How may nurses be enabled to contribute to, develop and advance their practice when working in bureaucratic and hierarchical health care settings? Corporate recognition and support for nurse–led change and development is gradually increasing. However, ‘top down’ change is still frequently imposed without due regard for the wisdom of practitioners. Nurses should explore the theory and practice of change, identify changes to enhance the quality of patient care, and systematically put these into practice. As a result, they will be better equipped to cope with the implementation of national and local policy initiatives, which include shared clinical governance and evidence based nursing practice, both of which are described in this text. This book documents how nurses attempt to undertake change and development in clinical practice through the use of the exploratory, creative, innovative and empowering process of critical action research. The text illustrates the evolution and outcome of the change process. The personal developmental process of engaging in collaborative change in clinical practice is clearly evident. Change is very difficult and complex and if it is to be accomplished successfully it needs to be clearly understood. Consequently, the book also explores the complexity of attempting change in clinical practice. This includes the identification of some of the disempowering processes (both actual and imagined) that currently exist in health care settings.