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Emergency Nurse Practitioners: Frequently Asked Questions

Section Editor(s): Hoyt, K. Sue; Proehl, Jean A.

doi: 10.1097/TME.0000000000000040

Disclosure: The editors report no conflicts of interest.

After receiving frequent e-mails from several emergency nurse practitioners (ENPs) with various queries, we decided to provide you with the answers to some frequently asked questions:

How many patients are seen in emergency departments (EDs)?

According to the National Hospital Ambulatory Medical Care Survey: Emergency Department Summary, there were 129.8 million ED visits in the United States last year (Centers for Disease and Control and Prevention [CDC], 2014).

How many patients do ENPs see annually?

Last year, ED patients were seen by the following providers: Emergency physicians saw 87%, physician assistants (PAs) saw 9%, and nurse practitioners (NPs) saw 4% of all ED patients (CDC, 2014). That translates into 5,192,000 ED patients seen by NPs in 2013.

What is an APP?

An APP is an advanced practice provider. This is a new term used by emergency physicians and other health care providers now to collectively describe NPs and PAs. We believe this term is being used today in lieu of the term “mid-level” provider, which has been deemed inappropriate by NPs and PAs (Hoyt & Proehl, 2012).

Which NP organizations/associations speci-fically address ENP issues?

The mission of the Emergency Nurses Association (ENA) is to “advocate for patient safety and excellence in emergency nursing practice” (ENA, 2014). The ENA with its more than 40,000 members has an NP Validation Committee to address ENP issues and published the first “Nurse Practitioner Delphi Study: Competencies for Practice in Emergency Care” (NP Validation Work Team et al., 2010). There is also an advanced practice track of educational offerings at the ENA Annual Conference each year and an ENA Special Interest Group (SIG) for ENPs.

The American Association of Nurse Practitioners (AANP), with more than 50,000 members, calls itself “the voice of the NP—leading the way in advocacy, continuing education, and professional development” (AANP, 2014a). There are 192,000 NPs in the United States and an estimated 7,500–9,000 NPs currently practicing in emergency care settings (AANP, 2014b). The organization has an ENP track at its annual conference now and an SIG for ENPs. This association is also offering a Convenient and Urgent Care Conference for the first time this fall.

A newly formed organization, known as the American Academy of Emergency Nurse Practitioners (AAENP), will hold its first formal meeting in Chicago, IL, the last weekend in October. The mission of the AAENP is to “promote high quality, evidence based practice for nurse practitioners providing emergency care for patients of all ages and acuities in collaboration with an interdisciplinary team” (AAENP, 2014). In addition to various nursing groups, this organization plans to work with the American College of Emergency Physicians and the American Academy of Emergency Medicine to promote ENP educational activities in collaboration with other health care providers. The academy will also be updating the ENP competencies and eventually hopes to offer grants and scholarships to ENPs who want to perform ENP outcomes research.

Is there a certification for ENPs?

The American Nurses Credentialing Center (ANCC) offers ENP specialty certification. “Certification through portfolio is a new assessment methodology to achieve ANCC board certification.... Portfolios must articulate performance in four domains of practice: Professional Development, Professional and Ethical Nursing Practice, Teamwork and Collaboration, and Quality and Safety” (ANCC, 2014). If an applicant meets the requirements, an Emergency Nurse Practitioner-Board Certified credential is awarded.

What does the future hold for APPs?

The future is bright for APPs, both ENPs and PAs. Recent surveys from major ED groups that employ ENPs (e.g., California Emergency Physicians, EmCare, Schumacher, and Team Health) all indicate these employers will continue to offer ENP positions. These groups will also continue to offer PAs similar jobs. The American Academy of Physician Assistants ([AAPA]; 50,000 members) is the national professional society for physician assistants (AAPA, 2013). This group represents “a profession of more than 95,000 certified physician assistants across all medical and surgical specialties in all 50 states, the District of Columbia, the majority of the U.S. territories and within the uniformed services” (AAPA, 2013).

Physician assistants can now obtain an Emergency Medicine Certificate of Added Qualification by demonstrating that they have advanced knowledge and experience in emergency medicine through the National Commission on Certification of Physician Assistants (NCCPA, 2014). Physician assistants seeking eligibility for the Emergency Medicine Specialty Examination “must meet requirements of specialty-specific continuing education experience in the field, and specific knowledge and/or experience in conducting procedures and being involved in patient cases that are deemed core to the specialty area of practice” (NCCPA, 2014).

In sum, ENPs cared for 5,192,000 ED patients whereas PAs saw 11,682,000 ED patients last year. There are lots of opportunities for ENPs. We need to get out there and apply, even if a job opportunity is labeled as a PA position. So, spread the word and let's start applying!

—K. Sue Hoyt, PhD, RN, FNP-BC, CEN,


Emergency Nurse Practitioner

St. Mary Medical Center

Long Beach, CA

—Jean A. Proehl, RN, MN, CEN,


Emergency Clinical Nurse Specialist

Proehl PRN, LLC

Cornish, NH

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American Academy of Emergency Nurse Practitioners. (2014). Mission statement. Retrieved from
American Academy of Physician Assistants. (2013). PA facts. Retrieved from
American Association of Nurse Practitioners. (2014a). Membership/benefits. Retrieved from
American Association of Nurse Practitioners. (2014b). Fact sheet. Retrieved from
American Nurses Credentialing Center. (2014). Specialty certification: Emergency nurse practitioner. Retrieved from
Centers for Disease and Control and Prevention. (2014). Fast facts. Retrieved from
Emergency Nurses Association. (2014). ENA's mission statement. Retrieved from
Hoyt K. S., Proehl J. A. (2012). Why the terms “mid-level provider” and “physician extender” are inappropriate. Advanced Emergency Nursing Journal, 34(2), 93–94.
National Commission on Certification of Physician Assistants. (2014). Emergency medicine CAQ. Retrieved from
NP Validation Work Team Hoyt K. S., Coyne E. A., Ramirez E. G., Peard A. S., Gisness C., Gacki-Smith J. (2010). Nurse practitioner Delphi study: Competencies for practice in emergency care. Journal of Emergency Nursing, 36(5), 439–449.
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