Purpose: This study aimed to identify and implement evidence-based initiatives and reinforce nursing involvement in reducing emergency department (ED) transfers among long-term care (LTC) residents to optimize outcomes, enhance quality of life, and support dying with dignity.

Methodology: A descriptive design explored factors influencing nurses’ decisions to transfer LTC residents to acute care. Participants attended an educational session on strategies for ED avoidance. Data from open-ended questionnaires were analyzed using Chi-square analysis.

Results: Thirty LTC nurses (Registered Nurses and Registered Practical Nurses), predominantly female and working full-time, participated, with clinical experience ranging from 0–25 years. After 12 weeks of implementing quality improvement initiatives, six participants reported increased confidence (p < 0.001). Responses related to advance care planning, early assessment, and chronic disease management were statistically significant (p < 0.005).

Conclusion: Nurses are pivotal in reducing ED transfers; however, several influencing factors extend beyond the scope of nursing practice. Findings suggest the need for broader community partnerships and stakeholder engagement to improve resource access and support acute medical management in subacute care settings.