action. Creativity, flexibility and being able to work under pressure are absolutely essential, as are top-notch problem-solving skills, sound judgment and the ability to prioritize which patients are the sickest.
“Critical thinking skills are very important,” says Jones. “You need to be knowledgeable in managing patients with life-threatening problems. You need to be up-to-date on current trends, such as new treatments for acute coronary syndrome. You need to read articles, so that you can explore new information with your colleagues and the physicians. And when you’re carrying out an order, it’s not enough to just do it—you need to understand why you’re carrying out that procedure.”
Because everything in the ED is based on verbal orders, Kuska adds, “you have to know your medicines and know exactly what things are for, so that you can make sure the doctors’ orders are correct. You have to be able to think, ‘Wait, I shouldn’t be giving Demerol to a head-injured patient,’ or ‘The potassium he ordered is too high for a two-hour drip.’ If you haven’t acquired that knowledge from prior experience in another area of nursing, you’re not ready for the ED.”
Ramirez adds one more essential quality to the list: the ability to be nonjudgmental when faced with emergencies that could have easily been prevented if the patient had used common sense. “We recently had a case where a mother was driving with her kids in the car and her little boy was not in a seatbelt,” she says. “She got into an accident and the child flew out the window. But I can only educate her—I cannot judge her. I have to be able to stay calm and say, ‘You know, it’s really important that you seatbelt your child; he could have died today.’ You have to be an exceptional teacher.”
Being an emergency nurse is a lot like being a detective, according to ENA immediate past President Benjamin E. Marett, MSN, RN, CEN. Often, he explains, someone will come into the ED in crisis and neither you nor the patient will have any idea what’s wrong. It’s up to the nurse to sift through all the clues—the patient’s vital signs, their medical history, what they did and ate that day, diagnostic tests such as EKG, electrolytes and cardiac monitoring, etc.—and deduce what the problem is.
“All you may know from the vital signs is that something isn’t quite right,” says Marett. “You need to have a keen ‘sixth sense.’”
Ramirez believes this “Sherlock Holmes component of emergency nursing,” as she puts it, is another crucial area in which minority nurses can make a culturally competent difference when treating patients who share their same ethnic heritage: They are more likely to be attuned to “cultural clues” that would not be apparent to someone outside of that population.
“I think that’s one of the things that gives me an edge in treating Hispanic patients of Mexican descent and some Latin patients,” she relates. “I was born and raised with these people, so it’s like an innate cultural knowledge. When they come to the ED and they’re talking a certain way, they’re using certain terms, you think: ‘Wait a minute, I know what this person is saying.’
“Last night I had a perfect example,” Ramirez continues. “A Hispanic woman came into the ED and she was using a Spanish phrase that, literally translated, means ‘I have tonsils.’ Immediately, I knew exactly what she was talking about. She didn’t have to tell me, ‘My throat hurts and I have fever.’ In my culture, when someone says ‘I have tonsils,’ it means that they’ve had a history of tonsillary problems and now it has come back.
“All I had to do was ask her, ‘What have they treated you with before?’ She told me, ‘The shot.’ I asked, ‘The one with penicillin?’ ‘Yes, that’s the one.’ ‘Does it help?’ ‘Immediately,’ she said. ‘It’s gone within two days.’ She could have said ‘I have tonsils’ to another nurse who wasn’t familiar with Hispanic culture and they would have had no clue. But to me, it made perfect sense.”
Even though the current shortage of emergency nursing specialists is forcing many emergency departments to hire nurses without prior ED training and experience, nurses who do possess solid emergency background and skills are in much greater demand. Moreover, because of its extremely serious and fast-paced nature, emergency nursing is definitely not a field for beginners.
“I would tell any nurse, minority or not, that before you can come to work in emergency nursing, you need a strong base in medical/surgical or another more general area of nursing,” Moses emphasizes. “If you jump right into the ER as soon as you graduate from nursing school, you’re only setting yourself up to be burnt out within a year. But if you get that base first, you’ll be able to function much better when you come to the ER.”
