Emergency nurses are responsible for the care of mechanically ventilated patients. Evidence-based care to prevent ventilator-associated pneumonia (VAP) must be initiated in the Emergency Department (ED) instead of after arrival in the critical care areas of the hospital. Nurses were surveyed assessing VAP prevention measures education, knowledge, and confidence. Nurses reported seldom to never monitoring patient/ventilator interactions (44.6%) and troubleshooting alarms (seldom/never: 48.9%) with confidence levels minimal (29.1%), moderate (54.1%) and high (14.5%). Nurses are responsible for titrating sedation but report contacting a respiratory therapist (RT) for all other ventilator management. ED nurses may not have the same exposure to VAP prevention education as their counterparts in the critical care areas. Increasing ED nurse knowledge and confidence in VAP prevention is necessary as EDs increasingly care for mechanically ventilated patients.