I can't thank you enough for publishing '"It's a Burden You Carry': Describing Moral Distress in Emergency Nursing." 1 As an emergency nurse who is well acquainted with "moral distress," I appreciate both the public recognition of this phenomenon and the authors' validation of the very real challenges associated with the emergency care system. I strongly agree that much of our distress as emergency nurses results from the incompatibilities that exist between our vowed values and ethics and environmental deficiencies and administrative priorities. 1 It is most unfortunate that we often must "ride the line" between what is right and what is expected.Although research for the development of a tool designed to measure the "manifestations of moral conflict" may provide a beneficial first step in helping nurses to better manage their own causes for discord, additional resolve to address other contributing factors remains largely unaccounted for with this approach. For lasting change to occur, I believe leaders at all levels must match the bedside nurse's accountability in this respect. Hocker and Trofino 2 attribute organizational conflict to barriers in communication and inconsistent values. Further, they assert that transformational leaders are instrumental in inspiring a common vision and acting as agents for positive change. 2 Therefore, inspirational nurse leaders are needed at the unit, organizational, and legislative levels to champion initiatives to improve the environmental and institutional factors that fuel such moral dilemmas.-Melony Chilcoat, BSN, RN