In health care, "Agency" refers to the capacity of an individual or team to make decisions and take actions that positively affect their situation or events. I recall seeing this in action in the late 1990’s when a seasoned Director of Nursing (DON), new to our area, took over this position at a skilled nursing facility (SNF) where I was the Medical Director. She had an “Open Door” policy that encouraged employees to enter and approach her with their concerns. Our employees quickly learned she was a good listener and would listen even to personal concerns that were affecting the employees’ work. She had the ability to coach an employee or a group of employees with a similar problem and then develop with them potential innovative actions that might improve the problem(s). During her time as our DON, the facility developed and sponsored scholarships for certified nursing assistants (CNAs) to go to nursing school. Our employees listened well to our patients and their families and helped them take action during the rehab process to facilitate their recovery. In a brief period, our state and federal surveys improved to the point of back-to-back deficiency-free annual surveys. Unfortunately, her husband took a job out of the area, ending her time as our model “DON.”