Daniel Andrews, BSN, MBA, RN, CEN, said not knowing what kind of patient is going to walk through the door drew him into the nursing specialty and keeps him engaged still today.
Andrews is among the speakers of the Relias emergency nurse certification review course designed to prepare ED nurses for the Certified Emergency Nurse exam.
Andrews, an emergency department nurse with four decades of experience, told us he and ED colleagues joke they are jacks-of-all-trades and masters of some.
“We have to be ready at any time to treat anything that walks through the doors,” he said. “It could be a young child with a breathing problem. It could be someone who is having a heart attack. It could be a patient who was just involved in a bad crash or accident.”
Andrews, who is director of operations at CHI Saint Joseph Health in Lexington, Ky., added, “we get to put our skills to test.”
“On the other hand,” Andrews continued, “there are those patients who may be having emotional or psychological issues or maybe have been victims of some type of substance overuse or abuse. Regardless of why they’re there, they’re asking for help.”
Training for the times
Though not mandatory, emergency nurse certification is especially important in the ever-evolving and fast-paced specialty, according to Nancy Bonalumi, DNP, RN, CEN, FAEN, who also is a speaker for the Relias course.
Many treatments that might have been done or therapies that were considered appropriate nursing interventions 10 years ago are not current in ED nursing today, according to Bonalumi, who is president of NMB Global Leadership, which provides international healthcare consulting and nursing education.
One example is how ED staff treat suspected spinal cord injuries.
“For many years, the standard of care in the emergency room was that these patients should be immobilized on a back board,” she said. “Now, there’s a physical examination, and if they’re at low risk then they can come off of that back board much sooner and not stay immobilized for a long period of time.”
Another example is how children with head injuries are treated in the ED. In the past, staff would routinely do a CT scan on children with suspected head injuries.
“We’ve learned that’s a lot of radiation and that’s not good for the developing brain, so now we have criteria,” she said. “There’s an algorithm to follow based on the type of injury and the child’s symptoms. So, if I was expecting a test question about pediatric care with head injuries, I might answer it incorrectly if I’m not current with the type of treatments that are currently being offered.”
The emergency nurse certification review course addresses the extensive knowledge base necessary in the specialty, including cardiovascular, orthopedic and other areas of care.
“Emergency nursing is such a broad specialization that it isn’t focused on only one body system, one disease process like diabetes, or one age group like pediatrics or the geriatric population,” Bonalumi said. “Emergency nurses are generalists across a spectrum but are specialists in those conditions that are urgent or life-threatening.”
A growing need for ED nurses
The number of ED visits continues to rise every year, according to Bonalumi.
“There are a number of government and non-government agencies that track the volume of patients seen in the emergency department, and we know that volume is continuing to increase,” she said. “We have a very large population of baby boomers who are headed into their later 60s and early 70s. And we know that people in that age group start to use healthcare services a lot more.”
ED utilization is relatively high for children. It tapers down through adulthood and then begins to rise pretty steeply as people start to hit age 65, according to Bonalumi.
“Today, interestingly, we have a population of what we call the ‘super elderly’ over-85 population and they are very high users of emergency care,” she said. “So we see continued demand despite efforts with the Affordable Care Act and insurance plans to drive people to physician practices and urgent care settings.”
Benefits of certification
More than 38,000 nurses achieved emergency nurse certification as of June 2019, according to the Board of Certification for Emergency Nursing.
Andrews said that in his experience, only about one in five ED nurses have the certification, and the ones who do feel a sense of accomplishment and stand out in the hiring process and among colleagues.
“Although most certifications are verified by an examination process, (there’s) still the preparation that goes into getting ready to take the exam and then the satisfaction of knowing that you accomplished something,” he said. “In addition to that I think you’re looked differently upon by your colleagues.”
Some employers offer incentives for nurses to pursue CEN certification, including a differential to those who achieve the certification, according to Bonalumi.
“I know that a number of hospitals that have achieved Magnet status will often offer support to a nurse who wants to become certified so they can be reimbursed for a review course and for taking the examination,” she said. “In addition to that, many offer a bonus to their certified nurses for having achieved certification.”