Abstract
What was thought to be a quick and limited quality performance improvement (QPI) project between a few departments providing telephone nursing services became an involved organization-wide QPI project to standardize telephone practice. Initially, telephone nursing practice, expanded roles of nurses, and extent of healthcare professionals using the telephone to provide care from afar were not well understood. Lack of standardization and quality and risk management issues were identified. The Good Samaritan Community Healthcare QPI plan of action provided the roadmap to standardize telephone practice across the organization. Many leadership challenges occurred along the road to QPI for telephone practice, as caution signs were acknowledged, hills were climbed, and corners maneuvered.