Critical Thinking Examples In The Er

Of the nation's 2,711,500 registered nurses, 180,000 work in emergency rooms, the Emergency Nurses Association estimated. Because an emergency room nurse often is the first to see a patient with a life-threatening condition, the nurse must be able to quickly assess a situation -- both physically and psychologically -- and administer treatment. ER nurses work with doctors to determine whether a patient should be discharged or admitted for further treatment.

"It takes a special type of person to work in the ER," said Dr. Beth A. Brooks, a registered nurse, fellow of the American College of Healthcare Executives and president of Resurrection University of Chicago. "They have to have an amazing ability to be quick on their feet, think in a crisis situation and handle competing and sometimes conflicting priorities. They have to have the ability to assess a situation quickly and determine what needs to be done."

Brooks said many nursing school applicants are initially attracted to the profession because they see emergency room nursing glamorized on TV series such as "ER."

"The excitement draws folks, but then you have to determine whether you have the personality for it," she said, noting a lot of men are drawn to emergency nursing. "Like anything else, some days will be very, very busy. Some days will be very, very quiet. It takes a certain kind of person to manage that."

Mateja sort of "fell into" emergency nursing after she graduated from nursing school in the mid-1970s and the specialty was just beginning to evolve.

"At the time, I didn't know anything about it," she said. After taking her first job, "it was something offered to me as an option," she recalled.

"When we started this in the mid-1970s, we had different physicians rotating through (emergency rooms). There were no emergency department physicians. Doctors were just becoming certified (in emergency medicine)." Additionally, Mateja said, the practice was for police or ambulance drivers to just load a patient and transport the person to the hospital as quickly as possible without administering any initial care. There were no paramedics to start IVs or begin treatment.

"I was fortunate enough to grow with it (the developing specialty). I was able to learn as I went along," Mateja said. "We got to make it up as we went along. That's the right way to learn."

Mateja said training became more formalized in the early 1980s. Nurses began taking courses in advanced cardiac life support and other treatments to enable them to intervene immediately when a patient is brought in. Waiting for a doctor to arrive on the scene and take over is just not an efficient use of resources, she noted.

Brooks said she's seen the number of nursing school applicants climbing, largely because healthcare has been expanding and health care institutions hired through the recession, when other businesses were cutting back.

"Students are looking for career stability," she said, noting that many applicants look to nursing when changing careers.

According to Mateja, an ER nurse needs "a great sense of humor, a lot of positive energy and a willingness to do whatever it takes. It's someone who doesn't give up and doesn't care about eating lunch -- someone who is resilient. It's really a tough job, a tireless job. You're on your feet non-stop and you keep going until your relief comes in. Each day is different. Each patient is different. You really do need a lot of energy for this type of work."

Mateja said critical thinking is an essential skill, along with the ability to change direction as the situation changes. The occasional frenzy needs to be handled with humor and energy. The toughest part of the job is when "we lose someone, despite our best efforts," Mateja said. "We can provide families and patients comfort. Any time we know the outcome is not going to be favorable, it's tough, always."

With proper training, job prospects are excellent

Emergency room nurses receive extensive training to enter this demanding, but highly rewarding field.

Candidates must have an associate or Bachelor of Science degree in nursing, including instruction in anatomy, physiology, pharmacology, human growth and development and sociology. Those who pursue master's degrees have the option of becoming nurse practitioners at the pediatric, adult/geriatric, family or acute care levels.


Quick thinking, decisive action and a strong stomach. Those are just three of the things you'll need for your career as an emergency room nurse. Emergency room (ER) nurses work in critical care emergency facilities to assist doctors and work with emergency medical technicians in helping people in pain and possibly life-threatening trauma.

ER nurses work as part of a team with physicians, other nurses and healthcare professionals to provide care, monitor health conditions, plan long-term care needs, administer medicine, use medical equipment, perform minor medical operations, and advise patients and their families on illness, care and continued care after a hospital stay.

Emergency rooms are often the first line of defense for accidents, allergic reactions, and any number of urgent medical care. ER nurses work to quickly assess the needs of each patient, prioritize care based on its critical nature, and work to stabilize a patient, treat the problem, discharge the patient after the emergency is over or make arrangements for a longer hospital stay.


According to the Bureau of Labor Statistics (BLS), registered nurses made a median hourly income of $31.10, or $64,690 a year.


Registered nurses must have one of the following: a bachelor's of science in nursing, an associate's degree in nursing, or have graduated from an accredited and approved nursing program.

In addition, licensure is required, and may be obtained from graduating an approved nursing program and passing the National Council Licensure Examination (NCLEX-RN). Depending on the state, there may be other requirements.

Nurses can then specialize in emergency room medicine through experience and continuous education.


  • Critical-Thinking Skills: Nurses will need to assess a patient's health, as well as detect changes in symptoms, health or pain, and will need to know when action is necessary.
  • Compassion: Nurses help people. They should be sympathetic to a patient's needs, and be able to deal with people in various states of pain, trauma and tragedy.
  • Attention to Detail: Nurses can help doctors operate, administer medicines and work with specific treatments that, if wrong could prove fatal. Attention to detail is crucial.
  • Organizational Skills: Nurses will face multiple patients, with differing needs, stages of health and risks. Being organized and knowing how to prioritize will be helpful.
  • Calm Under Pressure: ER Nurses face urgent, life-or-death situations almost daily. Being able to function in the heat of emergency will be necessary.
  • Patience: Giving care under stressful circumstances requires patience.
  • Communication Skills: Nurses communicate directly with patients who are scared, in pain or in shock. Families will have questions and want answers. Good nurses need to be patient listeners and good communicators to help keep everyone calm and help them understand the situation.


Advanced Practice Registered Nurse
Head Nurse


There is no specific information on ER nurses, however, with aging baby boomers and more medical advancements, registered nursing jobs will grow steadily through 2020, according to the BLS. Jobs are expected to grow 26% in that time period, must faster than the average.

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