Total Quality Management (TQM) is a management philosophy that has had great success in increasing quality and productivity in the private sector. Health care executives are interested in adapting this approach to a health care environment. This article discusses the implementation of theory based nursing practice as one initiative that lays the groundwork for the successful utilization of TQM in a nursing department. The barriers to quality are usually processes not people. Implementation of Jean Watson's nursing theory emphasizes that nurses are co-participants in the processes of health care which results in better outcomes. Nurses are viewed as knowledge workers. Treating them as such, removes barriers to pride of workmanship and renews their commitment to the pursuit of excellence in their care.