What are the responsibilities and duties of a registered nurse (RN) in the emergency department (ED)?

Responsibilities and Duties of Registered Nurses in the Emergency Department

Registered nurses in the emergency department function as frontline clinical providers who perform patient triage, assessment, treatment implementation, and care coordination under the supervision and direction of emergency physicians, with their scope clearly delineated by institutional policies, state regulations, and federal requirements including EMTALA compliance.

Core Clinical Responsibilities

Patient Assessment and Triage

• Conduct medical screening examinations as authorized by hospital bylaws to identify emergency medical conditions requiring immediate stabilization 1
• Perform rapid assessment of patient acuity and prioritize care based on severity of illness or injury 2
• Continuously reassess patients for changes in clinical status, particularly in high-acuity, rapidly changing situations 3, 4

Direct Patient Care Delivery

• Implement treatment plans including medication administration, procedural assistance, and therapeutic interventions under physician direction 2
• Provide pain assessment and management, including both pharmacologic and non-pharmacologic interventions 1
• Ensure proper use of medical devices and equipment, including safety protocols for specialized equipment 1
• Deliver nursing care across all age groups, requiring competency in pediatric, adult, and geriatric populations 1

Care Coordination and Transitions

• Arrange follow-up care through referrals and coordination with primary care providers after ED discharge 1, 5
• Facilitate patient education regarding discharge instructions, chronic disease management, and medication compliance 5
• Coordinate with consultative services, specialists, and inpatient teams for patient transfers and admissions 1

Regulatory and Compliance Duties

EMTALA Compliance

• Participate in federally mandated medical screening examinations as designated by hospital bylaws 1
• Ensure all patients receive necessary stabilizing treatment without delay and regardless of ability to pay 1
• Understand and comply with transfer requirements and documentation standards 1

Scope of Practice Adherence

• Function within clearly delineated scope consistent with state nursing practice acts, institutional policies, and professional certification requirements 1, 6
• Maintain valid state licensure and appropriate national certification for population focus 6
• Recognize limitations and escalate care appropriately to physicians for conditions requiring medical decision-making 1

Professional Development and Quality Improvement

Competency Maintenance

• Participate in ongoing education specific to emergency care, including resuscitation training and specialty certifications 1
• Engage in competency evaluations for pediatric care, trauma management, and critical procedures 1
• Complete supervised orientation programs demonstrating knowledge of ED-specific policies and procedures 1

Quality and Safety Activities

• Participate in performance improvement initiatives related to patient safety, care quality, and operational efficiency 1
• Engage in disaster preparedness planning and participate in emergency drills 1, 7
• Contribute to policy development and review of protocols for medications, equipment, and clinical procedures 1

Critical Caveats and Pitfalls

Supervision and Support Requirements

Newly graduated nurses require substantial support and should not be given sole responsibility for multiple complex patients, as their competence may not match the level of responsibility, potentially compromising patient safety 3, 4. The intersection of low clinical predictability, high acuity, and increased autonomy creates significant risk when inexperienced nurses lack adequate supervision 3.

Competency Overestimation

Emergency nurses, particularly those with limited disaster training, tend to overestimate their preparedness and competency, which can negatively impact patient outcomes during major incidents 7. Formal education and clinical experience are essential for accurate self-assessment 7.

Distinction from Advanced Practice Roles

Registered nurses are distinct from Advanced Practice Registered Nurses (APRNs) who have expanded scope including diagnosis and treatment 1. RNs do not replace physician expertise and must work under physician supervision for medical decision-making 1.

Workplace Environment Factors

Adequate nurse-to-patient ratios and prevention of boarding admitted patients in the ED are essential for safe practice 2. Insufficient staffing combined with high acuity increases risk of adverse outcomes 4, 2.

Collaborative Relationships

• Work in mutually supportive relationships with emergency physicians, maintaining clear communication about patient status and care needs 2
• Coordinate with Pediatric Emergency Care Coordinators when caring for children, ensuring appropriate resources and expertise 1
• Interface with EMS personnel, trauma coordinators, and community healthcare providers to ensure continuity across the care continuum 1