Leading the Change: How Nursing Leadership Can Champion the Revolution Toward Awake and Walking Intensive Care Units

This article explores the transformation of critical care initiatives by Polly Bailey’s approach of keeping patients awake and mobile compared with the historical reliance on sedation and immobility. It highlights the detrimental effects of prolonged sedation and immobility, including patient harm (delirium and intensive care unit-acquired weakness) and system-wide burdens (increased costs and nursing workload). The ABCDEF Bundle is an evidence-based approach promoting patient wakefulness, autonomy, and mobility, and is presented as a solution. The case study of “Diane” demonstrates the gap between documented bundle compliance and actual patient care, revealing that sedation and immobility practices persist despite superficial implementation of the ABCDEF Bundle documentation. This document calls for nursing leadership to champion the ABCEF Bundle to change intensive care unit culture, transform patient outcomes, and improve the burden of patient care throughout the health care system.