Emergency Nurse Practitioner

What is an Emergency Nurse Practitioner (ENP)?

Emergency Nurse Practitioners are experts in emergency medicine and trained to treat urgently ill or injured patients.  They have a strong background in primary care, acute and chronic conditions.  ENPs must be prepared to deal with exacerbations and new onsets of disease and injury.  Emergency Nurse Practitioners provide emergency care in the emergency department or urgent care center. 

Emergency NPs are certified to care for patients of all ages. They are an essential part of the healthcare team and can take care of differing acuity patients in the emergency department.  The Emergency Nurse Practitioner works closely with emergency physicians, specialists, physician assistants, nurses, and ancillary staff. 

The Emergency Nurse Practitioner (ENP) is a licensed, Board Certified Advanced Practice Nurse.  An ENP is a Registered Nurse (RN) who has graduated from an accredited educational program with a graduate degree (Master of Science in Nursing) or higher (Doctorate of Nursing Practice or Doctor of Philosophy).  

Recently, more Nurse Practitioners (NPs) are obtaining a Doctorate of Nursing Practice (DNP) or Doctor of Philosophy (Ph.D.) to enter practice as a Nurse Practitioner.  However, a terminal degree is not yet required.  

The Path to ENP

To become an Emergency Nurse Practitioner, you must become a Family Nurse Practitioner and sit for that exam.  Upon becoming an FNP, you can choose to specialize in emergency medicine and work in the emergency department can pursue this specialization.  

Only FNPs who have met one of the following three eligibility criteria can achieve the ENP specialization.

Option 1

  • 2,000 direct, emergency care clinical practice hours as FNP in the last five years
  • Evidence of 100 hours of continuing education in emergency medicine
  • Minimum of 30 hours of continuing education emergency care procedural skills within those five years

Option 2

  • Completion of an academic emergency care graduate/post-graduate NP program from an accredited nursing program, or
  • Achievement of a dual FNP/ENP graduate or post-graduate program from an accredited nursing program

Option 3

  • Completion of an approved emergency fellowship NP program.

Why do we need Emergency Nurse Practitioners?

Twelve percent of all provider visits take place in the emergency department, yet emergency doctors make up only four percent of the physician population.  While there is a current provider shortage in emergency departments, the deficit is expected to increase as physicians retire.  The need for emergency medical services is also projected to grow as the American population ages.  

In rural areas, there is often a lack of adequate physician coverage or health care access.  ENPs can fulfill the role of an emergency room provider in the face of this shortage.  Emergency Nurse Practitioners provide an extraordinary level of care that improves the health outcomes of disadvantaged populations.  It goes further than filling in for a deficit; NPs provide quality care to communities, families, and people who may not otherwise access health care.

ENPs deliver health care that places a unique emphasis on health maintenance, promotion, and preventative care. NPs generally focus on educating their patients about all aspects of their condition so that they can improve their well-being and stay healthy. Since Emergency NPs have a significant concentration on emergency medicine, they provide compassion and comfort in the emergency medical setting.

What does an Emergency Nurse Practitioner do? 

State laws that define the type of care that a Nurse Practitioner can provide regulate an Emergency Nurse Practitioner.  The job description for an ENP depends on your particular occupation.  

There are many options for the Emergency Nurse Practitioner to practice in, like:

  • Hospitals
  • Urgent care facilities
  • Freestanding emergency departments
  • Trauma Centers
  • Ambulances

Job Description

Emergency Nurse Practitioners are skilled practitioners who treat patients of all ages with varying levels of acuity in busy emergency departments, urgent cares, and ambulances.  ENPs thrive in a fast-paced environment while providing patient-centered interventions like encouraging lifestyle changes, giving age and developmentally appropriate care, and advocating for patients.

Emergency Nurse Practitioners are culturally competent providers who work in collaboration with health care providers and stakeholders. ENPs typically work in hospital emergency room, urgent care facilities, ambulances, or freestanding emergency departments.  They may also work in public health, emergency preparedness, research, or education.  

Scope of Practice

All ENPs can provide care to ambulatory, urgent, and emergency medicine patients across the lifespan.  ENPs assess, diagnose, and manage illness, injury, and acute exacerbation of chronic disease.  ENPs are skilled at triage, critical medical decision-making, and transferring care based on patient status.

