the country in chaos during the spread of the coronavirus, we’ve published many
stories on how to deal with it in various ways. But in addition to dealing with
it now, this experience may have gotten you thinking about your career in the
future—especially with emergency services.
While the Board of Certification for Emergency Nursing (BCEN) will celebrate its 40th anniversary this coming July, we interviewed its leader now to give you information that you may want if you’re contemplating moving into this kind of work and want to know about the Board Certifications available and how to get them.
Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, is the Executive Director of the BCEN, which is based in Oak Brook, Illinois. She answered our questions about what board certification for emergency nursing means and how to go about it.
is the importance of being board certified as opposed to simply earning another
kind of certification?
Holding a board certification vs. earning a
certificate are often confused and misunderstood.
A board certification, like for example BCEN’s Certified
Emergency Nurse (CEN ®) or Trauma Certified Registered Nurse (TCRN®)
designation, is an earned credential that demonstrates the individual’s
specialized knowledge and skills across an entire specialty body of knowledge. Certification
is awarded by a third-party organization, like the Board of Certification for
Emergency Nursing, and high-quality programs are accredited by an organization
such as the Accreditation Board for Specialty Nurse Certification (ABSNC).
Individuals receive their certification after meeting
strict eligibility requirements and successfully completing a rigorous national
certification examination. In addition, board certifications have ongoing
requirements that must be met to maintain the credential, ensuring the holder is
sustaining their level of expertise. Certifications are nationally recognized
and are appropriately included with the earner’s signature along with their
Where board certification is about validating mastery
across a specialty, a certificate and other instruction-based certifications importantly
help nurses acquire focused knowledge and skills. Examples of certificates are
Advanced Cardiac Life Support (ACLS) or Trauma Nursing Core Course (TNCC™).
Board certification is the highest professional
credential a nurse can earn, and being board certified demonstrates a commitment
to one’s career, patients, and organization.
do nurses earn this?
Earning a board certification from BCEN requires an
unrestricted U.S. RN license or equivalent. Just recently, we announced a new
international candidate process that for nurses educated and/or practicing outside
the U.S. We recommend that a nurse has two years of practice in the specialty area
before sitting for that exam. When ready, nurses complete an application to sit
for the exam, chose a testing time and site that works for them, and then take
the test on the specified day. Of course, there is much preparation that is
necessary prior to the exam.
nurses think they might be interested in becoming board certified, what do they
need to do?
Nurses who are interested in becoming board certified
should incorporate preparation into their career plans early. Often it is
required or recommended nurses have a certain amount of time working in their
specialty area—for example, 2 years.
Start by researching the nursing specialty
certification board that provides the credential in your specialty area. Take a
look at their website. They will have a candidate handbook that explains
eligibility and testing. Each certification exam has a test blueprint or
content outline. This is very helpful in determining what to expect on the exam
and what to study.
Many certification boards also provide a list of
reference books used to create their exams. These can be very helpful to know
what resources to use to study. Another thing that is highly effective is for
nurses interested in certification to form a study group and prepare for the
Nurses interested in certification should also ask their employers about the support and resources they offer. Many employers value the impact certified nurses make in the workplace and offer support in various forms. Membership in a professional association can mean you qualify for a discount on certification and recertification fees.
[BCEN’s resource page, which includes everything from
content outlines to test anxiety resources is here. Their resource page for students
Certified Emergency Nurse Q&A Practice
Get digital access to Certified Emergency Nurse Q&A Practice and pass your CEN® exam! This interactive web and mobile product includes:
BCEN has five national board certification programs—the CEN,
CPEN, CFRN, CTRN, and TCRN—which represent the high professional credentials for
registered nurses (RNs) specializing in adult/mixed
emergency, pediatric emergency, flight, critical care ground transport, and
trauma nursing, respectively.
BCEN was founded in 1980 as an independent
certification organization, and introduced its first board certification programs
for RNs in the same year. Today, over 39,000 RNs hold their Certified Emergency
Nurse (CEN), making it the most-held emergency nursing specialty certification
in the world. In total, over 48,000 nurses hold 54,000 BCEN credentials,
validating the specialty knowledge and expertise of emergency nurses.
