Nurses are the backbone of healthcare—especially in pediatric critical care, where they play a vital role in patient assessment, procedure support, medical device management, and providing emotional and family-centered care. Research consistently highlights that access to information, adequate resources, opportunities for professional growth, and meaningful staff engagement are critical for ensuring safe and effective patient outcomes.

At PGIMER, fostering ‘horizontal teams’ has empowered nurses by valuing their contributions and enabling them to perform at their highest potential. True nurse empowerment is about more than delegation—it’s about supporting their transition from traditionally subordinate roles to those of autonomous decision-makers and confident leaders within the healthcare system.

At PGIMER, our journey of nurse empowerment began over two decades ago, laying the foundation for strong collaboration and synergy across the healthcare team. This sustained effort has helped us build an effective horizontal team where every member contributes meaningfully. Early on, we identified key areas where nurses could take decisive leadership, and over the years, we have focused on equipping them with the training, confidence, and autonomy needed to lead with impact.

Competency in Basic and Advanced Life Support (BLS and ALS) is a fundamental skill every nurse must master. At PGIMER, our nurses have been empowered with the knowledge and hands-on training necessary to perform these life-saving interventions confidently and effectively. For over a decade, they have not only delivered BLS and ALS care but have also taken the lead in conducting numerous ‘for nurses, by nurses’ training programs—widely appreciated for their clarity, dedication, and peer-to-peer approach. Their leadership further extended to developing the ALS manual for nurses, which now serves as a standard reference for IAP-ALS training programs across the country.

Nurses also play a central role in infection prevention within the PICU. Daily nurse-led morning huddles offer a structured platform to review patient status, plan interventions, and reinforce infection control strategies. These huddles—rotated among nurses to encourage shared leadership—have enhanced awareness and accountability, significantly improving hand hygiene compliance and reducing device-associated infections, particularly central line-associated bloodstream infections. Monthly audits, led by nursing teams, involve reviewing critical incidents and sepsis data, identifying root causes, and collaboratively developing preventive strategies. Through these proactive measures, our nurses have transformed infection control from a protocol into a culture of safety and vigilance.

In the face of reduced nurse-to-patient ratios, parent-participative care has emerged as an essential strategy to ease the nursing workload while ensuring safe and effective pediatric care. Recognizing that caregivers are often laypersons, our nurses take the lead in guiding and supervising them through essential tasks. Nurse-led health talks play a vital role in empowering caregivers—educating them on basic yet critical aspects such as personal hygiene, feeding, and diaper changing. This collaborative approach not only enhances care quality but also fosters trust and shared responsibility between families and the healthcare team.”

Teaching and training are at the heart of improving nursing care. At PGIMER, our ‘for the nurses, by the nurses’ training programs have proven to be powerful tools in enhancing knowledge, shaping positive attitudes, and refining clinical practice. Our PICU nurses extend their expertise beyond the hospital walls through the IMPACT program—a collaborative initiative with the National Health Mission, Madhya Pradesh—where they mentor grassroots-level nurses, fostering skill development, autonomy, and confidence. Regular participation in simulated code drills and hands-on workshops empowers our nurses to master advanced procedures, reinforcing their competence and readiness in high-stakes clinical situations.”

Beyond education and training, our PICU nurses actively lead and participate in quality improvement (QI) initiatives that enhance care processes and generate meaningful, context-specific data. These nurse-driven projects reflect a deep commitment to advancing pediatric critical care through practical innovation. Notable QI efforts in our unit include successful initiatives to reduce CLABSI rates, the implementation of a nurse-led early mobilization protocol in the PICU, and regular monitoring of endotracheal (ET) cuff pressure. These initiatives not only improve patient outcomes but also empower nurses as change agents in healthcare delivery.

Our journey of nurse empowerment reached a significant milestone in 2023 with the launch of PGIMER’s formal one-year Competency-Based Pediatric Critical Care Nursing Fellowship Program. We take great pride in mentoring and graduating the first cohort of PICU fellowship nurses—trailblazers who embody the spirit of advanced practice and leadership. This program marks a transformative step forward in empowering nurses with the skills, confidence, and recognition they deserve.

Over time, these nursing empowerment initiatives have not only strengthened interpersonal relationships within the healthcare team but have also enhanced job satisfaction, boosted confidence and morale among nurses, and helped us build a collaborative ‘horizontal team’—one that works collectively and effectively to deliver high-quality care in the PICU.

Despite the strides we’ve made, we firmly believe the journey of nurse empowerment is far from over. It is a continuous, evolving process—one that thrives on education, leadership opportunities, and unwavering commitment. Yet, sustaining this momentum is not without its challenges. True progress demands that we recognize the vital role empowered nurses play in delivering safe, effective, and compassionate care. Only by valuing and investing in our nursing workforce can we create lasting change.