Critical care nurses can be instrumental in developing and implementing changes to improve patient safety. Targeted interventions, based on nurse-identified issues, can yield measurable results. There were several keys to engaging and sustaining nurses in this effort. Leaders at all levels of the organization consistently demonstrated their enthusiasm and support for every aspect of the initiative. Topics addressed-clarification of orders, establishing care protocols, strengthening chain of command, improving staff levels and staff education, and eliminating the overflow of nonspecialty patients to specialty units-arose from suggestions made by nurses through formal surveys, informal focus groups, clinical practice groups, or root cause analyses. Progress is measured, and feedback is frequent. The culture remains one of collaboration and continuous problem solving with nurses viewed as central to the process.