I am delighted to be asked to write the Foreword for Management and Practice in Emergency Nursing. More than any other nursing speciality Accident and Emergency work reflects change in society because it is the casualties of social upheaval, imbalance and inequality that you face every day. Here, unfortunately, A and E staff are confronted on a regular basis with child abuse, family violence, the result of terrorist activities, social violence, motor car accidents, personal loss of loved ones, the frustrations and aggression of life. Sometimes, though, some pleasant and funny episodes do occur but all too infrequently to become the norm. My own experience of A and E nursing is very limited; in fact, it goes back to the days of the Department being linked with Orthopaedics and being called 'Casualty' . It could, though, appear that in this day and age the wheel is tuming full circle and moves have been made in the last reorganization to link the two new distinct specialities again. This proposal was met with lots of protest from A and E staff which appears to have been defused. The arguments stemmed mainly from the fact that orthopaedics and A and E are two quite difficult specialities of care and skills and as such must be seen as autonomous.