In the ambulatory surgical setting, nurses are forced to wear a lot of hats. They are not only the nurse, but may be a respiratory therapist, secretary, physician liaison for physician office referrals, educator, physical therapist, housekeeping, infection control, quality coordinator, and any other role necessary to deliver exceptional care to the patient. With limited budget and resources, surgical facilities are still expected to maintain infection control and quality assurance (QA) programs to ensure patients are receiving the safest care. The Joint Commission requires QA programs to cover Infection Control, Performance Improvement efforts, and the Culture of Safety within the ASC. In Texas, the Department of Health (TDH) wants all transfers, emergency department admissions, hospitalizations, and patients returned to surgery to be included in reporting requirements.