Now more than ever, it is essential for hospice and palliative care nurse leaders to be front and center in the quality improvement (QI) arena. Because nurses are integral to the delivery of hospice and palliative care, they are pivotal in efforts to improve quality. This article sought to provide an in-depth understanding of the leadership role that nurses can play in QI activities from project inception and team formation, to the planning stage. The analysis revealed that hospice and palliative care nurses have a leadership role at the onset of the QI project that includes active team membership as a QI team leader, team member, and/or champion. Nurses also have a leadership role in formulating the project aims and choosing the appropriate project model within their organizations. Finally, hospice and palliative care nurses use their planning skills to develop QI project measures, data collection plan, data analysis plan, and communication/implementation/evaluation plan. The QI project provides opportunities for hospice and palliative care nurse leaders to use their clinical, technical, and administrative knowledge to improve the care of patients and families at the end of life.