Advanced Practice Nursing

How to Become a Toxicology Nurse

How to Become a Toxicology Nurse
Toxicology nurses are registered nurses (RNs) trained in treating poisonings, severe allergic reactions, and drug overdoses. Neither a master's nor certification is required for this job. Image from Unsplash
Lucien Formichella profile
Lucien Formichella February 3, 2020

From spider bites to Tide Pod challenges, toxicology nurses see it all. These professionals put their specialized knowledge to work to help people recover from a myriad of ailments. Plus, they can do it all with just a bachelor's degree.

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Toxicology nurses are registered nurses (RN) who have an extensive knowledge of poison and drugs. They help to diagnose and find solutions to issues like:

  • Accidental (and intentional) ingestion
  • Venomous bites
  • Overdose
  • Allergies

Toxicology nurses work in any number of settings, including call centers and hospitals, and often need to act quickly to help patients. If you’re comfortable with the high-stress conditions surrounding life-or-death crises, this may be a good job for you.

This article on how to become a toxicology nurse, covers:

  • Education required to become a toxicology nurse
  • How poison control nurses put toxicology skills to work
  • Other forms of toxicology nursing
  • Continuing toxicology education
  • Becoming a nurse practitioner

Education required to become a toxicology nurse

Before getting to all the drugs and poison, every toxicology nurse must first earn certification as a registered nurse. This means passing the NCLEX-RN exam, which tests basic nursing competency skills.

In order to qualify for the NCLEX-RN exam, you must first complete a nursing program accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). You can do this by earning a Bachelor of Science in Nursing (BSN) or an Associate Degree in Nursing (ADN).

A BSN, which is a four-year degree, takes longer to earn and is almost always more expensive than the two-year ADN, which most community colleges offer. One upside of the bachelor’s degree is that most employers prefer the BSN. In fact, it is possible that states will stop licensing ADNs as RNs in the not-too-distant future. ADNs who already have their RN license will be able to renew their licenses, but newbies will need a BSN for licensure.

For anybody reading this and thinking, “Oh crap. I already have an ADN”: fret not. There are numerous RN to BSN programs that can help you upgrade your degree. There are even RN to Master of Science in Nursing (MSN) programs available.

By the way: another upside of the BSN is that, should you later decide to pursue a Master of Science in Nursing (MSN), earning that degree will take less time if you already have a BSN.

How poison control nurses put toxicology skills to work

Many toxicology nurses find employment taking calls at poison control centers. In 2017, there was one call to a poison center every 14.9 seconds. Often the expert who answers is a registered nurse with an extensive knowledge of toxicology.

These nurses—who may have no more specialized outside training than an RN certification—help people through issues like “I just got bit by a snake” and “Uhhhh, I may or may not have eaten a Tide Pod…for fun.” On average, poison control nurses earn $76,762 a year, about $10,000 more than other RNs.

Some centers may require applicants to have passed the Certification for Specialists in Poison Information (CSPI) exam. This four-hour, 160+ question test is designed for healthcare professionals who have at least 2,000 hours experience answering poison emergency calls and 2,000 hours working with poison injuries and illnesses. The exam is sponsored by the American Association of Poison Control Centers (AAPCC) and administered by Pearson VUE. Those who pass demonstrate “competent skill, knowledge, education and experience to provide poison information to the public, healthcare providers, and public health agencies.”

You might think, “How could I possibly take 2,000 hours worth of calls? I don’t even have time to look at my phone at work.” One way to get experience is in a toxicology rotation program, such as the one through the University of Virginia. Nursing students in the rotation observe AAPCC-trained nurses take calls and attend rounds. You might also look into the Medical Toxicology Fellowship through the National Capital Poison Center, which is a two-year opportunity open to a broad range of medical professionals. Among other things, fellows learn:

  • Diagnostic skills
  • The effects of numerous drugs
  • Analytical and interpretational skills
  • How poison centers operate

Not every poison control center requires employees to have a CSPI certification; some are happy to train new hires. You might even be allowed to complete the certification within a specified timeframe after being hired.

