Peculiarities Of The Work Of a Nurse In ER Essay

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Being a professional nurse means caring for the overall general health and comfort, as well as, caring for and nurturing other individuals. Meeting both their physical needs for safety and good health, as well as providing comfort and ease for their emotional needs.Peculiarities Of The Work Of a Nurse In ER Essay
Being an Emergency Room Nurse is an empowering position that allows you to work along side other qualified health care professionals as a member of the Emergency Response Team, providing quality care to patients in a fast paced environment.
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They must be able to respond timely to emergency situations and assure open communication with not only patients and their families, but also with other emergency medical professionals in order to provide and ensure proper and accurate medical therapeutic intervention.

Working in such a fast paced environment, as a emergency room nurse, you will need to utilize your skills in time management. Not only prioritizing injuries, you will also be prioritizing your time while working in the emergency room. Finding yourself in an ever changing environment with many duties that you are responsible for, you will never be bored. Managing your time will allow you to confidently complete your duties in an organized manner. You can take pride in knowing your quick thinking and decision making abilities will provide quality care in your health care facility, even while multitasking.Peculiarities Of The Work Of a Nurse In ER Essay
Emergency room nurses work directly under physicians assisting the doctors in providing the best possible medical service to patients. As an emergency room nurse you will initiate an accurate ongoing assessment of each patient; identifying the unique problems and concerns of each individual. You will legibly document and compile a patient history regarding medical complaints, surgeries, and prescription medications. Collect information on current injuries, symptoms and evaluate the needs and concerns of the individual patient. The patient analysis will also note any allergies the patient

In the general conversational sense, professionalism is often considered in the context of the behaviors and actions displayed by a nurse during an episode of care delivery or while working in a healthcare setting. However, the concept has significantly greater and far-reaching implications that extend well beyond the time a nurse is on duty. Professionalism involves a state of mind that manifests through intentions, words, actions, and deeds. It’s intrinsically linked to an individual’s core values as a human being and is connected to a moral code that is set within the context of societal expectations for ethical practice.Peculiarities Of The Work Of a Nurse In ER Essay

In this framework, you’re a professional 24 hours a day, 7 days per week, whether you’re working or not. A public expectation of professionalism is the basis for nursing licensure: a state or jurisdiction grants a license to practice nursing as long as the individual nurse demonstrates that he or she is worthy of the public trust. Any actions by the nurse while working or off duty that call that trust into question can be reported to the professional regulatory body and can result in discipline, including license revocation.

Categorizing professionalism only in the sense of licensure, however, is extremely narrow and limited. If there were to be a professionalism scale from basic to advanced, for example, those behaviors and actions that only meet the standards for licensure would be at the most basic level. Numerous other opportunities exist to advance along the scale to progressively higher levels of professionalism. These include making meaningful contributions to the profession through ongoing self-development, accountability, mentoring, advocacy, and involvement. Although professionalism is rooted in an individual’s core values, it can be further developed through positive role modeling as well as through the learning and insights gained from lived experiences navigating complexity, conflict, adversity, challenge, and opportunity. The personal commitment to scholarship is a key component. According to Conard and Pape (2014), “Nurses demonstrate scholarly values as independent thinkers who engage in activities that advance teaching, research, and practice” (p. 88).Peculiarities Of The Work Of a Nurse In ER Essay

Professionalism is often considered in the context of goal achievement or reaching certain career milestones in nursing. Rather than simply identifying self-oriented career goals, however, Hinds et al. (2015) advocate that you develop a “legacy map” approach instead. A legacy map encompasses “the nurse’s plan to contribute knowledge, practice changes, or other aspects of health care to benefit those who receive nursing care” (p. 212). These goals are considered to be of a higher order, more enduring, and intrinsically connected to a sense of professional wellbeing that stems from improving the experiences or outcomes of others (Hinds et al., 2015).
Use a legacy map as a personal guide to accomplish the legacy you want to leave on the profession of nursing and through your life overall. Hinds et al. (2015) suggest these key questions to explore when creating a personal legacy map:
What do you want to be better in nursing because of you and your efforts?Peculiarities Of The Work Of a Nurse In ER Essay
What would you like best to be known for by others?
What do you hope your legacy will be in life?
Given the myriad of professional opportunities available to emergency nurses today, the only real boundaries are the ones that you impose upon yourself. Howard and Papa (2012) maintain that “as emergency nurses of the future, it is essential to focus on the changing health care system, consider personal career paths, establish goals, and meet the challenge to accomplish these goals” (p. 551). This chapter seeks to explore activities that promote professionalism so that emergency nurses can map their own career path to fulfillment and success.
Fostering evidence-based practice
There was a time not that long ago in nursing history when the accepted rationale behind nursing interventions was purely based upon concepts taught in nursing school or handed down as tradition by nursing “experts.” According to Proehl and Hoyt (2012), “…nursing practice has always been based on some sort of evidence. It just was not necessarily good evidence” (p. 1). Similarly, nursing actions were often primarily guided by physician orders. For any given disease entity or injury, there were few if any research-driven, standardized approaches to the treatment plan among the various providers. The notion of employing outcome-based methods that were supported by scientific evidence in patient care was not part of the framework for typical day-to-day nursing practice.Peculiarities Of The Work Of a Nurse In ER Essay