BCEN Executive Director Janie Schumaker, MBA, BSN, RN, CEN, CENP, CPHQ, FABC, tells prnewswire.com, “Patients and families receiving care from a nurse who displays a BCEN credential on their badge can expect a proven level of clinical knowledge from these dedicated professionals. BCEN’s commitment to excellence, achievement and impact spans 40 years, and we are incredibly proud of the accomplishments and commitment of BCEN-certified nurses…For healthcare teams and organizations, BCEN credentials distinguish nurses who noticeably contribute to improved patient outcomes, stay on top of the latest advances and best practices, champion clinical standards, promote safety and efficiency, solve problems, enhance collaboration, mentor novice nurses, and advocate for patients and their families.”
The 40th anniversary celebration of BCEN is centered on
their “Your Story is Our Story” campaign, featuring 40 stories about
BCEN-certified nurses and healthcare teams. To learn more about BCEN’s celebrations
in honor of 40 years of excellence, achievement, and impact in board certified
emergency nursing, visit here.
The key to finding work as an ER nurse is to be proactive before and during nursing school. Keep reading for pro tips on how to position yourself during school and after graduation.
The availability of ER nursing jobs—especially for new graduates—depends on the needs and financial status of the institutions and geographic area in question. As reimbursement becomes more and more dependent on patient reviews, hospitals strive to update the accommodations and technological capabilities to satisfy their patient populations. The expense of these updates can limit the hospital’s ability to hire or even cause a hiring freeze.
Most managers would prefer to hire a nurse experienced in the ER because it is very time-consuming and expensive to train a new nurse. Furthermore, it delays the increase in staff numbers that the nurse is hired to relieve. Many hospitals have created fellowship programs, which include a stepwise process of training for new grads to fully integrate them into the world of ER nursing. These are valuable programs for nurses who seek a comprehensive understanding of emergency nursing and an ongoing support system.
They are, however, pricey to the hospital, and lengthy: nurse fellows receive full salary and benefits, and these programs last between six months and two years. For new nurses, these fellowship programs can be very competitive.
As with any professional field, building bridges is a key to success. For ER nursing hopefuls, forming relationships within the ER can be a very strong indicator for acceptance into the fellowship program. This can be done by finding work at the ER as ancillary staff or volunteering.
Working as a nursing assistant before and during nursing school is a great way to expose an individual to the life of a nurse, and either reinforce or redirect their goals. If a position working directly in the ER isn’t available, then employment in other parts of the hospital can still build those relationships and improve your chances of getting a job in the ER.
Although acute care is a part of every nursing school curriculum, emergency room nursing is not. Nursing students interested in the emergency room can find out if their school has a relationship with a site that might allow them to shadow in the ER. They can also request through their nursing school administration to do requisite clinical work there.
A capstone in the ER is a highly effective way to set oneself up for employment there. It introduces the nursing student to nurses and management, which gives the student an opportunity to demonstrate work ethic and nursing acumen.
If opportunities for work, volunteering, or clinical shadowing are not available, developing relevant skills for the ER is another way to make oneself more marketable for work there. Many emergency medical technicians (EMT) go on to become nurses and already have highly sought-after skills when they graduate. Similarly, medical assistants, phlebotomists, radiology technicians, and scrub technologists all have skills and experience that are valuable to the ER.
Because nursing schools follow a general curriculum, there is no formal way to get into the ER as a nurse. The individual who hopes to be an ER nurse must take it upon themselves to be proactive in learning about the ER, building relevant relationships, and developing the skills necessary to be successful. Being proactive during training is a skill-building opportunity in itself, as the best ER nurses are highly motivated, humble enough to remain teachable, and bold enough to advocate for a seemingly unlimited range of patient populations.
Fast Facts for the ER Nurse is the only orientation guide and reference designed specifically for new ER nurses and the preceptors responsible for their orientation. The book includes disorder definitions, signs and symptoms, interventions, drugs, and critical thinking questions.
It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.
If you haven’t worked there, or haven’t for a long time, it could be that this lack of understanding is what leads hospital administrations to do one of the stupidest things imaginable. What is that thing? Banning food and drink from our work-spaces.
Now, this isn’t the case in my current job. But it is the case in all too many facilities. I talk to people. I hear things. And it’s usually justified with some unholy combination of infection control, Joint Commission and public health clap-trap, coalesced and refined, then circulated as a cruel policy.
