When our daughter was young, one of the books she frequently requested that my husband or I read was Love You Forever written by Robert Munsch. I have to confess, it is one of my favorite children's books as well. The part of the book that was soon memorized and read aloud in unison was

* I'll love you forever

* I'll like you for always

* As long as I am living

* My baby you'll be (Munsch, 1987).

From this book came the close for every letter, every card, and every e-mail we write to one another: Love you, always and forever. We would never think of turning the word "always" into "sometimes."

I began to think about what we could impact if we were to turn our "sometimes" into "always". If we always

* implement the Surgical Care Improvement Project (SCIP) measures such as preventing hypothermia beginning in the preoperative holding area by providing warmed blankets and by using warmed irrigation and infusing fluids throughout the patient's perioperative period, hospitals could prevent an estimated 13,000 patient deaths and 271,00 surgical complications each year (Brendle, 2007).

* focus on decreasing adverse drug events, we could cut patients' length of stay by 1.2 days and the additional cost of $1,850 per patient (The Advisory Board Company, 2007).

* work toward decreasing staff turnover to 12% or less, we could save 36% on higher costs per patient discharge (Page, 2004).

* eat breakfast everyday, we can impact long-term weight loss (Wyatt et al., 2002).

* achieve door to balloon times in ST elevation of myocardial infarction of less than 90 minutes, we can effect infarct size, patient length of stay, and hospital costs (Khot et al., 2007).

* practice the five rights, we can reduce medication errors.

* wash our hands, we can impact the increasing prevalence of nosocomial infections.

* practice what we preach to our patients such as the benefits of smoking cessation, we can have a healthier workforce.

* lessen the divide created by insensitivity to generational differences, we can improve the work environment.

* practice effective communication skills, we can enhance patient adherence, increase staff and patient satisfaction, and facilitate positive clinical outcomes (Antai-Otong, 2006).

* emphasize patient's pain control, we can positively impact patient length of stay (Banks, 2007).

* buckle our seatbelts, we can decrease the number of deaths on American highways.

The list can go on and on. Think of how you can change your "sometimes" into "always." Like the ripple effect of a stone thrown into a lake, the effect of turning your "sometimes" into "always" can be widespread and powerful.

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