The need for rigorous scientific inquiry to evaluate the validity and effectiveness of healthcare interventions as the basis for modern-day practice has only gained widespread recognition in nursing within the last 30 years or so. Our professional culture is finally shifting to one that questions the efficacy and necessity of the strategies and methods of delivering care that frontline nurses employ. The value of research as an essential component in professional nursing practice is now well accepted and mainstream. Not only is scientific evidence required to serve as the rationale for nursing actions, but the strength of that evidence is also critiqued to give practitioners a sense of how well-supported any particular strategy is in the current literature (Rishel, 2013).

In the ER, time moves quickly and there’s not a lot of time to adjust. One minute, you might work with a critically declining patient who has been in a major car accident. The next, you could see a patient with a common cold.

Every day in the ER is different, and ER nurses must be able to adapt and respond to new situations at a moment’s notice. Although working in the ER might be too fast-paced for some nurses, I have found it to be an incredibly rewarding field. As an ER nurse, I have learned valuable leadership, communication and critical thinking skills, while also expanding my nursing knowledge and expertise in a variety of specialties.Peculiarities Of The Work Of a Nurse In ER Essay

What do ER nurses do?
Along with other first responders and emergency medical professionals, ER nurses work quickly to provide the best possible care for patients who might be suffering from life-threatening injuries or illness.

ER nurses work in a variety of settings, from Level 1 trauma centers to rural hospitals or clinics. We treat a variety of injuries, illnesses and complications and work with patients of all ages and backgrounds.

Due to rapid patient turnover, ER nurses also work across several medical disciplines. Throughout my nursing career, I have gained valuable professional experience and knowledge in several different areas of the nursing field, from trauma to pediatrics.

What does it take to be an ER nurse?
ER nurses should have good communication and collaboration skills. You need to quickly build rapport with a patient in order to complete an initial assessment and work with a team of doctors and other nurses to make sure the patient receives appropriate care.

Strong critical thinking skills are also essential for ensuring optimal patient care, especially when there are lives are at stake. ER nurses need to be confident in their knowledge and training, but also use good judgment to act in the best interests of the patient, and ask for guidance from other members of the medical team when necessary.Peculiarities Of The Work Of a Nurse In ER Essay

Working with critical patients, I learned quickly how to adapt to urgent situations, work autonomously and think at a higher level.

How do I become an ER nurse?
The ER taught me that nursing is a profession that requires lifelong learning. I decided to pursue an advanced nursing degree to help expand my nursing knowledge so that I can provide my patients with the best possible care. I have also learned from working with other medical professionals and by participating in continuing education activities.

ER nurses are registered nurses (RNs) and must obtain at least an associate’s degree in nursing (ASN). Many ER nurses go on to obtain a bachelor of science in nursing (BSN) and additional certifications for specialized care, such as cardiopulmonary resuscitation and advanced cardiac, pediatric, and newborn life support. Some hospitals also recommend a Trauma Nursing Core Course (TNCC) certification.

Today, as an associate nursing professor at Herzing-Madison, I use my ER knowledge and experience to help students develop skills for a successful nursing career.Peculiarities Of The Work Of a Nurse In ER Essay

Times have indeed changed, but process and attitude changes have been slow to take root in day-to-day clinical practice. There are still substantial obstacles to applying research findings and incorporating evidence into practice at the point of care delivery. In a study that evaluated staff nurses’ use of research to facilitate evidence-based practice (EBP), Yoder et al. (2014) found that although nurses’ attitudes were positive about research, lack of time, resources, and knowledge were the most frequently identified barriers. They discussed a general theme in which staff nurses believed that unit educators or clinical nurse specialists—as opposed to themselves—were responsible for ensuring appropriate research utilization and incorporating EBP at the unit level.


