title: Quality care in an era of retrenchment.
abstract: SOURCE AND PURPOSE: Constraints in the healthcare delivery system are resulting in unprecedented challenges to quality nursing care. In response to concerns expressed by readers in a JSPN survey, we solicited input from prominent SPN members.
  
  
  CONCLUSIONS
  Quality care can be sustained through nurses' creativity, flexibility, leadership, and collaboration. The context for quality care is an organizational environment with attention to critical analysis, careful resource utilization, and improved outcomes.
  
  
  CONCLUSIONS
  Nurses can not only maintain premium standards of quality care but, by assuming leadership, help shape the future of health care.
authors.affiliation: Children's Hospital, Denver, CO, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Biester
authors.forename: M
authors.initials: M
authors.lastname: Duggan
authors.forename: M
authors.initials: M
authors.lastname: Perkins
authors.forename: L K
authors.initials: LK
authors.lastname: Powers
authors.forename: S
authors.initials: S
authors.lastname: Classick
mesh_terms: D003299:Cooperative Behavior; D003405:Creativity; D005544:Forecasting; D018166:Health Care Reform / Q000458:organization & administration*; D006801:Humans; D007587:Job Description; D007857:Leadership; D009738:Nursing Service, Hospital / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D014481:United States