Article Abstract: As part of the 2019 Emergency/Trauma/Transport Nursing Workforce Survey, nurses practicing across the emergency spectrum described their biggest challenges and recounted examples of when they or an emergency, trauma or transport nurse colleague made an important impact on a human, medical or operational outcome. This article presents 10 top themes from the impact and challenges data, features verbatim open-ended responses, and highlights select quantitative data from this expansive, first ever research.