How to Become an Emergency Nurse Practitioner

As more Americans rely on emergency care, emergency nurse practitioners (ENPs) will emerge as valuable unicorns in a pioneering category of advanced practice nursing.

If you’re already licensed as a registered nurse (RN) and your preferred work flow varies from steady to “stat,” you might consider becoming an ENP, an evolving type of nurse practitioner (NP).

“Although I have been an ENP for 17 years, the opportunities supporting and advancing ENP practice have only recently begun to gain momentum,” says Dr. Jennifer Wilbeck, an emergency nurse practitioner with a focus on acute care and families. “ENPs must be prepared to provide primary care and acute resuscitation, plus manage complex, unstable conditions in patients of all ages. Until recently, no academic programs offered this specialty training.”

While NPs have worked alongside emergency room physicians for more than five decades, the official title of ENP is relatively new; it was all but unheard of until the 1990s.

The specialty continues to grow, with more than 14,000 ENPs currently practicing, according to the American Association of Nurse Practitioners (AANP), the nation’s largest membership organization for NPs. New organizations continue to spring up; the American Academy of Emergency Nurse Practitioners (AAENP), which was established in 2014, now represents nearly 800 ENPs, according to the organization’s April, 2018 executive summary.

Because ENPs diagnose, treat, educate, and perform life-saving procedures, their roles will fill gaps in emergency medicine as significant physician shortages are expected by 2030. And as an ENP, your advocacy will help shape national health care policy.

Pros and cons of becoming an emergency nurse practitioner

Trained and licensed in the specific demands of emergency medicine, an ENP manages chaos while providing appropriate care in every imaginable setting—day and night. Typical salaries range between $103,368 and $123,748 depending on education, experience, and certifications, according to salary.com.

Pros

Advantages of becoming an emergency nurse practitioner include the excitement of constant change and the ability to save lives. Here’s where you will shine, not just as a nurse but as a healthcare advocate. In this pioneering field of ER nursing, you will be unique among this country’s 270,000 nurse practitioners (NPs). In some states, you may be able to practice without a physician’s supervision.

“The reliance on emergency care remains stronger than ever,” said Michael Gerardi, MD, FAAP, FACEP, president of the American College of Emergency Physicians (ACEP). “It’s the only place that’s open 24/7, and we never turn anyone away. Rather than trying to put a moat around us to keep people out, it’s time to recognize the incredible value of this model of medicine that people need.”

While one study suggests ED visits may be decreasing, with clients taking their less-critical health issues to urgent care centers and other non–emergency department acute care venues, the data are not conclusive, and the bottom line remains that emergency skills continue to be essential.

In 2016, the national emergency department (ED) visit rate was 45.8 visits per 100 persons, according to the National Ambulatory Medical Care Survey (NAMCS). Imagine waiting times in EDs and urgent care centers across America, especially with a projected shortage of up to 104,900 fewer physicians by 2030. The need for more skilled ED staff is certain to grow.

Cons

Downsides include stress, emotional exhaustion, and a constant grind that makes good footwear a critical wardrobe choice. Because of complications regarding insurance, many clients may still bypass other health care centers and go directly to the emergency room. The workload will be steady and challenging.

In advocating for patient rights, an ENP might grow especially weary, with fewer physician colleagues and less support while dealing with more patients. Be prepared to be on the receiving end of clients’ verbal abuse.

NPs often complain that physicians don’t understand their role in the emergency room. As a new type of NP, your role and scope of practice may futher perplex other medical professionals.

In other words, you are blazing trails. That ain’t easy.

Educational commitment to become an emergency nurse practitioner

To become an ENP through an accredited college or university, expect to pay between $800 to $1,000 per credit hour and to graduate in between four to seven semesters for a master’s. Application requirements include an RN license, a GPA of 3.0 or higher, and professional experience in an ED setting. After graduation, students can sit for the ENP certification exam (ENP-C) through the American Academy of Nurse Practitioners Certification Board (AANPCB).

Several graduate programs build upon the structure for family nurse practitioner (FNP) requirements. Others have developed specialized ENP tracks, with both in-person and online distance learning options.