When it’s enacted, clinical staff have their water bottles taken
away. Nobody is allowed to eat where they work. Dedicated, compassionate
staff members grow tired and dehydrated and hungry. (Maybe it’s a good
thing. They often don’t have time to urinate anyway, and water just
makes that happen more often.)
Mind you, the water bottles are sometimes kept in a nearby room, or on a nearby shelf. It’s an act of kindness, I guess. And the food? Well, all you have to do is take your break and go to the cafeteria or to the break room, right?
Those who come up with these rules don’t understand that a scheduled break is a great idea … that never happens. It’s an emergency department. It isn’t (technically) a production line; however, we try to impose time restrictions and through-put metrics. It isn’t “raw material in/product out.”
It’s “sick, suffering, dying, crazy human being in” and if all goes well, “somewhat better (at least no worse) human being evaluated, stabilized, saved, calmed, admitted, transferred, and sometimes pronounced dead” out of the other end of the line.
Those Herculean efforts can take anywhere from, oh, 20 minutes to 12 hours. During which time, it’s pretty hard to leave the critical patient in the understaffed department, with the “five minute to doctor” guarantee and the limitless capacity for new tragedy rolling through the door.
That setting makes it remarkably hard for breaks or even meals to happen at all.
As such, it’s nothing short of cruel and unusual for anyone to say to the staff of a modern emergency department, “you can’t have food or drink” — especially when it’s typically uttered by people who have food and drink in their offices and at their desks. People who have lunch meetings with nice meals or who have time to walk to the cafeteria or drive off-campus. And who feel so very good about protecting the staff from their deadly water bottles.
The argument, of course, is that the clinical staff work in a “patient care area.” Even when they aren’t at the bedside but are, for instance, behind a glass wall at a desk. If this is the case, then one could argue that the entire hospital (including administrative suites) is a “patient care area.”
They are afraid we’ll catch something. That it’s unsafe for us to eat or drink where we work. Of course, this is while we positively roll around in MRSA and breathe in the fine particulate sputum of septic pneumonia patients. This is while staff clean up infectious diarrhea and wear the same scrubs all day.
This is after we intubate poor immigrants who may well have tuberculosis and start central lines on HIV patients. This is after we wrestle with meth-addicts who have hepatitis C. And this concern for our “safety” occurs in places where physical security, actual security against potential violent attack, is a geriatric joke which is often tabled until the next budget cycle.
And as for our patients? Our food and drink are no danger to them. They and their families fill the exam rooms with the aroma of fried chicken, fries, and burgers, eaten at the bedside (often by the patient with abdominal pain). Their infants drag pacifiers across floors that would make an infectious disease specialist wake from bacterial nightmares in a sweat-soaked panic. In short, our food or drink are no threat to them and no threat to us.
But the absence of food and drink? That’s a problem. Because the ED is an endless maelstrom of uncontrollable events and tragedies, of things beyond our control for which we are responsible. It is a place of physical, emotional, and spiritual exhaustion where we rise to the challenge and manage (against the odds) to do so much remarkable good by virtue of our knowledge, our training, our courage, and our compassion.
In the midst of all that, a bottle of water, a cup of coffee, a glass of Diet Coke, a Styrofoam cup of iced tea is an oasis in the desert. And that sandwich, slice of pizza, cupcake, or salad is the fuel that helps make it happen.
More than that, food and drink are among the few pleasures we have time for each shift. They serve as bridges to the end of the day, small reminders of normalcy in a place where so little is normal.
Doubtless, one day someone will take away our music so that it doesn’t hurt our ears, or offend our patients. We’ll fight that battle when it comes.
But until then, depriving staff of food and drink proximate to where they work is of no health value and strikes me as just one more way of exerting control over the people actually engaged in the hard, grinding work of saving lives.
Some healthcare professionals see blood, mangled bodies, and death every day, yet certain days are worse than others. As when, for instance, a dozen police officers are gunned down or 20 kids are killed in their elementary school in a mass shooting. Because public mass shootings happen nearly every 6 weeks in America, these tragedies are having a more frequent impact on the healthcare workforce.
Research data are sparse. One study surveyed 24 surgical residents working at Orlando Regional Medical Center in Florida in 2016. On June 12 that year, a gunman shot 49 people to death and wounded 53 others at the mass shooting at the Pulse nightclub. Three months later, rates of post-traumatic stress disorder (PTSD) and major depression were two and four times greater among the 10 residents on call that night versus the 14 off-duty residents. Though the differences didn’t reach statistical significance, assessments were revealing. A survey of the same residents 7 months after the mass shooting found that PTSD persisted in those affected in the on-call group but completely resolved in the off-call residents.
