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Exam Number : CEN
Exam Name : Certified Emergency Nurse
Vendor Name : BCEN
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Certified Emergency Nurse | Advanced Resource Guide<br /> <meta charset="UTF-8"><br />





EDUCATIONAL SYMBOLIC ANALYSIS

The Comprehensive Architecture of Certified Emergency Nurse




I. Historical Context and Technical Foundation


Emergency nursing is a specialty within the field of professional nursing focusing on the care of patients who require prompt medical attention to avoid long-term disability or death. In addition to addressing "true emergencies," emergency nurses increasingly care for people who are unwilling or unable to get primary medical care elsewhere and come to emergency departments for help. In fact, only a small percentage of emergency department (ED) patients have emergency conditions such as a stroke, heart attack or major trauma. Emergency nurses also tend to patients with acute alcohol and/or drug intoxication, psychiatric and behavioral problems and those who have been raped.

Emergency nurses are most frequently employed in hospital emergency departments, although they may also work in urgent care centers, sports arenas, and on medical transport aircraft and ground ambulances.

Around the 1800s hospitals became more popular and there was a growth in emergency care. The first development of an emergency room was originally called the "First Aid Room." Originally, nurses only dressed wounds, applied eye ointments, treated minor burns with salves and bandages, and attended patients with minor illnesses like colds and sore throats.[1] The rule of thumb was first in, first served, but there were many cases where some people were in more need of emergency care than others, and as the situation became more intolerable, one of the greatest medical developments came into perspective: triage.

For centuries triage had been used in war but was not yet established in the emergency department. The first time triage was referred to during a non-disaster situation was at Yale New Haven Hospital, Connecticut, United States in 1963, and since then has become developed and more defined.[2]

Emergency nurses must be able to sit, stand, walk, reach, squat and lift throughout their eight- or twelve-hour shift. They must have good manual dexterity, hearing and vision. They must understand principles of human development, anatomy, physiology, pharmacology, They must also have a working knowledge of the many legal issues impacting health care such as consent, handling of evidence, mandatory reporting of child and elder abuse, and involuntary psychiatric holds. They must be adept and comfortable working with patients of many different backgrounds, cultures, religions, ages and types of disabilities. They must be calm and professional at all times, especially when dealing with situations which are difficult, emotional or disgusting. Emergency nurses must also know how to care for themselves physically and emotionally.





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II. Deep-Dive: Core Domains and Technical Specifications


The role of the emergency nurse is to evaluate and monitor patients and to manage their care in the emergency department. They may also supervise licensed practical nurses and unlicensed assistive personnel ("nurse aides" or "care partners"). It can be a challenge to get everything done quickly and correctly in an ever-changing environment. Some ED nurse functions are common to other nursing specialties, while others are specific to emergency nursing. These can be divided into 1.) assessment, 2.) planning and managing care, 3.) tasks, 4.) communication, and 5.) teaching.

An emergency nurse is assigned to triage patients as they arrive in the emergency department, and as such, is the first professional patients will see. Therefore, this emergency nurse must be skilled at rapid, accurate physical examination and early recognition of life-threatening conditions. Based on the triage nurse's findings, a triage category is assigned. The Emergency Severity Index (ESI) triages patients into five groups from 1 (most urgent) to 5 (least urgent).[3][4]

An experienced emergency nurse is put in the role of charge nurse or team leader. This nurse is responsible for the overall "flow" of the department. He or she assigns nurses to patients, assures patients are being transported to and from tests outside the ED, addresses patient complaints and concerns, communicates with the house supervisor, takes phone calls, and assures nurses get their breaks.

Nurses who specialize in palliative care are sometimes utilized to bring rapid-symptom relief and timely goals-of-care discussions to patients presenting to the emergency department.[5] Similar programs exist which rely heavily on social workers and chaplains for the early introduction of palliative care in the hospital encounter.[6]

A specialist nurse will independently assess, diagnose, investigate, and treat a wide range of common accidents and injuries working autonomously without supervision by medical staff. They primarily treat a wide range of musculoskeletal problems, skin problems and minor illnesses. They are trained in advanced nursing skills. Under the National Health Service grading system, ENPs are typically graded Band 6 or 7.

Additionally, some specialized nurses perform as emergency care practitioners. They generally work in the pre-hospital setting dealing with a wide range of medical or emergency problems. Their primary function is to assess, diagnose and treat a patient in the home in an emergency setting.