Research and EBP are actually complementary but different entities. Research yields findings related to specific study questions and is a component of EBP. The concept of EBP involves reviewing research findings, evaluating the strength of the findings based on study design, and even taking into account expert opinion when research in a particular area is lacking or inconclusive. According to Yoder et al. (2014), “EBP models consider many types of evidence, including empirical research, clinical expertise, the expressed needs of patients, and the opinions of thought leaders” (p. 26). It’s clear that EBP encompasses far richer sources of information than research results or scientific inquiry alone. Of significance is the integration of professional expertise, science, and patient-centeredness into the EBP construct. In this regard, Salmond (2007) nicely summarizes EBP in the following manner:Peculiarities Of The Work Of a Nurse In ER Essay
Evidence-based practice (EBP) requires a shift from the traditional paradigm of clinical practice grounded in intuition, clinical experience, and pathophysiological rationale. In the EBP paradigm, clinical expertise is combined with integration of best scientific evidence, patient values and preferences, and the clinical circumstances. (p. 114)
Following clinical practice guidelines
Ultimately, expert critical thinking is required to synthesize evidence into models or clinical practice guidelines (CPGs) that can be applied directly to patient care.
Clinical practice guidelines—Documents that provide the framework to care for a particular clinical situation. Clinical practice guidelines provide an assessment of the benefits and harms of alternative care options and help to optimize patient care by standardizing care based on scientifically sound research.
Emergency nurses on the frontlines can support true EBP in a variety of ways. Using CPGs that contain the best available evidence to inform clinical decision-making is essential. CPGs serve to facilitate the translation of EBP into actual care delivery at the bedside (Clutter, 2009). Emergency nurses “…should have foundational knowledge of EBP CPGs and deliver care using EBP guidelines” (Clutter, 2009, p. 460). Because the quality and strength of the evidence are of paramount importance, pre-appraised evidence sources are available that have been rigorously evaluated to help busy frontline clinicians (Salmond, 2007). An excellent public resource that contains a very large collection of evidence-based CPGs is the National Guidelines Clearinghouse, sponsored by the Agency for Healthcare Research and Quality (AHRQ), available online at (AHRQ, n.d.). You can access this site, search, and download CPGs across a wide range of healthcare topics. The strength of the evidence to support interventions listed in the CPG is included. This site is an excellent repository of high-quality information that you can utilize instead of reinventing the proverbial wheel when the need arises for a new or updated CPG in your own practice setting.
Other valuable sites that offer access to a variety of evidence-based CPGs include:

Centers for Disease Control and Prevention (CDC), which focuses on public health and disease prevention. This website can be accessed at
U.S. Preventive Services Task Force (USPSTF), which contains recommendations for preventive health services, can be accessed at
The Emergency Nurses Association (ENA) has a dedicated “Practice Resources” section on its website that provides a host of excellent materials for EBP, including CPGs, position statements, standards of practice, and tool kits to help emergency nurses elevate their practice. These resources can be accessed at Of The Work Of a Nurse In ER Essay
Searching evidence-based literature
Given the rapid pace of scientific advancement, you should strive to engage in practice with an open, inquiring mind that formulates questions and pursues answers to clinical and operational questions through searching evidence-based literature. Conard and Pape (2014) suggest that “nurse scholars immerse themselves in the literature and become experts in their topic” (p. 88). No longer should you simply accept at face value what is told to you as fact; nor should you depend upon long-held beliefs or view rituals in patient care as sacred truths. Salmond (2007) provides a different and much more robust EBP framework in which to consider all aspects of professional nursing care delivery:

The new values of EBP call for all practitioners to adopt a mindset of informed skepticism. The EBP clinician asks the wicked questions: Why are we doing it this way? Is there a better way to do it? What is the evidence for what we do? What practice guidelines are available to support my practice? Would doing this be as effective as doing that? and What constitutes best practice? (p. 118)
To stimulate professional growth and foster a vibrant practice environment at work, you can pose such clinical questions or controversies and share results of the literature review with colleagues at staff meetings or through unit-based newsletters. Peculiarities Of The Work Of a Nurse In ER Essay Forming an ED journal club is an excellent strategy to communicate information from the literature, promote evidence-based practice, introduce the value and evaluation of research, and build interprofessional collaboration skills (Rishel, 2013). Questions can be developed which help to guide you in a critical review of the articles selected for discussion (Rishel, 2013). In this way, the staff-at-large can participate to the degree that they are comfortable, and new information can be appraised and carefully considered for possible integration into practice.

