The Mott PICU Nurse Practitioner Program was begun in 2006. Our very own longstanding PICU bedside nurse, Janella Reske, was the founding member. The program has grown its ranks to eleven, recruiting nursing expertise from diverse acute care settings. The nurse practitioners are integrated team members, practicing shoulder-to-shoulder with physician counterparts. In addition to providing vital direct patient care to all types of PICU patients, they are also an outstanding educational resource for rotating residents and beginning fellows, and provide valuable continuity with their 7-days-a-week, 365 days-a-year presence on the unit. Nurse practitioners in the Mott PICU are also actively engaged in patient safety and quality improvement activities.