An advanced practice nurse assesses, diagnoses, and treats a variety of common illnesses, injuries and disease processes in emergency care settings. ENPs are trained in advanced nursing and medical skills such as x-ray interpretation, ophthalmic slit lamp examination, suturing, local and regional anesthesia, abscess incision and drainage, advanced airway techniques, fracture reduction, and casting and splinting.

Australian nurse practitioners follow the clinical practice guidelines developed by the Victorian Emergency Nurse Practitioner Collaborative (VENPC), which has supported nurse practitioner development in Victoria. These guidelines include attending to minor head injuries, burns, open wounds, joint pain, haemophilia, blood and fluid exposure, PV bleeding, urinary tract infections (UTIs), abdominal pain, cellulitis, and more.[7]

Emergency nurses work in various places, many of which are understaffed as there are nursing shortages across Africa. There is also a shortage of doctors, leaving many tasks for nurses with limited guidelines or standards to deal with, and the scope of practice is quite undefined for many emergency nurses. Nurses may be required to work outside their scope, causing frustration and increasing the opportunities for occupational health hazards. It can be speculated that triage protocols are either lacking or not being followed. The limited basic knowledge and skill of emergency nursing included in undergraduate nurse training programs, and the limited number of nurse trainers, provides difficulty for many pending nurses to acquire the skills needed to work in emergency settings.[8]

Emergency nursing is a demanding job and can be unpredictable. Emergency nurses need to have basic knowledge of most specialty areas, to be able to work under pressure, communicate effectively with many types of patients, collaborate with a variety of health care providers and prioritize the tasks that must be performed.

It can be quite draining both physically and mentally for many nurses. Australian emergency departments treat over eight million patients each year as of 2018.[9] They spend much of their time on their feet and must be ready for unexpected changes in patients' conditions as well as sudden influxes of patients to the emergency department. Emergency department nurses may be exposed to traumatic situations such as heavy bleeding, dismemberment and even death.

Violence is a growing challenge for many nurses in the emergency department. Emergency nurses often receive both physical and verbal abuse from patients and visitors.[10]

The Certified Emergency Nurse (CEN) designation is granted to a registered nurse who has demonstrated expertise in emergency nursing by passing a computer-administered examination given by the Board of Certification for Emergency Nursing (BCEN). The certification exam first became available in July 1980,[11] was accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC) in February 2002, and was re-accredited in 2007, 2012, and 2016.[12] The certification is valid for four years, and can be renewed either by passing another examination, or by attesting that the nurse has completed 100 continuing education units (CEUs) in the specialty.

As of 2019, the BCEN has designated over 38,000 active CENs in the United States and Canada.[13] The CEN exam has 175 questions; 150 are used for testing purposes, 25 are sample questions. The candidate has three hours to take the exam and a passing score is ≥70%.[14]

The Certified Pediatric Emergency Nurse (CPEN) designation is applied to a registered nurse who has demonstrated expertise in pediatric emergency nursing by passing a computer-administered examination given jointly by the Board of Certification for Emergency Nursing (BCEN) and the Pediatric Nursing Certification Board (PNCB). The certification exam first became available on January 21, 2009,[15] and was accredited by ABSNC in May 2015.[16] The certification is valid for four years, and can be renewed either by passing another examination, by completing 100 contact hours (continuing education) in the specialty, or by completing 1,000 clinical practice hours and 40 contact hours in the specialty.[17]






III. Deployment Pathways and Implementation


As of 2020, the BCEN and the PNCB have designated over 5,200 active CPENs.[18] The CPEN exam has 175 questions; 150 are used for testing purposes, 25 are sample questions.[19] The candidate has three hours to take the exam[20] and a passing score is ⪀ 87%.[21]




IV. Evolution of Certification Standards







Resource Attribution: Data dynamically aggregated from multiple educational wikis and open repositories. This document contains zero proprietary exam data and is intended for conceptual education only.


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CEN exam Format | CEN Course Contents | CEN Course Outline | CEN exam Syllabus | CEN exam Objectives

Exam Code: CEN
Exam Name: BCEN Certified Emergency Nurse
Number of Questions: The exam consists of 175 multiple-choice questions- of which 150 are scored and 25 are unscored pretest questions.
Passing Marks: 106 out of the 150 scored questions correctly- which corresponds to approximately 70.67%.
Time Allotted: 180 minutes (3 hours)- including 5 practice questions at the start for functionality familiarization.

The CEN exam is for nurses in the emergency department setting who want to demonstrate their expertise- knowledge and versatility in emergency nursing.

