Context: One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. Purpose: The purpose of this study was to determine the influence of registered nurses' certifications and years of experience on comfort level in emergencies. Methods: Data were collected using a survey design. The questionnaire gathered demographic data, number and type(s) of certifications held, and comfort level with 7 emergency interventions. The sample was recruited from registered nurses (RNs) working in 10 Critical Access Hospitals that represented different geographic locations and different distances to larger, more comprehensive hospitals in an upper Midwestern state. Findings: Mean comfort level of all respondents with the 7 selected emergency interventions ranged from 2.3 for assisting with thoracentesis to 3.6 for assisting with precipitous vaginal delivery, indicating only a moderate comfort level with the selected emergency interventions. While 70% of the 86 respondents answered "yes" when asked if they felt comfortable in emergency situations, the percentage of respondents who reported being comfortable ranged from 33% to 83%. Conclusions: Number and type(s) of certifications and years of experience as an RN were associated with higher comfort levels. Responses to open-ended questions provided insight into the realities of rural emergency nursing and strategies for improving comfort levels of rural nurses in emergency situations.