It takes years of experience and education to become a capable senior nurse and I am always saddened when experienced nurses leave our specialty. Unfortunately, this is far too common.

The absence of a long-term nursing workforce strategy has a role to play in events involving avoidable harm to patients, and burnout and moral injury to nurses.

With pressures mounting it is imperative that we prioritise the well-being of our teams. We can only provide safe and effective care if we have the resources and training necessary to meet the issues facing us, and knowledgable and compassionate leaders to support us.

Having been an emergency nurse for 25 years, I am aware of the need to provide safe and effective triage. I have seen different approaches from the initial assessment process, particularly when increasing patient attendances and insufficient access to primary care have resulted in extreme risk in emergency departments.

The article on page 35 by Anna Mackway-Jones and her team highlights the complexities of the initial assessment process and how using a quality improvement methodology can improve safety.

Also in this issue, the expert advice article on page 10 discusses what is termed ‘the real’ 12-hour standard.

This target aims to maximise safety by moving the sickest and frailest patients onto wards as soon as possible, freeing space for emergency arrivals. It will be interesting to see if NHS organisations prioritise this above the four-hour standard.