Applying research to the bedside
The critical competency for emergency nurses is the ability to effectively translate the results of evidence-based research from the literature to the bedside (Carman et al., 2013). Even though the study results might indicate that a particular intervention, process, or practice appears to be successful, Carman et al. (2013) caution that the quality of the study, the efficacy, and the applicability of the findings to a particular emergency department setting have to be carefully considered; the “fit” may or may not be appropriate, and adjustments may be necessary before implementation is attempted. Otherwise, unrecognized or under-appreciated differences in the ED environment from the study setting (such as the physical structure, culture, policies, resources, and politics) can affect the success of translating the research into practice. Similarly, Wolf et al. (2013) warn that practice changes are typically not made based upon a single study alone: “One should not take a single study and use the results to implement change, unless the study is so large and so well done that professional practice organizations are suggesting changes” (p. 199).Peculiarities Of The Work Of a Nurse In ER Essay

An excellent strategy to stimulate interest in evidence-based practice and apply the findings in the clinical setting is to have research experts involve emergency nursing staff directly in a research project. Based upon their interest and aptitude, staff can be invited to participate in any phase of the study process, from reviewing the literature to assisting research experts with study design considerations, implementing the intervention, collecting the data, or analyzing the results. Tanabe, Gisondi, Barnard, Lucenti, and Cameron (2009), for example, found that a staff-based participatory research methodology led to positive operational changes as a result of having charge nurses help to design, implement, and evaluate a process that involved closing the ED waiting room during certain hours of the day.

Academic teaching hospitals, particularly those that have achieved Magnet® designation, often employ PhD-prepared nurse scholars who can guide the design of a research project and help to obtain the necessary institutional review board (IRB) permissions to conduct the study. In Magnet® hospitals, these nurse scholars can advise and facilitate the work of frontline nurses who are members of evidence-based practice councils or research councils. Emergency nurses certainly have the option of joining these councils if they have a sincere interest in research, or they can participate in approved research by serving in a data-collection capacity. For the majority of hospitals that do not have research experts readily available, developing partnerships with nursing faculty in a university setting can be mutually beneficial for both the healthcare facility and the academic institution. When information on a particular subject is lacking in the literature, you can then pose a study question to experienced faculty as a means of stimulating a possible collaborative research effort.Peculiarities Of The Work Of a Nurse In ER Essay

ENA also has an Institute for Emergency Nursing Research (IENR) that promotes EBP through advancing research efforts in emergency nursing. Its website ( includes a listing of both current and completed research studies, CPGs, research priorities, requests for feedback via surveys, external research and funding opportunities, and white papers. In an article series written by members of IENR’s Advisory Council to stimulate bedside nurses’ interest in and understanding of research and EBP concepts, authors made a compelling argument as to why research is essential on the frontlines of care delivery: “As the most direct person providing care to persons in their most dire hour of need, it is imperative that we ask the questions, find the evidence, and translate it into the best of care” (Wolf et al., 2012, p. 591).

Seeking lifelong learning/maintaining competency
The pursuit of continuous learning is not only an obligation to maintain competency, but also the cornerstone of professionalism in emergency nursing. The Institute of Medicine’s (2011) Future of Nursing report specifically cited lifelong learning as an essential component of nursing practice. Given the rapidly evolving healthcare system, professional and societal expectations also dictate the need for nurses to pursue lifelong learning (Rishel, 2013). It’s important to recognize that lifelong learning and competency are fundamentally related. The Emergency Nurses Association’s (ENA) Code of Ethics (2015a) explicitly identifies your obligations related to competency by stating, “the emergency nurse maintains competency within, and accountability for, emergency nursing practice” (p. 1). However, Harding, Walker-Ciollo, Duke, Campos, and Stapleton (2013) assert that “competence occurs not in isolation but needs to be tailored to the current best evidence, quality initiatives and indicators, and safety” (p. 255). Because maintaining competence is a duty for the duration of your career, and the science that underlies nursing theory and practice is being constantly updated, a commitment to lifelong learning is vital. As new knowledge is integrated into the literature and incorporated into standards of care, you must “remain abreast of new technology, treatments, and trends across health care” (Howard & Papa, 2012, p. 551).Peculiarities Of The Work Of a Nurse In ER Essay

