There are very few academic programs in the United States that offer the emergency nurse practitioner specialization, and many emergency department providers are not familiar with the competencies and skills of the emergency nurse practitioner. This can make transitioning into emergency department practices a challenge for the emergency nurse practitioner. This grounded theory study was conducted to identify the process by which nurse practitioners successfully integrated into a variety of emergency department practices. The purpose of this case study is to illustrate the twist and turns of sampling in grounded theory research. Ethical and methodological issues that must be considered throughout this process are identified.