Here are four excellent schools that take the guesswork out of ENP preparation:

• Vanderbilt University
  Nashville’s Vanderbilt School of Nursing combines an FNP foundation with the ENP specialty. Near Vanderbilt University Medical Center, one of the nation’s top academic medical centers, Vanderbilt is ranked as the eighth-best graduate school of nursing, according to U.S. News & World Report. Applicants must have at least two years of current RN experience. Of those two years, one full year must be as an RN in the ED. Distance learning is an option.
• Jacksonville University
  Located in Jacksonville, Florida, this school’s College of Health and Sciences and Keigwin School of Nursing is one of the few colleges in the United States to prepare ENPs with an FNP/ENP dual degree. Whether you select the full-time or part-time program, you must first have a Florida RN license or be eligible for endorsement in Florida. Other requirements include one year of clinical experience in an emergency setting and Advanced Cardiac Life Support prior to taking the first ENP course. Both full- and part-time students must complete 46 program hours. Clinical rotations are in regional ED settings. Graduates are eligible to take the ENP-C.
• Drexel University
  Located in Philadelphia, PA, Drexel University offers an online ENP post-master’s certificate. Course work is designed for family nurse practitioners in emergency care settings or for NPs who want to make a career change. Online courses cover law and ethics, technology, theories, and culturally sensitive health promotion. Offline, you will need to complete faculty-supervised clinical hours. After graduation, you can sit for the ENP-C. To apply, you need an unrestricted United States RN license and two years’ experience in ED, critical care, urgent care, or trauma as an RN or APRN. You also need national board certification and licensure as an FNP.
• Emory University
  The Nell Hodgson Woodruff School of Nursing is an Atlanta-based school with a full-time four-semester ENP program and a part-time option. In addition to clinical rotations, examples of courses include: “Becoming an APRN,” “Introduction to Clinical Specialty: Emergency Nurse Practitioner,” and “Business of Health Care: Finance.” Applicants should have prior experience in emergency nursing, disaster/crisis management, military service, or other related fields. After graduation, you can sit for the ENP-C. To apply, you must have a baccalaureate degree from an accredited nursing program and possess an RN license in the state of Georgia.

Licensure and accreditation for becoming an emergency nurse practitioner

There are two ways to become an ENP outside of academic courses:

__1. ENP-C
Available through the AANPCB since 2017, this three-hour certification exam features 150 questions on various topics, including nervous system disorders and medical screenings. After you pass, you can add ENP-C to your credentials.

To apply, you must first be an active RN licensed in the U.S., U.S. territories, or a Canadian province or territory. Second, you must be currently certified as an FNP. Third, you must have specific emergency room experience. Certification is good for five years.

__2. Emergency Nurse Practitioner-Board Certified (ENP-BC)
In 2013, the American Nurses Credentialing Center (ANCC), the largest nurse-credentialing organization in the world, developed the emergency nurse practitioner board certification (ENP-BC). You earn their certification through portfolio assessment, not by exam. First, you must have a valid license as an RN or APRN. Second, you must have practiced two years as a full-time NP with 2,000 advanced practice hours in emergency care. Third, you need 30 hours of continuing education in advanced emergency care. Finally, you need to complete two additional professional development categories that include academic credits, presentations, publication or research, preceptorship, or professional service.

Like the ENP-C, the ENP-BC is valid for five years.

Resources for becoming an emergency nurse practitioner

Perplexed by all the medical acronyms? Here are eight quality networking sources to put in your back pocket as you review scholarships, jobs, and symposiums:

• American Academy of Emergency Nurses (AAEN)
  Established in 2014 as an organizational member of AANP, AAEN should be your first stop for gleaning information about this specialty practice. In addition to providing job listings, this resource also keeps you informed about regional conferences.
• American Nurses Association (ANA) Founded in 1896 as Nurses Associated Alumnae, the ANA represents four million RNs. In addition to organizing conferences and other events, ANA maintains a helpful blog that provides practical tips, like how to create your nursing resume.
• American Nurses Credentialing Center (ANCC) As part of the ANA, the ANCC has developed respected certifications like the ENP-BC to promote standards of excellence.
• American Association of Nurse Practitioners (AANP) The AANP can guide your career from start to finish and even after retirement. With more than 98,000 members, the AANP is a go-to source. Event listings include the AANP Fall Conference and the AANP National Conference in addition to poster events, where nurses can share displays about their programs and explain new discoveries to their peers.
• American Academy of Nurse Practitioners (AANPCB) Certification Board Since 2017, the AANPCB has offered computer-based examinations called the ENP-C.
• American Academy of Emergency Medicine (AAEM) Established in 1993, the AAEM has been “a leader in protecting board certification in emergency medicine and confronting the harmful influence of the corporate practice of medicine,” according to its website.
• American College of Emergency Physicians (ACEP) The ACEP represents patient rights. The organization has testified before Congress to advocate for more transparency and for reductions of unexplained costs in the ED.
• Advanced Emergency Nursing Journal The Advanced Emergency Nursing Journal is a peer-reviewed journal with articles ranging from “Emergency Nurse Practitioner Core Educational Content” to “Unique Educational Needs of Emergency Nurse Practitioners.”

(Last Updated on February 26, 2024)

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