Let’s say you are currently a med/surg nurse who would like to make a career change to the more exciting field of emergency nursing. What specific education, experience and credentials will you need to add to your resume?
“Our hospital requires you to have taken the TNCC (Trauma Nurse Core Course), the ACLS (Advanced Cardiac Life Support) and PALS (Pediatric Advanced Life Support),” says Salazar. “There’s also a critical care course offered at our local university, and I advise the students I work with to take that. Most of the students who take those courses and then look for a job in emergency nursing are the ones that are hired right away.”
In addition, Moses advises potential ED nurses to obtain a strong grounding in technology skills by taking computer classes. “Nowadays, the whole ED is computerized,” she explains. “The patient’s x-rays, medication, everything is on the computer. For discharge planning, you press a key and you get discharge instructions; for patients’ lab work, you pull it up on the computer screen.”
One way today’s hospitals are trying to develop a larger pool of experienced emergency nurses is by increasing their investment in on-the-job training. Jones, who has earned a certificate for the ENPC (Emergency Nurses Pediatric Course) as well as the TNCC, ACLS and PALS, is a good example of a minority nurse who performs this crucial educational function within a hospital ED setting. “I precept most of the new staff that comes in, whether they are nursing students, nurse interns, ED technicians or newly hired RNs,” she says.
Jones created Howard University Hospital’s ED training and orientation program, which puts heavy emphasis on hands-on learning. In addition to classes on topics like pediatrics and critical thinking, preceptees closely shadow Jones and other ED nurses in their clinical settings. The training program also includes mock Code Yellows, mock traumas and other simulations that teach new staff members how to think and act quickly in unexpected emergency situations.
How important is the Certified Emergency Nurse credential, conferred by the Board of Certification for Emergency Nursing (BCEN)? Although the ENA endorses earning the CEN, board certification is not required to work in emergency nursing, and most of the nurses interviewed for this article agree that the CEN does not necessarily increase a nurse’s chance of being hired over a candidate without certification. Still, says Kuska, “I think that having to take the certification exam and keep up with the CEUs makes you a more well-rounded nurse. Having those letters after your name shows that you are truly committed to your specialty.”
Despite all the excitement, variety and respect that emergency nurses enjoy, this career is not for everybody. “You will see horrible, terrible things in the ED—gunshots, stabbings, burns, child abuse, car crash victims and more,” Marett cautions. “But it does have exceptional rewards that come when you make a real impact in saving someone’s life.”
Thelma Kuska couldn’t agree more. “It’s very rewarding, because you make decisions that really make a life-or-death difference,” she says. “If you’re an astute nurse who knows what to look for, you can really feel like, ‘Wow, I made a difference today!’
“For example, suppose a woman of child-bearing age comes in complaining of severe abdominal pain. Her blood pressure’s a little low; her pulse is a little fast. You ask when her last period was and she says, ‘Five or six weeks ago.’ So you put the pieces together and think, ‘Maybe it’s an ectopic pregnancy.’ You make the decision and tell the ER doctor, ‘I think we need an OB consult.’ There have been many times when I’ve picked up on something like that and the doctor told me, ‘Because of you, that patient went to the operating room right away. You saved a life today.’”
Emergency Nurses Association
915 Lee Street
Des Plaines, IL 60016-6569
Phone: (800) 900-9659
Fax: (847) 460-4001
Web site: www.ena.org
The ENA’s mission statement emphasizes that “respect for diversity of patients and colleagues is inherent to emergency nursing practice and emergency care.” According to George Velianoff, DNS, RN, CHE, the association’s deputy executive director of nursing, “We are very concerned about recruiting more nurses of color into the profession. There is a tremendous need for more minority emergency nurses.”
The ENA offers many resources for current and potential emergency nurses, including: