How do we as nurses know we are providing the best care possible? We ultimately want to improve the patient healthcare journey. In 2010, Mandie Sunderland (CEO of the then Heart of England Foundation Trust) spoke to Irish nurse managers at a national conference about her worries in the provision of care by all her nurses in her Trust. She spoke of assuming care was okay unless told otherwise. She reassured high level managers that care delivered by nurses was up to the proper standards. After the Mid Staffordshire Report showed severe deficiencies of care in a neighbouring Trust, she felt she needed more than assuming care was meeting standards in her Trust and set about developing “metrics” to measure the fundamentals of care. Metrics highlighted improvements she needed to make immediately to support nurses to ensure care reached the required standards. When Mandie spoke to Irish nurse managers, she was candid in saying that the reality of care delivery was far from rosy.