Implementation of innovative patient care delivery models provides an opportunity to examine how effective nurse leaders are leading change in the healthcare system. The trends and pressures that make change imperative, not optional, are discussed in other articles in this issue. The focus of this article is on how chief nursing officers improve patient safety and increase care quality while managing the complexities of the nursing workforce and controlling costs. The authors examine the leader's role in the change process, in particular, the role of nursing leaders. The care delivery model is considered an instrument for change, and the chief nursing officer is a change agent.