ER Nurse Job Description Template

ER Nurse Job Overview

An ER Nurse provides emergency nursing care across the full acuity spectrum in an acute care emergency department setting. In this role, you'll triage patients using the Emergency Severity Index (ESI), initiate and manage stabilization interventions, coordinate with emergency physicians and consultants, and transition patients to admission, discharge, or transfer with accurate handoff and documentation.

The role reports to the ED Charge Nurse and Nurse Manager within an emergency team that includes emergency physicians, mid-level providers (NPs/PAs), emergency medical technicians, patient care technicians, social workers, and case managers. On a typical shift, you'll carry an active assignment of 3-6 patients in various stages of evaluation, treatment, and disposition — while covering hallway patients and boarding admissions during high-census periods.

Success in the ED is about accurate triage judgment, rapid clinical decision support to the physician team, procedural confidence, and the ability to restart that process for a new chief complaint 15 minutes later. The best ER nurses here make the high-acuity rooms look calm when they're actually anything but, and they leave nurses, physicians, and patients with the same confidence in their clinical judgment.

Performance is measured by door-to-provider times, patient throughput contribution, patient satisfaction scores, documentation completeness, and peer and supervisory review outcomes.

Key Responsibilities

• Perform ESI-based triage assessment on all presenting patients, accurately assigning acuity levels 1-5, initiating standing orders where applicable, and communicating priority cases to the charge nurse and provider team immediately

• Conduct rapid, systematic primary and secondary assessments on assigned patients, identifying life-threatening conditions requiring immediate intervention and activating appropriate emergency response protocols (trauma, stroke, STEMI, sepsis)

• Establish peripheral IV access, initiate fluid resuscitation, collect blood specimens, and administer ordered medications including IV push medications, continuous infusions, and time-sensitive thrombolytics per physician orders and ED protocols

• Assist with emergency procedures including intubation, central line placement, chest tube insertion, cardioversion, procedural sedation, lumbar puncture, and orthopedic reduction — managing the nursing role with technical precision and sterile technique

• Monitor and interpret cardiac rhythms on continuous telemetry, recognizing STEMI, symptomatic arrhythmias, and other cardiac emergencies requiring immediate provider notification and protocol initiation

• Manage psychiatric emergency patients including behavioral de-escalation, safety searches, one-to-one monitoring coordination, and psychiatric hold documentation in collaboration with social work and behavioral health

• Coordinate active communication between the patient, family, physician team, consultants, and ancillary departments — translating clinical information into patient-appropriate language under time pressure

• Document all assessments, interventions, medication administrations, and patient communications in the ED EHR (Epic, Meditech, or equivalent) with accuracy and specificity required for continuity, billing, and risk management

• Discharge patients with clear, specific instructions verified through teach-back, including medication management, activity restrictions, return precautions, and follow-up requirements

• Participate as an active team member in code blue, trauma activation, and mass casualty incident responses, executing the nursing role within the team structure without requiring direction for standard protocols

Required Qualifications for an ER Nurse

• Active, unrestricted Registered Nurse (RN) license in the state of practice

• Minimum 2-3 years of clinical RN experience, with at least 1-2 years in an emergency department, critical care, or procedurally intensive setting (new graduate ED intern track positions specify accordingly)

• Current ACLS and BLS certification; PALS required for pediatric emergency or general EDs serving pediatric patients

• Demonstrated triage experience or Emergency Nursing Pediatric Course (ENPC) certification for general ED settings serving pediatric patients

• Trauma Nursing Core Course (TNCC) certification or willingness to complete within 12 months of hire (required for Level I/II trauma centers)

• Proficiency with ED-specific EHR workflows: triage documentation, orders management, medication administration record, and discharge documentation

• Demonstrated ability to manage simultaneous care for multiple patients across different acuity levels without clinical tasks falling through in either direction

• Physical stamina for high-pace, high-volume shifts requiring extended periods of standing, moving, and rapid repositioning during procedures

Preferred Qualifications

• Certified Emergency Nurse (CEN) certification through the Board of Certification for Emergency Nursing (BCEN)

• Experience in a Level I or Level II trauma center emergency department

• Completion of Emergency Nursing Pediatric Course (ENPC) and/or Pediatric Advanced Life Support (PALS)

• Prior triage nurse experience with documented ESI triage accuracy

• Experience in high-census urban emergency departments (>60,000 annual patient visits)

• Bilingual fluency aligned with the patient population served by the facility

• Prior experience as an emergency department preceptor or charge nurse

Essential Skills & Competencies for ER Nurses

Technical Skills:

• ESI triage: accurate 5-level acuity classification, standing order initiation, and rapid reassessment for triage category changes

• Rapid assessment: primary survey (airway, breathing, circulation, disability, exposure) and focused secondary assessment within initial 5-10 minutes of patient contact

• IV access: peripheral IV insertion under pressure, IO placement (IO drill operation) in emergent situations per protocol, blood draw timing and labeling accuracy

• Medication administration: IV push medications, rapid sequence intubation drug preparation, thrombolytics (tPA, TNK), cardiovascular drugs, procedural sedation agents (ketamine, propofol, etomidate, fentanyl)

• Airway management assistance: bag-mask ventilation, laryngoscope preparation, ETT and RSI support, post-intubation ventilator setup and settings confirmation

• 12-lead EKG acquisition and artifact-free technique; STEMI recognition for rapid cath lab activation

