Health

The role of family nurse practitioners in emergency care

The emergency room (ER) and urgent care settings are busy, fast-paced environments where staff can never be certain what the day or night will bring. Many different medical professionals work in emergency care settings and it attracts those who are quick at thinking on their feet. While emergency care roles are highly demanding where staff witness those at their most distressed and vulnerable, it is also a highly valuable role, where medical professionals make a difference every single day to those in need. There are several different nursing roles in emergency care and although it may not be the first thing you think of when considering emergency care, family nurse practitioners play an important role.

Family nurse practitioners

FNPs are advanced practice registered nurses who provide healthcare services to people of all ages. Usually after qualifying, new nurses work as registered nurses (RN) for a few years. After this, many take further qualifications to help them advance their careers. Nursing is a career that suits the ambitious, with many different paths—and one of these is to become an FNP.

FNPs can work in a variety of settings including in schools and the community, often with their own practice and patient list to whom they provide primary care at all stages of their lives. However, many also choose to work in hospitals, and this can include the emergency room and other urgent care settings.

Working in emergency departments provides a different type of work for the FNP. Unlike the community-based roles which usually have set working hours and provide mostly primary care, those who work in ERs will have a more irregular shift pattern of work, including working weekends and holidays, and offer mostly urgent care.

Becoming an FNP

To become a nurse practitioner (NP) nurses usually undertake further study with a master of science in nursing (MSN) or a doctoral program (DNP). There is usually a choice as to whether to undertake an MSN or DNP with the aim of becoming an FNP or an AGPCNP, with the latter providing adult and gerontology primary care. While there is some overlap in the role, FNPs must also cover pediatric care, while AGPCNPs will take courses that cover the unique care that elderly patients require. MSN programs are widely available at universities both in person and through online study.

The University of Indianapolis offers accredited online MSN and DNP programs that include clinical placements for nurses aiming to become an FNP or an AGPCNP. If you considering the benefits of an FNP vs. AGPCNP course, then finding out more about the different programs at the University of Indianapolis can help you make the decision. Both are highly rewarding roles that will provide a diverse and challenging experience as a nurse. However, for those wanting to work in the emergency department, the FNP programs may be better options as usually ERs will need NPs with expertise and experience in pediatrics.

FNPs who work in ERs will find themselves in an adrenalin-fueled, fast-paced working environment where they will undertake a variety of roles to care for patients of all ages who need urgent and emergency care.

Primary care

Although the perception of the ER is of a place patients go after a catastrophic accident or when suddenly becoming dangerously unwell, the reality is different. Most people coming to the ER are there for minor reasons and can be quickly treated or discharged.

One role the FNP might undertake in the ER is the management of chronic conditions. Patients can sometimes struggle to manage a chronic condition, particularly when newly diagnosed and if they get into difficulties at a time when their usual healthcare provider is closed, they will likely come to the ER. FNPs usually have a lot of experience in the management of chronic conditions such as diabetes or asthma and so are well-placed to offer advice and support. They may need to monitor the patient’s condition and can give further advice on good management. Often what the newly diagnosed most need is reassurance that they are acting correctly, and their condition is not getting worse.

Pregnancy is another anxious time and expectant mothers will be advised to seek help for any concerns. When their usual care setting is closed, they may come to the ER for an easily treated ailment such as a UTI. FNPs in the ER may also treat those with more serious problems such as severe nausea. There may be serious concerns also for the unborn baby such as pain or bleeding with the threat of premature birth or concerns over fetal movements. In these cases, the FNP may need to provide monitoring or arrange for checks on the pregnancy such as an ultrasound. While often the expectant mother can be discharged, feeling reassured all is well, the FNP may need to call in an obstetrician if there is a risk to the life and health of the mother and/or the unborn child.

Children

Children can be accident-prone, often suffering injuries that can range from minor to life-threatening. When ill, their condition can change rapidly and they may not be able to easily articulate exactly what is wrong. Parents and carers tend to be understandably anxious in the face of illness and injury. As a result, the advice is generally that it is far better to get a minor injury or illness checked out if the parent is worried than risk not getting help and it turning out to be serious. 

Children and infants make up a high proportion of patients in ERs and specialist care can make a big difference to the outcome. FNPs with their pediatric training are well placed to provide primary care for children with minor injuries or illnesses. They may also be called upon to provide urgent care for children either alone or with other medical professionals, where their experience with caring for children’s health renders them highly valuable.

