Promoting innovative nursing practice during radical health system change.

Between 1995 and 1999, the United States veterans healthcare system underwent a radical transformation. The reinvention effort remains a work in progress, but the results have documented improved access to care, significantly higher service satisfaction, and substantially higher quality of care, while reducing per patient costs by 25%. Although turbulent at times, the changes instituted during this period created a dynamic milieu for nursing that has provided fertile ground for innovation and unprecedented opportunities to improve patient care.