Killexams is the only source for emergency nursing professionals and their employers to obtain recognized certification with proven results for greater knowledge and performance. Enhance your knowledge- your career- and patient care with specialty certification in emergency nursing.

One of the more common questions we get from our customers is about the difference between a certification and a certificate. Here is the difference in a nutshell:

A certificate comes from an educational program where a certificate is awarded after the individual successfully completes the offering. Examples of certificates are Advanced Cardiac Life Support (ACLS) or Trauma Nursing Core Course (TNCC).

A certification- like the Certified Emergency Nurse (CEN) is an earned credential that demonstrates the individuals specialized knowledge and skills. Certification is awarded by a third-party organization- such as Board of Certification for Emergency Nursing. Individuals receive their certification after meeting strict eligibility requirements and successfully completing the required examination. In addition- certifications have ongoing requirements that must be meant to maintain the credential- ensuring the holder has maintained their level of expertise in the specialty area. Certifications are nationally recognized and are often utilized as part of the earners signature.

Earning professional certifications such as the CEN- CPEN- CFRN- CTRN and TCRN offered by BCEN- and completing certificate programs such as ACLS- PALS- ENCP and TNCC- are critical to the work emergency nurses do- but there are significant differences.

1. Cardiovascular Emergencies 20
A. Acute coronary syndrome
B. Aneurysm/dissection
C. Cardiopulmonary arrest
D. Dysrhythmias
E. Endocarditis
F. Heart failure
G. Hypertension
H. Pericardial tamponade
I. Pericarditis
J. Peripheral vascular disease (e.g.- arterial- venous)
K. Thromboembolic disease (e.g.- deep vein thrombosis [DVT])
L. Trauma
M. Shock (cardiogenic and obstructive)
2. Respiratory Emergencies 16
A. Aspiration
B. Asthma
C. Chronic obstructive pulmonary disease (COPD)
D. Infections
E. Inhalation injuries
F. Obstruction
G. Pleural effusion
H. Pneumothorax
I. Pulmonary edema- noncardiac
J. Pulmonary embolus
K. Respiratory distress syndrome
L. Trauma
3. Neurological Emergencies 16
A. Alzheimer's disease/dementia
B. Chronic neurological disorders (e.g.- multiple sclerosis- myasthenia gravis)
C. Guillain-Barré syndrome
D. Headache (e.g.- temporal arteritis-migraine)
E. Increased intracranial pressure (ICP)
F. Meningitis
G. Seizure disorders
H. Shunt dysfunctions
I. Spinal cord injuries- including neurogenic shock
J. Stroke (ischemic or hemorrhagic)
K. Transient ischemic attack (TIA)
L. Trauma
4. Gastrointestinal- Genitourinary- Gynecology- and Obstetrical Emergencies 21
A. Gastrointestinal
1. Acute abdomen (e.g.- peritonitis- appendicitis)
2. Bleeding
3. Cholecystitis
4. Cirrhosis
5. Diverticulitis
6. Esophageal varices
7. Esophagitis
8. Foreign bodies
9. Gastritis
10. Gastroenteritis
11. Hepatitis
12. Hernia
13. Inflammatory bowel disease
14. Intussusception
15. Obstructions
16. Pancreatitis
17. Trauma
18. Ulcers
B. Genitourinary
1. Foreign bodies
2. Infection (e.g.- urinary tract infection- pyelonephritis- epididymitis- orchiitis- STDs)
3. Priapism
4. Renal calculi
5. Testicular torsion
6. Trauma
7. Urinary retention
C. Gynecology
1. Bleeding/dysfunction (vaginal)
2. Foreign bodies
3. Hemorrhage
4. Infection (e.g.- discharge- pelvic inflammatory disease- STDs)
5. Ovarian cyst
6. Sexual assault/battery
7. Trauma
D. Obstetrical
1. Abruptio placenta
2. Ectopic pregnancy
3. Emergent delivery
4. Hemorrhage (e.g.- postpartum bleeding)
5. Hyperemesis gravidarum
6. Neonatal resuscitation
7. Placenta previa
8. Postpartum infection
9. Preeclampsia- eclampsia- HELLP syndrome
10. Preterm labor
11. Threatened/spontaneous abortion
12. Trauma
5. Psychosocial and Medical Emergencies 25
A. Psychosocial
1. Abuse and neglect
2. Aggressive/violent behavior
3. Anxiety/panic
4. Bipolar disorder
5. Depression
6. Homicidal ideation
7. Psychosis
8. Situational crisis (e.g.- job loss- relationship issues- unexpected death)
9. Suicidal ideation
B. Medical
1. Allergic reactions and anaphylaxis
2. Blood dyscrasias
a. Hemophilia
b. Other coagulopathies (e.g.- anticoagulant medications- thrombocytopenia)
c. Leukemia
d. Sickle cell crisis
3. Disseminated intravascular coagulation (DIC)
4. Electrolyte/fluid imbalance
5. Endocrine conditions:
a. Adrenal
b. Glucose related conditions
c. Thyroid
6. Fever
7. Immunocompromise (e.g.- HIV/AIDS- patients receiving chemotherapy)
8. Renal failure
9. Sepsis and septic shock
6. Maxillofacial- Ocular- Orthopedic and Wound Emergencies 21
A. Maxillofacial
1. Abscess (i.e.- peritonsillar)
2. Dental conditions
3. Epistaxis
4. Facial nerve disorders (e.g.- Bells palsy- trigeminal neuralgia)
5. Foreign bodies
6. Infections (e.g.- Ludwig'sangina- otitis- sinusitis- mastoiditis)
7. Acute vestibular dysfunction (e.g.- labrinthitis- Ménière's disease)
8. Ruptured tympanic membrane
9. Temporomandibular joint (TMJ) dislocation
10. Trauma
B. Ocular
1. Abrasions
2. Burns
3. Foreign bodies
4. Glaucoma
5. Infections (e.g.- conjunctivitis- iritis)
6. Retinal artery occlusion
7. Retinal detachment
8. Trauma (e.g.- hyphema- laceration- globe rupture)
9. Ulcerations/keratitis
C. Orthopedic
1. Amputation
2. Compartment syndrome
3. Contusions
4. Costochondritis
5. Foreign bodies
6. Fractures/dislocations
7. Inflammatory conditions
8. Joint effusion
9. Low back pain
10. Osteomyelitis
11. Strains/sprains
12. Trauma (e.g.- Achilles tendon rupture- blast injuries)
D. Wound
1. Abrasions
2. Avulsions
3. Foreign bodies
4. Infections
5. Injection injuries (e.g.- grease gun- paintgun)
6. Lacerations
7. Missile injuries (e.g.- guns- nail guns)

