Registered Nurse Tier 2 ER
Company : Appalachian Regional Healthcare
Location : Hyden, KY, 41749
Job Type : Full Time / Part Time
Date Posted : 30 December 2025
Overview
The Registered Nurse requires substantial specialized knowledge, judgement and nursing skills based upon the principles of psychological, biological, physical, and social sciences in the application of the nursing process in the respective departments in which assigned. The RN must collaborate with physicians and multidisciplinary team members; provide physical and psychological support to patients, friends, and families; supervising assigned team members and students.
Responsibilities
- Completes patient assessments, formulates plan of care, oversees implementation of plan of care, evaluate and adjust plan of care utilizing critical thinking skills
- The performance of other nursing acts which are authorized or limited by the board, and which are consistent either with American Nursing’s Association Standards of Practice or with Standards of Practice established by nationally accepted organizations of registered nurses.
- Care, counsel health teaching and promotion, utilizes Teach Back methodology as affirmation of comprehension
- The administration of medication, intravenous therapy and treatment as prescribed by a LIP
- Supervision, delegation and follow-through to other personnel in the performance of activities relating to nursing care.
- Mentors and precepts students and orients new staff as assigned
- Reports up chain of command Clinical Nurse Manager/Nurse Manager/House Nurse Coordinator pertinent information
- Participates on various teams, committees or performance improvement initiatives
- Ensures a safe and secure environment for patients, coworkers and self
- Participates in Discharge Planning and Transition of Care (able to define pt needs)
- Serves as a patient advocate and escalates patient related concerns timely
- Timely documents pertinent findings in medical record
- Assist patients in performing activities of daily living and functions as an active team member
- Assumes responsibility for personnel professional development
- Utilizes effective communication skills and active listening, exhibits compassionate and empathetic attitude
- Practices Hands Off communication utilizing SBAR; Performs Bedside Shift reporting utilizing SBAR (unless contradicted)
- Functions as a positive influence, role model and adheres to professional code of conduct
- Respects dignity and confidentiality of all matters relating to patients
- Performs other job duties as assigned.
- Training for all personnel assigned to the Emergency Room shall consist of the following:
- 1.State and federal regulations related to emergency services.
- 2.Nursing management of trauma.
- 3.Nursing management of cardiac related disorders.
- 4.Performance of EKG procedures, EKG interpretation, and appropriate nursing intervention.
- 5.Pharmacological intervention (IV therapy).
- 6.Patient assessment (triage).
- 7.Nursing management of pediatric emergencies.
- 8.Medicolegal aspects, particularly related to proper documentation.
- 9.Nursing management of obstetrical emergencies.
- 10.Patient/family emotional response.
- 11.Cardiopulmonary resuscitation and airway management.
Qualifications
- Associate's Degree Graduation from an accredited school of nursing. Required
- Bachelor's Degree Preferred
- Up to 1 year Preferred Minimum of one (1) year acute care nursing experience (1) year of experience should be relevant to specific department in which they will be working. Refer to addendums for additional requirements. Experience with Electronic Health Record Preferred. Preferred
- Excellent interpersonal skills and ability to work with providers at all levels essential.
- Able to communicate clearly in writing and verbally and effectively influence others to achieve necessary outcomes.
- Demonstrated ability to follow direction and facilitate a working environment conducive to change, enabling positive outcomes in a highly complex system.
- Exhibit Critical Thinking Skills
- Must possess basic computer skills.
- Ability to pass Medication Exam.
- Completion of hospital approved training program and documented competence in emergency care procedures as determined by the Director of Nursing Services.
- Moderate Sedation
- Completion of Stroke Modules
- Restraints
- The nurse shall be adequately oriented to the unit policies, procedures, and equipment. Orientation shall include safety procedures, infection control practices and performance improvement monitoring.
- Registered Nurse in State Required
- BLS Required
- De-Escalation Training within 6 months of hire Required
- ACLS Required
- Trauma Nurse Core Curriculum Certification Required
- Pediatric Advanced Life Support Certification Required
- NIH Stroke Certification Required
- Advanced Dysrhythmia/EKG Required
- Rural Trauma Team Development Course Preferred
- Emergency Nurse Pediatric Course Preferred
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Frequently asked questions
In Hyden's emergency settings, a Registered Nurse Tier 2 ER combines specialized clinical skills with rapid assessment and decision-making to stabilize patients. Their role involves multitasking under pressure, coordinating with ER teams, and applying trauma and cardiac care protocols tailored to urgent cases common in rural Appalachian hospitals.
Certifications like Trauma Nurse Core Curriculum, Pediatric Advanced Life Support (PALS), and Advanced Cardiac Life Support (ACLS) are vital for Registered Nurse Tier 2 ER professionals in Kentucky. These credentials ensure proficiency in emergent care tailored to local patient demographics, enhancing clinical outcomes in critical care scenarios.
Advancement often involves gaining certifications in critical care subspecialties, leadership training, and pursuing Bachelor's or Master's degrees in nursing. Many Registered Nurse Tier 2 ERs progress into roles like ER Nurse Manager or Clinical Nurse Specialist, leveraging their emergency expertise to influence patient care standards and team leadership.
Appalachian Regional Healthcare provides structured orientation programs, ongoing education in emergency nursing protocols, and mentorship opportunities. Their commitment to fostering a collaborative environment helps Registered Nurse Tier 2 ERs enhance clinical competencies, stay updated on trauma care advancements, and prepare for leadership roles.
Working in a rural healthcare system like Appalachian Regional Healthcare, nurses encounter diverse trauma cases with limited resources. Challenges include managing high-acuity patients with a smaller multidisciplinary team, adapting to regional health trends, and balancing emergency demands with compassionate community-centered care.
Registered Nurse Tier 2 ERs in Hyden, KY, typically earn between $55,000 and $70,000 annually, reflecting the rural healthcare market. This range is competitive locally due to demand but might be lower than urban centers, balancing cost of living with the specialized skills required for emergency nursing in this region.
Beyond national certifications, Registered Nurse Tier 2 ERs in Hyden benefit from training in rural trauma team development and stroke care modules tailored to regional health challenges. Familiarity with Kentucky’s state protocols for emergency services and local medicolegal documentation standards is also highly valued.
The Hyden region experiences steady demand for ER nursing due to its rural setting and limited healthcare workforce. While competition exists, qualified Registered Nurse Tier 2 ERs with specialized certifications and acute care experience have favorable hiring prospects, especially within Appalachian Regional Healthcare’s emergency departments.
At Appalachian Regional Healthcare, Registered Nurse Tier 2 ERs collaborate closely with physicians, paramedics, and support staff, serving as key patient advocates. They engage in shift handoffs using standardized communication methods, participate in performance improvement committees, and contribute to discharge planning, ensuring cohesive and efficient emergency care.
The organization emphasizes critical thinking in patient assessments, proficiency in intravenous therapy, EKG interpretation, trauma and pediatric emergency management, and effective delegation. Mastery of hands-off communication protocols and compassionate patient education are also essential for delivering high-quality emergency nursing within their facilities.