What a New ER Nurse Must Focus On

ACLS and PALS, the ABCs, the common conditions, getting clinical exposure, and what to do at the end of each day and on your days off.

What a New ER Nurse Must Focus On

A new ER nurse must be proactive in building their foundation. This means taking ownership of your learning: actively seeking out experiences, engaging with diverse patient populations, reading outside of work, asking questions, and keeping notes. In the beginning, focus on gaining a strong understanding of ACLS, PALS, the ABCs, common emergency conditions, and thorough assessments — including the right questions to ask. • ACLS and PALS are essential in the ER. They cover critical rhythm issues like VTach, VFib, SVT, and symptomatic bradycardia, as well as cardiac and respiratory arrest, airway management, critical medications (e.g., epinephrine, amiodarone), and treatment protocols for strokes and acute coronary syndromes. • The ABCs (Airway, Breathing, Circulation) are the foundation for assessing and stabilizing any critically ill patient. You should understand not just how to assess each component, but what interventions or maneuvers are appropriate when something is wrong. • Common conditions such as CHF exacerbation, STEMIs, pulmonary embolisms, allergic reactions, seizures, and GI bleeds should be familiar to you. Know how they present, what the expected workup is, and what treatments are typically used. When it comes to clinical exposure, be hands-on as much as possible. It can be intimidating, but advocate for yourself — ask your charge nurse for high-acuity assignments, from newborns to geriatrics, so you can gain experience with a variety of conditions and sharpen your critical thinking skills. If there's a sick patient on the unit and you're free, go help. Watch every procedure you can — whether it's a chest tube placement, intubation, or drain insertion — and think through the "why" behind everything. At the end of each day, review what you learned. If there are any knowledge gaps, look them up. Write down your questions. Try to answer them yourself first to get your brain working, then confirm your understanding with your preceptor, educator, or provider. There are no dumb questions — this is how you grow. On your days off, try to dedicate just an hour to reading an emergency nursing book or watching clinical videos. Over time, you'll recognize conditions and treatments you've already read about, and your understanding of the pathophysiology and clinical decision-making will deepen. Little by little, your ER brain will grow. Know that it takes time. In my experience, it usually takes around a year for everything to start clicking. That's when new nurses begin to feel truly confident. So be patient with yourself, but also strategic and intentional about your growth. Building a strong foundation now will make you a safer, more capable nurse — for your patients and for yourself.

Updated 12 Sep 2026