Congratulations you got your first job in the Emergency Department (ED). You’re going to be where the action is and that’s exciting, but getting started…”It’s like drinking from a fire hose!” This is how beginning your nursing career in the ED can feel. One minute you are asked to get a bedpan and the next help with a chest tube insertion. You will feel like you’re being pulled in so many different directions throughout the day. So how do you go from being a new graduate nurse to getting the hang of the ED workflow? These five tips will support you on your journey to becoming an expert nurse.

1. Ready, Set, GO! Adjusting to the fast pace of the ED.

First things first - be CONFIDENT. Remind yourself that you graduated from nursing school, passed the NCLEX, and mastered many skills during your clinical rotations. Additionally, make sure to get to know your co-workers and form bonds. Your co-workers are your best source of knowledge during your experience. It’s also important to remember that anything can happen during your shift, so learn to be flexible and go with the flow. Finally, one of the most important aspects of being an ED nurse is learning how to manage stress. Try yoga, meditation, an exercise routine, or anything you enjoy as a way to relieve stress. This way, you will be ready to give 100% at your next shift.

2. An Orientation is Essential to Learning on the Fly in the ED.

Approximately 25% of newly hired nurses had deficiencies in critical thinking abilities, including problem recognition, reporting essential clinical data, initiating independent nursing interventions, anticipating relevant medical orders, providing relevant rationale to support decisions, and differentiation of urgency. A good orientation program can literally make or break you, which is why it’s one of the most important factors to consider when applying for a nursing position. It’s also critical to pay attention, ask questions, and take notes during your shift. You may feel that doing this makes you appear inexperienced, but it actually shows that you are there to learn and work hard.

3. Preceptors are there to help you.

Preceptors are not there to scare you. They are there to help you improve your nursing skills. If they are taking the time to make a point so that you remember something, that means it’s a big deal! In these cases, you should:
  • Take notes so that you can review them later.
  • Thank your preceptor for pointing out ways to increase your nursing knowledge.
  • Avoid taking it personally if someone critiques you. Remember that they are only trying to help you become a better nurse.

4. Improving IV placement skills = Practice, Practice, Practice.

If you didn’t get much experience starting IVs in your clinicals, there are many things you can do to prepare before hands-on practice. Keep these tips in mind when learning to improve your IV placement skills:
  • Understand the different variables that can help or hinder IV placement.
  • Stick to the “two strikes and you’re out” rule. If you can not start the IV after two attempts, call someone else to help.
  • Again, stay confident in your skills.

5. Signs of Deterioration: This can be life or death.

Patient safety can be directly affected by the critical thinking abilities of a nurse. Nurses must have the ability to recognize changes in patient condition, perform independent nursing interventions, anticipate orders, and prioritize. These are skills you will learn through hands-on care. If you are unsure, ask your preceptor. If it feels like something is wrong, it probably is, get help. Catch it early and save a life.

Remember that you took an ED nursing position for the excitement and challenge. The tips discussed above can serve as a helpful starting point for a new nurse. Use them to hone your skills and effectively handle the stress from the fast-paced atmosphere of the ED. Keep in mind shifts will get easier and then harder again, so train yourself to go with the flow. Think about what skills you will have a month from now, six months from now, and even a year from now. Keep setting goals and going for them!


(Buerhaus PI, Donelan K, Ulrich BT, Norman L, Williams M, Dittus R. Hospital RNs’ and CNOs’ Nursing Economics. 2005;23(5):214–221.) [PubMed] [Google Scholar]

(Fero et al. J Adv Nurs. 2009 January; 65(1): 139-148. doi:10.1111/j.1365-2648.2008.04834.x.)
[Google Scholar]

photo of author Heather M. Wilson, MSN, FNP-BC Heather M. Wilson, MSN, FNP-BC, started her nursing career in the emergency department. She has worked as a Family Nurse Practitioner for the past 12 years. She is a freelance health content writer based in Tennessee. She is a wife and mother of three girls. You can reach her at