How is emergency medicine staffed?

Historically, the first person in the emergency department a patient would meet is not a clinical provider but an administrative registration clerk. These staff members take a patient’s name, date of birth and other personal details and collect insurance provider information. Once checked-in, a patient might see a triage nurse next.

However, with improved ED systems as well as governmental law (EMTALA), the first person a patient will meet is a clinical provider whose job it is to medically screen a patient and triage that patient to an appropriate level of care. The registration person may see the patient next, or at some point later in the patient’s ED visit.

Care in the ER is not first-come, first-served. If a patient arrives at the ER in an ambulance, unconscious or unresponsive, or with symptoms that might indicate a heart attack or stroke, the triage process puts that patient at the top of the list, ensuring care before a patient with a less-serious illness or injury.

Once moved to the treatment area, a patient will be cared for by the primary emergency department nurse. Often a registered nurse, this person has a degree in nursing and the training and experience to manage and assist with a variety of emergency situations, from complaints about broken bones and sprained ankles to cardiac arrest. An emergency department nurse may clean wounds and burns, suction an airway, administer intravenous fluids, aid in neurological evaluations, field family members’ concerns and arrange for transportation to another floor of the hospital.

Some emergency departments also have a charge nurse, an experienced nurse responsible for overseeing the flow and dynamics of the entire nursing department and managing complex patient cases. The first half hour you’re treated in the ER, the charge nurse may be one of several nurses assisting your primary emergency department nurse in providing preliminary care and interventions.

Also, in the treatment lineup: your physician or advanced practice clinician (APC, either a physician assistant or nurse practitioner). The physician or APC may be the first provider to see a patient or possibly the last. This depends on a variety of factors including the acuity of the patient and how busy the department is at a given time. Attending physicians have completed medical school and residency, and are either medical doctors (MDs) or Doctor of Osteopathic Medicine (DOs). PAs have specialized training after college directed at assisting physicians in a number of fields, including emergency medicine. NPs have nursing degrees and further specialized medical training.


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