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10 Emergency Nursing Skills You Can Only Learn on the Job

Many nurses are called to the emergency department and find satisfaction in helping patients on their most challenging days. Their training, compassion and ER nurse skills are put to the test with every patient interaction.

“Working in the ED is rewarding for me, because I get a lot of satisfaction from caring for people from all walks of life. From the CEO to the homeless,” said Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN, president of the Emergency Nurses Association. “As an emergency nurse, I may be in the presence of a patient or a family that would later describe that visit as one of the worst days of their life, yet as a nurse, I was there to help ease some pain and provide comfort in that difficult time.”

Being an emergency nurse requires an incredible amount of skills and knowledge, and today’s educators use simulation and clinical experiences in a variety of settings to prepare new graduates for the fast-paced, high-stress environment, reported Melody Eaton, PhD, MBA, RN, FAAN, a nursing professor at James Madison University in Harrisonburg, Virginia.

“Our goal is to train professionals who can critically think, synthesize information and really connect with patients and not just machines or computers,” said Eaton, adding that preceptors can help with the transition to an emergency nurse position.

Yet only time practicing in the emergency setting will enable a nurse to hone these all-important skills.

10 Key ER Nurse Skills

1. Maintaining Accurate Patient Assessments

Assessing the patient hands-on can make a huge difference, Eaton said.

“Patient conditions often change, and the nurse must be able to recognize subtle cues in a patient’s condition and understand whether the condition is improving or worsening,” added Linda Wicker, MSN, RN, a nursing instructor at Thomas Edison State University in Trenton, New Jersey.

“ED nurses know not to take anything at face value,” said Kristi Dalby, DNP, RN, CNE, faculty lead for the undergraduate nursing program at Southern New Hampshire University in Manchester. “They must ask questions and conduct assessments that are targeted to help guide the care that is ultimately delivered. ED nurses utilize their experience and evidence to make clinical judgements that can impact prioritization of care.”

2. Thinking and Acting Quickly

Emergency departments are fast paced, often with a steady stream of patients arriving by automobile or ambulance. Emergency nurses must prepare for whomever arrives in whatever condition, from sprained ankles to motor vehicle traumas.

“Nurses need to think fast and act quickly,” Eaton said.

3. Prioritizing Effectively

Prioritizing starts in triage. But emergency nursing skills also include prioritizing what patient conditions can wait, such as a broken arm, and what needs immediate attention, such as breathing issues.

“ED nurses must be able to continually assess and re-assess situations as more information becomes available and the needs of patients shift,” Dalby said.

4. Remaining Calm Under Pressure

“The ED is one area of the hospital where the number and types of patients coming through the door cannot be managed,” Dalby said. ED nurses must be flexible and cool under pressure. A calm demeanor helps set the tone for other staff, patients, and families in this high-stress environment.

5. Developing Coping Methods

Situations in the emergency department can be both physically and emotionally taxing, and nurses “need to be resilient, because they are going to see a lot of things, and all outcomes,” Eaton said.

“ED nurses must be able to balance compassion with their own self-care,” Dalby said. “They should be able to engage in a staff debriefing after difficult situations and recognize that seeking help is often an important part of the self-care and self-compassion process.”

6. Learning to De-Escalate Situations

Emergency patients and their friends and family are having one of their worst days. Combined with sometimes long waiting periods, emotions can escalate, and patients with mental health challenges can become especially agitated. Workplace violence can result.

De-escalating these difficult situations is an essential emergency nursing skill that usually starts with verbal de-escalation techniques, but may require other nonverbal methods.

7. Playing Well on the Team

Everyone from the patient care technician to the trauma surgeon must work together for the benefit of the patient.

“ED nurses need to work as a team, especially when critically unstable patients arrive,” Wicker said. “Many interventions need to be done quickly to stabilize patients. This can only be done effectively with help from the team.”

“It is important for ED nurses to recognize the scope of the team members’ roles and responsibilities so everyone can communicate and collaborate effectively,” Dalby said. “ED nurses are also in a unique position in that they collaborate with external team members, such as first responders. Excellent communication with these external team members is vital to ensuring a seamless transfer of care.”

8. Communicating Effectively

“Nurses must be able to update healthcare team members on changes in a patient’s condition and also act as a communication bridge between the providers and patients and their families,” Wicker said.

“Communication–both verbal and nonverbal—is a crucial skill in our profession to ensure we provide the best treatment for the patient,” Foster said. “It is also the basis of many other skills, including teamwork and being able to remain calm in a high-pressure situation. You also need the ability to empathize and sympathize with everyone. What may be a normal day at work for you may be frightening or nerve-racking for a patient or family.”

Nurses must serve as an advocate for patients in their care, Eaton added, and speak up when necessary. 

9. Remaining Flexible

“Each day is completely different than the day before,” Wicker said. “ED nurses must be flexible enough to ride the waves as they come.”

“Circumstances can change quickly, with patients or volume, and nurses need to be able to hand off or assume care of other patients at any moment,” she added.

10. Being Great Educators

Emergency nurses not only must provide quality care, but also educate their patients who are discharged home.

“Patients that are discharged often are going home with new treatments or medications, [so] the nurse must educate the patient or family on how to safely manage their health at home, when to return, and how to follow up on their care,” Wicker said.

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