The unpredictability of acute care, rising patient multimorbidity and the under-resourcing of community palliative care services mean that more patients are presenting to emergency services in the final stages of illness, with emergency departments (EDs) increasingly becoming places where people experience end of life. Nurses are often the first to recognise a dying patient and initiate essential care in the ED’s high-pressure, intervention-focused environment. This narrative review article explores how emergency nurses can provide high-quality care at the end of life when supported by access to appropriate advanced care planning documentation, integrated records, education and interprofessional collaboration. Given these circumstances, nurses can have a critical role in recognising dying patients, managing their symptoms and supporting their family members. However, the emotional burden and organisational pressures of providing end of life care can also contribute to moral distress among emergency nurses.