In November 2006, I had the privilege of attending the Royal College of Nursing Emergency Care Association conference. It was a wonderful opportunity to renew friendships with dear colleagues, and to build new relationships as well. The Emergency Care Association has much to be proud of, as the conference was a great success for all the attendees (and Imight add that all emergency nurses in the UK should take advantage of this annual gathering to renew and recharge their career!). I attended courses that were very strongly research based, including pain management of emergency patients and diabetes care. A major initiative being undertaken by the National Health Service is the implementation of an electronic medical record. While many hospitals in the United States have put such programs in place, there is no national initiative using a common vendor, and likely neverwill be.While the US government has set in place standards for privacy of electronic records, and has legislated that medical records become electronic at a date far in the future, it is very unlikely that the free-enterprise, market-driven US health care systemwill ever agree to a single vendor. The benefits of information access and portability will be realized by the citizens of the UK long before it occurs in the US. One lecture stands out in particular to me. Entitled ‘‘Vital signs-how vital?’’, it spoke of how vital signs serve as an ‘‘early warning system’’ for patients who experienced a catastrophic event requiring intensive care admission. The premise that a nurse providing early intervention could prevent significant deterioration of a patient’s health underscored what Brian Dolan stated in his address during the Edith Buckles lecture. Simply stated, Brian made the case that nurses make a difference

Observations of an American Nurse

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