Finally, we would be remiss if we did not repeat the dodgy advice offered by Michael Scott and Dwight Schrute on The Office: “Call poison control if you’re bitten by a spider/But make sure it’s covered by your healthcare provider.”

Other forms of toxicology nursing

Toxicology nursing is not an officially recognized specialty, which means that even though you may be able to specialize in toxicology, it will probably not be the only thing you do. Helping a patient recover from an overdose or taking samples for the toxicology report will only be part of most job descriptions.

Nurses who make use of toxicology knowledge generally work in emergency rooms or intensive care units. They often have the following job titles:

Emergency room nurse

“Calm. Cool. Collected. The certified emergency nurse is the cornerstone of every ED,” says the Board of Certification for Emergency Room Nursing (BCEN). The only requirement to sit for its certification exam is an RN license, though the organization recommends that all applicants have two years of experience in their “specialty area.”

The CEN exam has an entire subsection dedicated to toxicology. The topics are:

  • Acids and alkalis
  • Carbon monoxide
  • Cyanide
  • Drug interactions (including alternative therapies)
  • Overdose and ingestions
  • Substance abuse
  • Withdrawal syndrome

The Emergency Nurses Association online review course devotes an entire module to “Environment and Toxicology Emergencies.” It addresses the many toxicological issues an ER nurse might come across.

This certification must be renewed every four years by maintaining your license and completing 100 contact hours of continuing nursing education. Emergency room nurses earn an average of $65,870 per year, though that number can increase with experience and education.

Intensive care unit nurse

Becoming a nurse in the ICU requires an internship after you successfully complete the NCLEX-RN exam. During this internship, you’ll assist current ICU nurses.

After completing the internship, you can apply for jobs. At some point, you should consider taking the Critical Care Registered Nurse (CCRN) exam. Toxicology is among the subjects covered on the exam, as a part of the multisystem section. The topics include:

  • Toxin/drug exposure (including allergies)
  • Toxic ingestions/inhalations (e.g., drug/alcohol overdose)

The CCRN certification is not always a job requirement for ICU work, but it does make you a more desirable candidate because it demonstrates proficiency and dedication. There are two ways to complete the work requirements:

  • Provide 1,750 hours of “direct care of acutely/critically ill adult patients” over the past two years as an RN or advanced practice registered nurse (875 hours must occur in the second year)
  • Provide 2,000 hours of “direct care of acutely/critically ill adult patients” over five years (144 hours must occur in the final year).

ICU nurses earn the same average income as emergency room nurses.

Continuing toxicology education

There are some specific certifications that current nurses can complete to expand their toxicology knowledge. The University of Florida offers a 15-credit graduate Certificate in Clinical Toxicology. Its curriculum includes courses in:

  • Clinical toxicology
  • Epidemiology and biostatistics in clinical toxicology
  • General toxicology
  • Introduction to clinical toxicology
  • Toxic substances

The program is open to nurses, and prepares graduates to move into careers, like:

  • Medical scientist
  • Biochemist
  • Biophysicist
  • Epidemiologist
  • Statistician

Michigan State University has a similar program for students looking to advance their career in pharmacology or toxicology. Though open to nurses, these programs aren’t specifically designed for them.

Becoming a nursing practitioner

A nurse practitioner (NP) is closer to a doctor than an RN. Though it is not possible to be an NP that specializes in toxicology, it is possible to be an emergency nurse practitioner, which means that treating poisoning patients will be part of your practice.

The process of becoming an NP includes earning a master’s degree in nursing (MSN) or a Doctor of Nursing Practice (DNP) and then passing the Emergency Nurse Practitioner Certification through the American Academy of Nurse Practitioners Certification Board (AANPCB).

It is a lot of extra work, but nurse practitioners earn over $100,000 per year, according to the BLS.

The bottom line is this: there are so many ways to become a toxicology nurse, even if most of them don’t come with the title “toxicology nurse.” You could help somebody in the emergency room, ICU, or even over the phone at a poison control call center. One way or another, you will have the ability to put your toxicology knowledge to work.

(Last Updated on February 26, 2024)

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Tom Meltzer spent over 20 years writing and teaching for The Princeton Review, where he was lead author of the company's popular guide to colleges, before joining Noodle.

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