In the fast-paced, highly acute, and complex world of emergency nursing, lifelong learning is especially relevant because the scope of practice encompasses the full range of illness, injury, and associated human responses from birth through death across the entire age spectrum. The knowledge necessary for expert emergency nursing practice is extremely broad. Because you deliver care to patients at some of their most vulnerable periods, time is often of the essence. You must possess a ready, actionable knowledge base that is up to date. Your initial actions can directly affect patient outcomes by what you do, or do not do. Harding et al. (2013) categorize emergency nursing competencies in the context of specific ED processes such as triage, the use of assessment tools like the Broselow Tape, and the ability to utilize commercial products such as a high-volume fluid infuser. Remaining current in regard to assessment techniques, priority setting, care delivery standards and tools, the patient’s anticipated clinical course, diagnostic modalities, and outcome evaluation is critical to safe and effective nursing practice.Peculiarities Of The Work Of a Nurse In ER Essay

Equally important to safety and overall professionalism are the competencies related to maintaining collaborative inter- and intradisciplinary relationships, risk management, hand-off communication and care transitions, as well as efficient emergency department operations. All together, these aspects of the emergency nursing role clearly dictate the need for ongoing education to inform professional practice. You must make a conscious effort to assess your learning needs in an ongoing manner to have an accurate sense of the type of educational opportunities that you need to pursue. Scholarship and self-directed learning are hallmarks of professional practice.

Approach to learning
Your core attitudes and beliefs about lifelong learning as a professional obligation are key determinants of professional success. From a worldview perspective, you may perceive learning as either a burden or a growth opportunity. This worldview influences whether you approach educational experience passively or actively:Peculiarities Of The Work Of a Nurse In ER Essay

In the passive approach, an educational activity is a job or licensure requirement that must be accepted, tolerated, or even endured. You only participate because you know the activity is required and not participating would likely result in a negative consequence. However, depending upon your overall interest in the topic and the effectiveness of the educator in stimulating new ways of thinking or practicing, your degree of engagement with the learning activity may be negligible.
“Individual professional development starts when nurses acknowledge that they must be a lifelong learner” (Rishel, 2013, p. 539).
In the active approach, you enter the learning event with an openness and intellectual curiosity that enables critical thinking and integration of new knowledge into practice. You also seek opportunities for ongoing learning. With an inquisitive mind, you pursue answers to the question why in clinical practice and research best practice approaches using high-quality, evidence-based resources and appropriate point-of-care references. An active pursuit of learning is both in the moment as well as deliberately planned to incorporate a variety of educational opportunities over the course of a career.Peculiarities Of The Work Of a Nurse In ER Essay
Learning venues
There are multiple formal and informal learning venues for emergency nurses. These include hospital-based in-service education, both of the mandatory and elective varieties; conferences external to the healthcare institution; and academic programs that lead to a BSN, MSN, MBA, or doctoral degree (DNP or PhD). All certainly have significant value. Ideally, you should take advantage of the offerings as your professional needs, time, resources, and personal circumstances allow. Technology has added to the repertoire of available options. In the past, nursing education has been offered in lecture-based formats for learning. However, many nurses expressed a clear preference for hands-on or case-based learning opportunities. The growing popularity of simulation labs both in nursing schools and in hospitals speaks to the value of both learning and applying new knowledge in a realistic clinical scenario. High-fidelity manikins offer opportunities for full participant engagement in the scenario and hands-on competency development in relation to acquiring or honing practical skills. The use of healthcare actors who play a patient role provides nurses with challenging situations in which interpersonal communication skills may be challenged and ultimately improved. These types of learning experiences are frequently conducted using teams that include physicians, nurses, and allied health personnel to promote more effective teamwork, collaboration, and the development of interdisciplinary competence in patient care.Peculiarities Of The Work Of a Nurse In ER Essay

Stepping outside of your institution to attend local, regional, or national conferences, such as the Emergency Nurses Association Annual Conference, brings significant benefits. You have the chance to update your knowledge base regarding the latest developments and thinking about current topics in emergency nursing. You can also derive value by networking with colleagues from other facilities who may be dealing with similar issues or challenges. Professional relationships can form, which can evolve into long-lasting connections that are beneficial over the course of your career.

If the conference attracts international participants, you can come away with a very well-rounded view of current emergency nursing challenges and how they are addressed on a more global scale. Learning about the nursing or healthcare issues in another country helps place perspective on the significance of the issue and enables innovative approaches to problem solving. It’s especially interesting and often eye opening to learn of the resource constraints that exist in other healthcare settings and how other emergency nurses deal with the situation. This cross-cultural exchange supports rich dialogue, deeper professional connections, and the ability to look outside of the usual ways of thinking about issues.Peculiarities Of The Work Of a Nurse In ER Essay

