The management of essential IV information and the application of patient care technology are essential that I consider most important to my practice. My nursing skills and technology are put to the test every day when I work. New technology, changes in procedures and new equipment are essential to working in the cardiac catheterization laboratory. You have to adapt and change daily to keep up and stay educated. New physicians join us and we must learn their technical styles and equipment needs while maintaining exceptional patient care. Basic Organizational and Systems Leadership Essential II for Quality Care and Patient Safety is also an essential element that all nurses face daily. “Leadership skills are needed to emphasize ethical and critical decision making, establishing and maintaining effective working relationships, using mutually respectful communication and collaboration within interprofessional teams, care coordination, delegation and the development of conflict resolution strategies. » (American Association of Colleges of Nursing, 2008, p. 13) This essential element begins on the first day of orientation and ends on the day the nurse retires. The importance of ethical decisions, critical decisions, and respectful communication cannot be overemphasized. Whether it is an aggrieved family member or a fellow staff member, one must always strive for quality.