Autonomy and teamwork

Many nurses are drawn to becoming FNPs because they can work with a high level of autonomy without the supervision of a senior nurse or physician. When they work in the community, they may have their own practice where they work independently with patients whom they treat throughout their lives, making decisions on treatment or referring them to other medical professionals. The ER is a very different environment, staffed with a wide variety of medical professionals.

Whether the FNP working in the ER works autonomously or as part of a team will change regularly depending on the condition of the patient and how busy the ER is. FNPs can still work autonomously in the ER and in a busy department, and this is part of what makes them highly valuable as it can be difficult to spare the staff for supervision purposes.

However, not everyone who comes to the ER is there for a minor or easily treatable condition and some cases are both urgent and complex. In these cases, a team will be required and the FNP, as an experienced nurse with skill in working with all ages in a wide variety of conditions, can be a valuable member of that team. This teamwork aspect of the role is often one of the reasons why FNPs choose to work in the ER and other urgent care settings. As each member of the team will bring their own unique abilities to the emergency, there is the chance for the FNP to share their expertise with other medical professionals, while also enhancing their own knowledge through learning from others and gaining a greater insight into their roles. Working with other medical experts is an effective way of boosting their own professional development.

High acuity cases

The acuity level refers to the severity of a patient’s condition with high acuity meaning a high level of severity. Although most patients visiting the ER come for more minor reasons, there will also be a sizable account with high acuity trauma, injury, or illness such as in cases of a car crash or heart attack, who will need urgent and often complex care. FNPs are among the medical professionals who may offer this treatment.

High acuity patients may require urgent stabilization in a life-threatening case and this can include acute resuscitation. An FNP working in the ER will require high levels of competency in this. These life-and-death situations are very different from the type of work an FNP will usually encounter when working in their own practice in the community, but for the patient, having a skilled team that includes an FNP working on them can make all the difference.

How to work in an ER as an FNP

Although FNPs play a valuable role in ERs and urgent care settings, it is still not their usual place of work. If becoming an FNP in the ER interests you, there are ways you can increase your chances of finding a position. Once you have qualified as an RN, try to get experience working in an ER. This will allow you to see how an ER functions and to be certain it is the right working environment for you. 

Darning your MSN, you will be expected to undertake a number of clinical hours. It is a good idea to undertake some of them within an urgent care setting or an ER. If your university provides support in securing clinical placements, let them know that this is the type of clinical placement that would interest you. For those on an online degree, you will likely take your clinical placements at a location near your home, but a good online course provider will still offer support in securing the placements that will meet your ambitions. Many nurses continue to work while studying for their MSN and if this includes ER work, then this will be valuable when you are applying for positions as an FNP in an ER.

When applying for jobs make the most of the connections you have built up through work and clinical placements.

Emergency nurse practitioners

Patients attending an ER may expect to see an emergency nurse practitioner (ENP) rather than an FNP, and for nurses keen to work in the ER this may be the career path they aspire to. ENPs have often qualified as an FNP first and much of the training in MSN or DNP programs will also prepare you for life as an ENP. However, once qualified as an FNP there will be further training, including getting an advanced cardiovascular life support (ACLS) certification, with other certifications available in acute and emergency inpatient care. Further training can be carried out through education at a university or on-the-job training. Passing the emergency nurse practitioner exam will give you a valuable certification and complete the progression from FNP to ENP.

Working in the ER

FNPs working in the ER need to expect the unexpected. Unlike a practice where you will often know in advance the patients scheduled for the day, in the ER you will never know who your next patient might be. It might go from monitoring a small child with a bumped head, reassuring the parents that there has been no permanent damage, to the horrific injuries of a road traffic accident. But if you are someone who can think quickly under pressure and thrive in a fast-paced environment, a career in the ER could be for you. Many medical professionals work in the ER and an FNP is not the most obvious that people think of, but the wide-ranging skills and experience of an FNP are becoming increasingly valued by hospital departments including the ER and urgent care settings. If this is a career path that interests you and you are already an RN, then starting an MSN-FNP program could be the first step into a career working in the ER, making a vital difference, sometimes in life-and-death situations, to patients who need urgent care.

Hussnain Ali

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