Hey there , ER RN checking in here . Recently been doing a lot of research on this exact thing . It ' s a rabbit hole that ' s for sure , and definitely seems very regionhospital specific as to your scope once you achieve this goal . In a very basic sense , the progression will be BSN MSN FNP Two years in urgent care Land an ED job most likely isolated to do doing fast track work , working up ESI 4 ' s , 5 ' s , and maybe a 3 here and there . With that said . There are quite a few things that I ' m not 100 % clear on , but I will gladly share what I have found out . There are ENP Emergency NP programs out there , some online , some not , depends on where you or if you ' re willing to relocate . Some of these programs provide you with a specific ENP cert , some will get you dual certified as a FNP and AGACNP , and usually require something around 250350 hours of ER Clinical compared to FNPonly programs that will be all primary care clinicals . The ENA has some good info on Emergency NPs , what they ' re trying to do to get this a more nationally recognized specialization , and available programs currently . There are also some fellowship programs that you can follow up your FNP with . I don ' t know where you are , but Carilion in Roanoke VA has one that looks really good . It ' s a year long fellowship , they ' re a level 1 trauma center , and you get to learn with PAs , EM residents , and from ER Docs . It ' s looks really good to me . It ' s a fulltime , paid fellowship with benefits . I don ' t know how good it is . Anyway , like I said it was a bit overwhelming to me when I started digging , and digging , and digging . But if you have any questions , I ' ll be glad to share anything I ' ve found out .