Funding learning opportunities
Unfortunately, institutional funds to support emergency nursing education may be limited in many settings. When they are available, the employer may only fund attendance at facility-based or local educational events. Participation in a regional or national conference often requires that you finance part or all of the expenses out-of-pocket. Typical costs include travel, meals, incidentals, as well as the fees associated with conference registration and any special pre-conference workshops. Although these costs may be prohibitive, several effective strategies can help to manage the financial impact:

Set up a workable personal savings plan to fund attendance at a high-quality conference every 1 to 3 years. This strategy entails the ability to create a realistic budget for conference participation as well as the discipline to save the necessary amount of money, factoring in possible price increases.Peculiarities Of The Work Of a Nurse In ER Essay
Itemize taxes to deduct costs as business or professional expenses. Personal recordkeeping is essential in this endeavor to show evidence of and validate legitimate tax-deductible expenses.
Utilize frequent flier miles or hotel points that are part of brand loyalty plans to reduce conference travel costs. Check to see whether local hotels have arranged for reduced rates for those attending the conference. You could also consider sharing a hotel room with colleagues as a cost-saving measure.
Join a professional organization that provides membership discounts for conference attendance. A benefit of active participation at the local chapter level is that it sometimes comes with opportunities to apply for conference scholarships. There might also be an option to serve as a chapter delegate at the conference itself with funding from the organization, particularly if you are a chapter officer.
The Internal Revenue Service (IRS) allows many legitimate educational expenses to be deducted from a nurse’s income, reducing the amount of income subject to tax. To qualify, the education must be required either by law or the employer to keep present salary, status, or job and serve a bona fide business purpose to the employer or maintain/improve the skills needed to work as an emergency nurse (IRS, 2015). It’s important to work closely with your tax professional to ensure that all deductions meet the requirements of the law.Peculiarities Of The Work Of a Nurse In ER Essay
Apply to be a poster presenter or podium speaker. Such participation, particularly as a speaker, frequently leads to reduced or waived registration fees and perhaps even reimbursement for selected travel expenses within specified limits by the conference organizer.

The other benefit is the lifelong-learning opportunity to develop or refine skills in poster presentation, public speaking, and even publication that arise from this level of conference participation.

Completing an academic program
Academic programs are very much a part of a successful educational plan for lifelong learning. Pursuing baccalaureate education is a must if your entry-level nursing education was from a diploma or associate’s degree program. The American Nurses Credentialing Center (ANCC, 2013) requires that all hospitals seeking Magnet® designation or re-designation must achieve an 80% rate of baccalaureate education in the nursing staff by the year 2020. Not having a baccalaureate degree in nursing will serve as a significant rate-limiting step for both jobs and career-enhancement potential. Nursing employers, particularly those with Magnet® hospital designation, may offer some degree of tuition assistance to offset the costs of returning to school.Peculiarities Of The Work Of a Nurse In ER Essay

The baccalaureate degree is the springboard into master’s, doctoral, and post-doctoral academic programs. Deciding how far to go in the academic realm is determined by your career aspirations and the corresponding formal educational preparation requirements. As you move through your career, scholarly aspirations may shift in different directions as new interests develop and personal or professional needs change. The key to success is to plan so that no barriers stand in the way of moving from one educational level to the next when the time is right. That means maintaining excellent grades, building lasting professional relationships with faculty, and selecting quality academic programs that support seamless transitions.


Gaining certification
Certification in a nursing specialty area represents an objective mark of professional excellence and commitment for the emergency nurse. In the broad perspective, it validates that you’ve successfully acquired an up-to-date body of knowledge, skills, and experience that encompasses the scope and standards of practice for a particular nursing specialty (Rishel, 2013). Certification engenders a measure of professional recognition and achievement for the recipient. In that context, it may be a requirement for advancement or promotion if your healthcare facility has a nursing leadership structure that offers a formal clinical ladder. Attaining certification might also entitle you to receive a certification pay differential or a higher salary overall.Peculiarities Of The Work Of a Nurse In ER Essay

