Background <p>The demand for emergency nurses to engage in advance care planning (ACP) and end-of-life decision-making using advance directives (ADs) has increased. However, effective strategies to support their roles within emergency departments remain limited.</p> Aim <p>To explore the perspectives on ACP and its role in end-of-life decision-making among emergency nurses.</p> Methods <p>A qualitative study was conducted using focus group interviews with a purposive sample of emergency nurses divided into two groups. The interviews were thematically analyzed.</p> Results <p>Four themes emerged from the interviews with nine emergency nurses. First, suboptimal and inconsistent implementation of ACP was reported. Second, multilevel complex barriers were identified, with systemic, institutional, and personal obstacles hindering the implementation of ACP. Third, the nurses suggested multilevel comprehensive solutions and strategies to overcome these barriers. Fourth, distinct roles of healthcare providers were highlighted, with physicians focused on treatment-oriented care, while nurses provided explanations and emotional support to patients and caregivers.</p> Conclusions <p>Emergency nurses face significant barriers to the implementation of ACP and ADs. To improve ACP engagement among emergency nurses, comprehensive strategies addressing barriers at the institutional, provider, and personal levels are required, including standardized systems, role clarification, and targeted training.</p> Clinical trial registration <p>Not applicable.</p>