To a visitor, it may look like an ordinary business meeting. But this assembly of high-powered nurses is part of an ambitious organizational structure DFCI implemented nine years ago to improve patient care and obtain the coveted Magnet credential developed by the American Nurses Credentialing Center to recognize health care organizations that provide nursing excellence.

The effort is emblematic of the sweeping changes that have transformed the nursing profession over the past decade, says Patricia Reid Ponte, chief nursing officer and senior vice president for patient care services at the Dana-Farber Cancer Institute, director of nursing and clinical services at Brigham and Women's Hospital, and chair of the Magnet Program.

Nurses today, she says, have much more control over their working environment.

Unlike in decades past, nurses at DFCI and other hospitals across the state influence many areas formerly controlled by senior level physicians and executive managers. These areas include staffing and scheduling, policies, and procedures.

"Shared governance has gained popularity and is gaining strength. We recognize that the people closest to the work should influence decisions about how that work is done," says Nancy Shendell-Falik, chief nursing officer at Tufts Medical Center. It is more commonplace now to recognize that you want to engage your frontlines to be part of the solution on how health care is delivered."

This monumental shift has occurred thanks to a growing body of evidence that links good nursing practice to patient outcomes. "When I started in nursing in 1976, it was known that patients were highly satisfied when cared for by competent nurses," says Reid Ponte. Today, however, numerous studies show that nursing excellence reduces adverse events such as pressure ulcers, falls, infections, cardiac failure, respiratory arrest, stroke, and even death.

One of these studies, published in 2002 in the Journal of the American Medical Association, found that around 20,000 people die each year because they have checked into a hospital with overworked nurses. A 2006 study published in Health Affairs provided evidence that hospitals that invest in appropriate RN staffing could save thousands of lives and millions of dollars each year. Both studies were authored by Linda Aiken of the University of Pennsylvania.

Says Mary Sullivan Smith, associate vice president of patient care services at New England Baptist Hospital (NEBH), "The research has given us a framework and a language for working together to advance our profession and improve patient care."

Nurses today are better educated, more respected, and more tech-savvy than ever. They come from more diverse backgrounds and include more men among their ranks. They are also more likely to be specialists and to work on multidisciplinary teams.

One thing remains constant however: Nurses are at patients' bedside 24 hours a day, 7 days a week-more than any other health care professionals.

With this background and perspective, nurses are poised to play a pivotal role in health care reform.

"There is a lot of foreboding about reform," says NEBH's Smith, "but nurses have a great opportunity to make a difference. Nurses are at the epicenter of helping patients navigate the system, looking out for problems or pitfalls, and knowing how to handle a problem once it has occurred." She adds that nurses "have fabulous ideas about how to trim costs by systematizing the things they do on a daily basis."

Nurses at NEBH, for example, have come up with protocols for managing wound care, lowering the risk of a serious hospital-acquired infection, and reducing the amount of time people with hip replacements stay in the hospital after surgery.

Another area in which nurses are innovators is patient safety, says Carole Billington, chief nursing officer and vice president for patient care services at St. Anne's Hospital in Fall River. Nurses use electronic health records, computerized physician order entry systems, automatic dispensing stations, and bar coding technology that helps to ensure that the right patient gets the right dose of medication at the right time. "These technologies have reduced medication errors and transformed our workflow," Billington points out.

The advances have led to a growing specialty, nursing informatics, which involves managing, interpreting, and communicating medical data and information.

Another important development nationwide is the use of expert nurse practitioners and advanced practice nurses to provide primary care. Research shows that when nurses manage caseloads of patients in a primary care setting there is no drop in satisfaction or quality, says Shendell-Falik. "At Tufts, our physicians are highly supportive of nurse practitioners and use them in a variety of services."

"Nursing is an art and a science," concludes St. Anne's Billington. "The art hasn't changed, but the science is changing nursing practice daily."