According to the Board of Certification for Emergency Nursing (2015), more than 30,000 emergency nurses are currently certified.
The healthcare institution also benefits from employing certified nurses. Certification serves as tangible evidence of your commitment to and individual responsibility for professional development (Kaplow, 2011). A high rate of professional certification is very favorably viewed and even expected by a number of hospital accrediting agencies such as The Joint Commission, the American College of Surgeons Consultation and Verification Program for trauma centers, and the American Nurses Credentialing Center’s Magnet Recognition Program®. Patient outcomes are also positively affected: Kendall-Gallagher, Aiken, Sloane, and Cimiotti (2011) found that for every 10% increase in hospital nurses who had both their BSN and professional specialty certification, the risk of 30-day inpatient mortality and failure to rescue decreased. However, Altman (2011) found that some key barriers can negatively affect certification rates in the hospital: “Fear of test-taking or failure and lack of resources or organization recognition are reasons many nurses cite for not becoming certified” (p. 68).Peculiarities Of The Work Of a Nurse In ER Essay
Professional certification requirements vary depending on the type of specialty exam but typically include a practice requirement in the specialty, passing a standardized test, and either periodic re-testing or maintaining a specified composition of continuing education credits and professional activities, such as presentation or publication in every certification review cycle. Recertification intervals are dictated by the certifying body and generally fall in the 3 to 5 year range. Some certifications also mandate specific academic credentials like a bachelor’s degree or master’s degree in nursing as a qualifier to sit for the exam. For example, certification as a clinical nurse specialist or nurse practitioner requires a graduate degree in the appropriate nursing specialty area.

Each certification exam has its own unique application process and fee schedule. The application includes standard demographic and academic information. It may also contain questions about your practice setting and license or registration number. An unrestricted registered nurse (RN) license is an admission requirement. Depending on the exam, practice hours or years of service may be either recommended or required as a qualification to sit for the exam; a nursing supervisor signature may be needed to substantiate that the applicant has attained the specified work experience. Application fees vary by exam type and usually fall within a $200 to $400 range. If the certification exam is associated with a particular professional nursing organization, discounts on testing fees are usually available as a benefit for active membership. Some hospitals do offer reimbursement for exam fees and preparation expenses associated with the exam as both an incentive and a reward for successfully passing the test. In the same manner, institutions may also reimburse the expenses related to recertification.Peculiarities Of The Work Of a Nurse In ER Essay

Unrestricted license—A license to practice nursing without active disciplinary action by the professional licensing board.
Once the application is processed, you’re sent a letter or electronic communication confirming that you can sit for the exam. Also included in the correspondence is pertinent information about how and where the test is offered and any special requirements such as having a valid driver’s license with picture identification available for admittance to the testing site.
Although some exams may still be offered in a paper and pencil format, the most common testing modality is via the computer in a designated, proctored testing center. Fear of test-taking is a common concern among nurses (Teal, 2011). The most important success strategy is devoting sufficient time and effort to test preparation. Exam preparation books, sample questions, review courses, and other educational resources should be obtained well in advance of the testing date to support test-taking readiness. Forming a study group is another excellent strategy to facilitate learning as well as build a peer support network for two or more emergency nurses studying for the same exam.Peculiarities Of The Work Of a Nurse In ER Essay

Another common option if you have specialized training in forensic nursing is to obtain the Sexual Assault Nurse Examiner–Adult (SANE-A) and/or Sexual Assault Nurse Examiner–Pediatric (SANE-P) certification through the International Association of Forensic Nurses. There are also several certification exams available that cover a wide range of nursing specialties and have relevance to various aspects of emergency nursing practice, including adult or pediatric critical care nursing, gerontological nursing, nursing leadership, staff development, as well as a host of advanced practice certifications if you have a graduate degree. As long as the requirements are met for initial certification or recertification, you can achieve a number of certifications to represent your expertise. The challenge becomes the time, effort, and expense in maintaining all of them.

Adhering to institutional policies and procedures
As an emergency nurse, you have a professional obligation to maintain knowledge of the institutional policies and procedures that govern practices and operations in your workplace. These policies and procedures are often established to meet regulatory requirements set forth by federal, state, and local government agencies as well as hospital accrediting bodies such as the Centers for Medicare & Medicaid Services (CMS), The Joint Commission, and the American College of Surgeons Committee on Trauma. Other policies and procedures may be connected to standards of care based on evidence-based practice sources as well as institutionally derived protocols and processes. At the most basic level, knowledge of the laws that govern nursing practice as well as institutional policies, procedures, and processes is an important defense against professional liability (Balestra, 2012).Peculiarities Of The Work Of a Nurse In ER Essay

In that regard, failure to follow institutional policies and procedures can lead to personal, professional, and institutional liability; regulatory consequences such as institutional citations or de-accreditation; and employer sanctions up to and including termination of employment. An important caveat, however, is that an institutional policy or procedure cannot override federal or state law or regulations if the documents are at odds. Laws and regulations supersede hospital policies.

