I am the clinical nurse manager of a community-based emergency center. I have 11 years of experience in the hospital-based and freestanding emergency departments. I found the research article “Shared Governance and Work Engagement in Emergency Nurses” interesting and true to the problem in our emergency departments—employee apathy and disengagement. The authors report that only 33% of ED nurses are engaged—7% less than the general nurse population. Research proves that a shared governance workplace harbors the greatest percentage of engaged nurses. The American Nurses Credentialing Center’s Magnet designation has been on the leading edge to promote a new wave of nursing professionalism. I recognize this same need to foster shared governance, work autonomy, and professional stewardship in the emergency department.

Concern about antibiotic overuse has become heightened as bacterial resistance to antibiotics continues to increase. Patients experiencing respiratory symptoms frequently present to urgent/emergent care settings such as fast-track emergency care departments and primary care retail settings with the expectation that they will be prescribed antibiotics. The Centers for Disease Control and Prevention (CDC) reports that approximately 2 million people will become ill with bacteria that are resistant to at least one antibiotic, approximately 23,000 people die as a direct result of these infections, and many others die as a result of complications related to antibiotic-resistant infections.

The Agency for Healthcare Research and Quality ranks septicemia as the most expensive condition treated in United States hospitals, resulting in an aggregate cost of $20.3 billion (5.2%) of the total aggregate cost for all hospitalizations. For many years, emphasis has been placed on improving acute myocardial infarction (AMI) and stroke outcomes through implementation and management of the hospital quality core measures mandated by the Centers for Medicare and Medicaid Services (CMS), which has resulted in better outcomes and reduced morbidity and mortality from these conditions.

A 7.2% increase in patient volume from 130,700 to 140,800 in 2012 prompted St Joseph's Regional Medical Center Emergency Department to review existing triage processes to decrease turnaround time. "Pivot triage" is a new, efficient intake process that entails use of 4 rather than 8 determinants to identify acuity levels. The purpose of this performance improvement project was to create alternatives to traditional triage to decrease ED length of stay and door-to-physician time.

Veterans eligible for health care in the Veterans Administration (VA) health system often receive care in community emergency Departments. In line with initiatives from Joining Forces and the American Academy of Nursing, emergency departments have an opportunity to screen for veterans during routine ED visits and provide resource information regarding various VA services.

More than a decade ago, the Institute for Safe Medication Practices (ISMP) reported a number of serious safety events associated with the use of medications with doses displayed as ratio expressions. At that time, in 2005, there had already been more than 75 reports in the ISMP database dating back at least 10 years.Unfortunately, wrong dose/wrong strength errors have continued to be common, and alarmingly, they include medications frequently used in emergency departments or procedural settings such as calcium, epinephrine, lidocaine, magnesium sulfate, isoproterenol, neostigmine, and sodium bicarbonate.