All Emergency NPs have the clinical expertise to assess patients, diagnose differential diagnoses and medical conditions, and order diagnostic tests (e.g., laboratory tests, urinalysis, cultures, X-rays, CT/MRIs, Ultrasounds, Doppler studies).  They perform the complete health history and physical exams, prescribe medications, assess for risk factors and contraindications to treatment, refer patients to appropriate specialties and facilities, and educate patients and their families.  

The scope of the Emergency NP varies is directly related to state-specific rules and regulations.  States permit different levels of autonomy among APRNs.  Nationwide, there is a push to allow NPs to practice more independently.

The American Academy of Nurse Practitioners Certification Board (AANPCB) designated the  ENP specialization in January of 2017 to create a role for NPs who are experts in emergency medicine.  As of 2018, there are only 495 ENPs nationwide.  

As the specialization grows, the specific role will continue to expand and evolve. A collaborative approach with physicians and the efficient utilization of ENPs for patient outcomes are needed.

How much does an Emergency Nurse Practitioner make?

Emergency Nursing is a fast-paced and challenging career that demands fair pay.  Since Emergency Nurse Practitioners have advanced qualifications, medical knowledge, and an increased risk of liability, ENP pay corresponds with their level of expertise and responsibility. 

The Bureau of Labor (2017) predicts a positive outlook for all Nurse Practitioner specialties and subspecialties.  The job market will increase by 36%, significantly beyond the average rate for most careers in the U.S. The need for Emergency Nurse Practitioners will continue to grow as the average age of the United States population increases.  Emergency Nurse Practitioners have a rewarding career with a positive job outlook and an appealing salary.  

Emergency Nurse Practitioner salaries range between $102,441 and $122,640.  The average salary is $110,222.  Pay is dependent on certifications, skills, and the number of years of experience. (Source)

The American Academy of Nurse Practitioners (AAPN) states that there are a total of 495 Board Certified Emergency Nurse Practitioners (ENP-BC) in the United States. However, the number of FNPs that function as Emergency Room NPs in the United States is higher. 

Emergency Nurse Practitioner Certification

Only a Registered Nurse can become an Emergency Nurse Practitioner. To become an RN, you should earn a Bachelor’s of Science Degree in Nursing (BSN) from an accredited institution.  Next, you must pass the NCLEX-RN examination and become a Registered Nurse before applying to an ACNP degree program. Most Nurse Practitioner programs prefer that applicants have practiced as a Registered Nurse before admission. 

Upon completion of the ENP program and receiving your advanced degree (MSN or DNP), you will qualify to sit for the ENP-BC certification exam.  This examination may seem challenging, but remember that it is protecting the sanctity of your license and all that it represents.  National certification ensures that all board-certified Emergency Nurse Practitioners meet specific standards of the profession.  

The National Certification Exam

Emergency Nurse Practitioners pass a national exam from a certifying body to achieve certification.  The American Academy of Nurse Practitioners Certification Board (AANPCB) gives the certification exam.  The AANPCB is a non-profit organization that was established in 1993 to provide a way to evaluate many different types of Nurse Practitioners reliably.

The ENP-BC was the AANPCB’s first specialty certification examination, established in 2017 for FNPs with education and practice in emergency medicine.  The ENP specialization is designed to meet the requirements of the Consensus Model.

Major stakeholders like the AAPN, ANA, and AACN to establish a uniform model for regulation of APRNs across the United States developed this 2008 APRN Consensus Model. Emergency care is considered an APRN specialty, yet the focus of emergency medicine is beyond one of the four major APRN roles and population focus.

ENPs must possess the skill and knowledge outlined by the accrediting body. To take the exam, you submit an application for the 90-day sliding window to schedule your exam.  The ENP-BC requires that you apply again if you are unable to make the exam during that time.  There are 150 questions on the test, but only 135 items count towards the candidate's score.  Fifteen questions that don't count towards the final results are labeled pretest questions. 

Pretest questions are used to obtain statistics for future exams about how appropriate the questions are for prior exams.  They are indistinguishable from the other test questions. The test covers five domains: medical screening, medical decision-making and differential diagnosis, patient management, patient disposition, and professional, legal, and ethical practices.

You instantly learn the results of the ENP certification exam after completion. In 2018, 327 ENP candidates took the exam and with an 87% pass rate.

The ANCC certification and credential of the ENP-BC is available for renewal only.  You can renew this certification every five years.  As long as you maintain your license, you can maintain the credential.  

If you fail the exam, you must contact the organization to retake it.  If you passed the exam, you now join the ranks of the ENP worldwide.  You apply to the board in each state that you would like to be a licensed provider.