Integrated delivery systems have become a major trend in health care systems across the United States (Kim, Stoskopf, Glover & Park, 2004). Integration among two urban Midwest organizations joined the major health care trend in 2008. A grounded theory qualitative study was conducted to encourage the emergency department nursing staff and managers to report their experiences following the integration. Maximum variation sampling was used for selection of participants. Data collection was done using an interview process of four nurses from each emergency department. Editing analysis style was used for data analysis. The results of the study were analyzed and shared with the administrator of the five emergency departments which integrated to determine if further changes need to occur for the integration process to be effective.