8. Pressure ulcers
9. Puncture wounds
10. Trauma (i.e.- including degloving injuries)
7. Environment and Toxicology Emergencies- and Communicable Diseases 15
A. Environment
1. Burns
2. Chemical exposure (e.g.- organophosphates- cleaning agents)
3. Electrical injuries
4. Envenomation emergencies (e.g.- spiders- snakes- aquatic organisms)
5. Food poisoning
6. Parasite and fungal infestations (e.g.- giardia- ringworm- scabies)
7. Radiation exposure
8. Submersion injury
9. Temperature-related emergencies (e.g.- heat- cold- and systemic)
10. Vector borne illnesses:
a. Rabies
b. Tick-borne illness (e.g.- Lyme disease- Rocky Mountain spotted fever)
B. Toxicology
1. Acids and alkalis
2. Carbon monoxide
3. Cyanide
4. Drug interactions (includingalternative therapies)
5. Overdose and ingestions
6. Substance abuse
7. Withdrawal syndrome
C. Communicable Diseases
1. C. Difficile
2. Childhood diseases (e.g.- measles- mumps- pertussis- chicken pox-
diphtheria)
3. Herpes zoster
4. Mononucleosis
5. Multi-drug resistant organisms (e.g.- MRSA- VRE)
6. Tuberculosis

8. Professional Issues 16
A. Nurse
1. Critical Incident Stress Management
2. Ethical dilemmas
3. Evidence-based practice
4. Lifelong learning
5. Research
B. Patient
1. Discharge planning
2. End of life issues:
a. Organ and tissue donation
b. Advance directives
c. Family presence
d. Withholding- withdrawing- and palliative care
3. Forensic evidence collection
4. Pain management and procedural sedation
5. Patient safety
6. Patient satisfaction
7. Transfer and stabilization
8. Transitions of care
a. external handoffs
b. internal handoffs
c. patient boarding
d. shift reporting
9. cultural considerations (e.g.- interpretive services- privacy- decision making)
C. System
1. Delegation of tasks to assistive personnel
2. Disaster management (i.e.- preparedness- mitigation- response- and recovery)
3. Federal regulations (e.g.- HIPAA- EMTALA)
4. Patient consent for treatment Performance improvement
6. Risk management
7. Symptom surveillance
a. recognizing symptom clusters
b. mandatory reporting of diseases
D. Triage


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