• Cardiac monitoring: dysrhythmia recognition and priority classification, defibrillation, cardioversion, and transcutaneous pacing

• Trauma care: hemorrhage control, trauma bay setup, massive transfusion protocol activation, tourniquet application

• Procedural assistance: central line tray setup, chest tube insertion support, laceration repair, lumbar puncture, joint aspiration — sterile field maintenance and assistant role competency

• Sepsis bundle implementation: lactate, blood cultures x2 before antibiotics, time-sensitive antibiotic administration, fluid resuscitation volume management

Soft Skills:

• Triage judgment that distinguishes ESI 2 from ESI 3 in seconds, consistently, across a full lobby of undifferentiated complaints

• Controlled urgency — the ability to move fast without creating chaos around you

• Communication that is concise, direct, and impossible to misinterpret in a noisy environment

• Emotional containment during mass casualty events, pediatric codes, and trauma activations that require clear function while processing difficult situations

• Boundary-setting with patients and families who are frustrated, in pain, or hostile due to wait times or difficult news

• Situational awareness across the full ED — knowing what's happening in all your rooms and the hallway simultaneously

• Recovery speed: the ability to reset mentally and clinically for the next patient after managing a traumatic or unsuccessful resuscitation

ER Nurse Salary Range & Benefits

Salary Overview

ER Nurses earn a specialty premium above the general RN median. Based on the BLS median RN annual wage of $81,220, emergency nurses in most markets earn 10-25% above the general RN median due to acuity complexity, night/weekend exposure, and procedural demands.

Top-Paying Metropolitan Areas (Senior ER RN):

• San Jose, CA: $155,000+

• San Francisco, CA: $148,000+

• Vallejo, CA: $140,000+

• Seattle, WA: $126,000+

• Sacramento, CA: $118,000+

Travel ER nurses in shortage markets routinely earn $65-$100/hour in all-in package rates. Night differential, trauma activation pay, and charge differentials add meaningful amounts to base hourly rates across most ED settings.

Benefits Package

Competitive ER Nurse offers in 2026 typically include:

• Medical, dental, and vision insurance with employer-subsidized premiums

• 401(k) or 403(b) with 4-6% employer match

• Paid time off: 18-25 days annually

• CEN certification reimbursement and renewal support

• TNCC and ENPC course sponsorship with paid study time

• ED nurse residency / internship programs for new ED hires (6-12 months structured orientation)

• Emergency department shift differentials: evening, night, weekend, holiday

• Trauma activation pay at Level I and II centers

• Employee assistance programs with critical incident stress debriefing access

• Violence prevention and de-escalation training (regularly offered, not optional)

• PSLF loan forgiveness eligibility at qualifying nonprofit EDs

• Annual wellness support: peer support programs, resilience training, mental health resources specific to emergency nursing burnout

Frequently Asked Questions About ER Nurses

Q: What does an ER Nurse do?
A: An ER Nurse triages patients, performs initial assessments, establishes IV access, administers emergency medications, assists with procedures, monitors cardiac rhythms, coordinates with emergency physicians, and prepares patients for admission, discharge, or transfer. ER nurses manage multiple patients simultaneously across every acuity level from critical to non-urgent, in an environment where priorities shift rapidly and without warning.

Q: What qualifications do you need to be an ER Nurse?
A: Active RN licensure, ACLS and BLS certification, and 2-3 years of clinical experience (with at least some emergency or acute care exposure) are the standard baseline. TNCC is required or expected at most trauma centers, and PALS is required for EDs serving pediatric patients. CEN certification is strongly preferred and accelerates career progression. New graduates can enter through ED internship programs at select facilities.

Q: How much does an ER Nurse make?
A: ER Nurses earn 10-25% above the BLS median RN wage of $81,220 based on specialty complexity. Experienced ED RNs in California markets earn $108,000-$155,000 in permanent positions. CEN-certified nurses and those at Level I trauma centers command the highest premiums. Travel ER nurses in shortage markets earn $65-$100/hour all-in.

Q: What is CEN certification and should ER nurses pursue it?
A: CEN (Certified Emergency Nurse) is the specialty certification offered by the Board of Certification for Emergency Nursing (BCEN). It requires validated emergency nursing experience and a passing exam. CEN demonstrates clinical commitment and specialty competency validation and is increasingly required or expected within 1-2 years of hire at Level I trauma centers and academic emergency departments. It typically adds $3,000-$8,000 to annual base salary.

Q: What is the difference between an ER Nurse and an ICU Nurse?
A: ER Nurses manage undifferentiated patient presentations across the full acuity spectrum, stabilizing patients rapidly for disposition over hours. ICU Nurses manage established, critically ill patients over days to weeks with sustained, intensive monitoring and therapy management. ER nurses breadth their knowledge across dozens of conditions; ICU nurses depth their expertise on a smaller, more complex patient population.

Q: How do you assess an ER Nurse candidate?
A: Ask scenario-specific triage questions: given a set of chief complaints and vital signs, where would they place each patient on the ESI and why. Walk through a sepsis presentation and ask what they initiate before the physician evaluates. Ask how they handle a waiting room full of ESI 3 patients when two ESI 2s arrive simultaneously. Evaluate whether candidates understand that triage is a dynamic, repeating clinical process — not a single checkpoint. For trauma center positions, ask specifically about their experience in trauma activations and the nursing role they played.