For example, if the Nurse Practice Act in a particular state does not allow nurses to delegate intravenous catheter insertion to unlicensed assistive personnel (UAP), but a hospital policy authorizes this practice, the nurse who follows the hospital policy could be found guilty of professional misconduct by the nurse licensure board.Peculiarities Of The Work Of a Nurse In ER Essay
Given the vast number of policies and procedures in most institutions, it’s typically not possible to retain detailed information about all of them through memory alone. It’s your professional responsibility to know how to locate the relevant policies and procedures and consult them as needed to inform practice and ensure that care delivery conforms to institutional expectations. The professional obligation does not stop there, however. In cases when the policy or procedure does not adequately address the issues at hand, use the ED’s administrative chain of command to seek expert clarification of the appropriate course of action when needed. In this case, you’re in an optimal position to raise awareness about gaps in policies and procedures that demonstrate the need for policy revision or development, and also participate in the effort to update or create the document based upon a review of current standards or best practices in the literature. This effort gives you an excellent opportunity to expand your knowledge base on the subject matter, take a leadership role in problem resolution, and become a resource for other staff on the topic. If the policy or procedure is not available at the point of care in a user-friendly format, you can also advocate for system changes that improve access to essential information when it is most needed in clinical practice.
Though the rationale underlying most institutional policies and procedures is rooted in good intentions, some may impose barriers to appropriate care delivery or add unnecessary burden. With that said, the policies or procedures cannot simply be ignored. Change is needed. When the policy or procedure is institutionally derived and not based on accreditation, regulatory requirements, or the latest best-practice evidence, the process simply requires that you make the effective argument for revision to the institutional leader(s) who maintain(s) the documents. Having data, current literature, or expert opinion to support your recommendations enhances the strength of your argument for change. This revision process may still take significant time, especially if new processes have to be developed, reviewed, tested, signed-off on by all key stakeholders, and then successfully disseminated to staff. If the policy or procedure that requires modification is linked to a regulation or statute promulgated outside of the healthcare facility, the change process is much more complex and time consuming. It may require statutory change that ultimately must undergo legislative action. The take-home point is that if you see a need for modifications in institutional policies and procedures, an important aspect of professionalism is advocacy for positive change.Peculiarities Of The Work Of a Nurse In ER Essay

Serving on institutional committees
Having the opportunity to serve on an institutional committee can significantly contribute to your professional growth. Emergency nursing leaders are often asked by organizational leaders if they can appoint one or more members of their staff to institutional committees or work groups. These committees are generally focused on system-level concerns that may also be relevant to various aspects of emergency care or operations. You can offer critical insights as an emergency nurse into issues as well as support the development of organizational strategies and goals. At the same time, “…soliciting staff input on goals, specific targets, and solutions may lead to an overall sense of ownership and investment,” inspiring a culture of shared responsibility for achieving organizational goals in frontline nurses (Berkow et al., 2012, p. 167). Emergency nursing leaders may solicit participation from the nursing staff-at-large and then appoint a nurse in good standing who volunteers. The leader might also choose to select a nurse who has previously expressed a specific goal or interest area that fits well with the committee’s mission or purpose, or one who has demonstrated a complementary skill or competency that will prove valuable to the committee.Peculiarities Of The Work Of a Nurse In ER Essay

Becoming a committee member enables you to step outside of the ED worldview, build new connections, and gain a broad-based perspective on issues pertinent to the healthcare facility, the community, the state, and perhaps the nation. This perspective can help you better understand key organizational initiatives and decisions as well as translate their relevance to ED co-workers. At the same time, your professional perspective contributes to a more robust approach to strategic analysis, planning, and problem resolution, especially when committee goals, objectives, or issues touch upon the ED in some way. Needleman and Hassmiller (2009) corroborate the value of frontline nurses’ participation in decision-making:

Nurses develop substantial knowledge of the strengths and weaknesses of hospital systems and how they fail … nurses’ perspectives must be represented at the highest levels of hospital leadership and integrated into hospital decision making. In addition, consistent with process-improvement research that identifies the active involvement of front-line staff as a critical factor in making and sustaining change, processes for engaging nurses and other front-line staff also need to be expanded. (p. w627–w628)
When considering an appointment to an institutional committee, you should make a sincere effort to understand the goals and objectives of the group, as well as all of the expectations of the members, ahead of time. If the requirements do not appear feasible, it’s best not to accept the appointment and allow another representative who can meet the expectations to serve.Peculiarities Of The Work Of a Nurse In ER Essay

Common areas of focus for institutional committees that you may participate in as an emergency nurse include access to care, hospital operations, quality and safety, process improvement, infection prevention, human resources, patient flow, standardized care pathways, nurse staffing, employee engagement, electronic medical records, and accreditation. Peculiarities Of The Work Of a Nurse In ER Essay

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