Nursing school does not really prepare any nurse for the real world. The ED can be fast-paced, and let's face it, we were all scared or perhaps, terrified, when were done with orientation and were expected to be real nurses. Take a deep breath and know that, like many before you, you will survive. One piece of advice that is paramount to learning and surviving in the ED, or on any floor, is to ask questions. If you don't understand the reasoning behind an action, ask your preceptor. Some preceptors may assume that you know more than you do (like operating some of the equipment). If you don't know how to use something, don't be afraid to say so. Now is not the time to fake it. If you have a patient that presents with something you are unfamiliar with, go home and learn more about that particular disease process. You'll be glad you did, because I guarantee that you will see it again. Don't be afraid of the psych patients, many are just grateful for a kind word and a little attention. The most difficult part of being a nurse in the ED is working in an environment in which patients are very sick, but the cause of their illness is unknown. I like to think of the ED as the Sherlock Holmes of nursing. When you walk through the door, on Monday, remember that all of the nurses you will be working with were once in your shoes. Be friendly, open, and hard-working. As the preceptorship unfolds, remember that you will have great days and off days. You will experience things you have never experienced before. Absorb everything like a sponge and enjoy your new career! Welcome to the ED!