As part of an ongoing effort by MedPage Today to explore job stress and burnout among healthcare professionals, reporter Shannon Firth talked at length with physicians and nurses who shared personal experiences with mass shootings and how they affected their lives and careers.
On November 21, the US House of Representatives passed the Workplace Violence (WPV) Prevention for Health Care and Social Services Act of 2019 (the bill now moves to the Senate). Strongly supported by the Emergency Nurses Association, the bill now moves to the Senate for consideration.
In the U.S., the prevalence of workplace violence (WPV) in the healthcare industry is four times higher than in other private industries. According to surveys by the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA), some 70 percent of emergency department (ED) nurses have been hit or kicked while at work. Because of ease of public access, crowding, long wait times, presence of weapons, and other factors, the emergency department is a highly vulnerable area, especially where triage occurs.
ED Health Providers Literally on the “Front Lines” for WPV
The shocking statistics on WPV in emergency departments are behind ACEP and ENA’s campaign, “No Silence on ED Violence.” This joint effort aims to educate, empower and protect doctors and nurses working in emergency departments. By raising awareness of the serious WPV dangers emergency health providers face every day, and promoting action among stakeholders and policymakers, the campaign seeks to ensure a violence-free workplace for emergency nurses and physicians.
Acts of workplace violence (WPV) can cause physical and/or
psychological harm to emergency nurses. WPV can lead to job dissatisfaction,
emotional exhaustion, burnout, secondary trauma stress, PTSD, absenteeism, and
intentions to leave the job or nursing profession, all of which have potential
impacts on patient care.
Workplace Violence Affects Majority of ED Doctors and Nurses
ACEP President William Jaquis, MD, FACEP, said, “If you asked the majority of our nurses and our physicians, they have all been impacted directly by violence—as have I. It goes everywhere from verbal violence, which happens frequently, to physical violence. Ultimately, we hope that in sharing our stories we will gain insight and share resources on how to prevent future harm to our medical teams and our patients.”
The “No Silence on ED Violence” website includes a variety of workplace violence resources for emergency healthcare providers, including guidelines for safety in and around the Emergency Department, and lists of warning signs indicative of potential violent events.
Inspired by the Raise Your Hand movement—which first encouraged emergency nurses in 2018 to share their workplace violence experiences — ACEP and ENA have collaborated on this effort to minimize the frequency of attacks, protect emergency department professionals and build a new level of awareness about this crisis.
Some Tips on Staying Safe
To increase program effectiveness, it is recommended that a workplace violence prevention program include education and training; formal incident reporting procedures; and administrative, environmental and consumer risk assessment, physical design, and security components to address all types of WPV.
Trust your feelings if you feel uncomfortable
around a patient.
Don’t isolate yourself.
Have security around.
Call security when you first become aware of a
Maintain safe distance.
Keep an open path for potential exit.
Present a calm, caring attitude.
Don’t match the threats.
Don’t give orders.
Acknowledge the person’s feelings.
Avoid any behavior that may be interpreted as
Limit eye contact.
Further, if you do become a victim of workplace violence, report it! Underreporting is a documented barrier to effective identification and mitigation of workplace violence. Although many nurses do report WPV incidents using both informal (e.g., telling a supervisor or colleague) and formal channels, the latter is only likely when an injury is sustained. Organizational commitment including workplace policies such as zero tolerance and the role of nursing leadership for establishing a just culture that discourages bullying and retaliation—is essential to mitigating all types and forms of WPV in emergency nursing and other healthcare environments.
Passed in the House, Now Advocate for the Bill With Your Senator
Among other features, the “Advocacy” page on StopEDViolence.org focuses on S. 851, the Workplace Violence Prevention for Health Care and Social Service Workers Act. Resources include an easy form for writing your Senator to support the act. In its current form, S.851 will require health care and social service employers to develop and implement comprehensive workplace violence prevention plans. These plans must include procedures to identify and respond to the common risks that make health care settings so vulnerable to WPV incidents. In addition, the bill is designed to help ensure that employees are appropriately trained in mitigating dangerous situations. For examples of action taken in State legislatures, see this PDF.