The purpose of the project was to consolidate pediatric care in the two Knoxville hospitals with pediatric intensive care units (PICU). Prior to this project, the two institutions were competitors for the pediatric patient until 2000 when a white paper agreement divided the admission criteria between the two units. In 2010, a staffing and management agreement further delineated the admission criteria. This a retrospective study of two institutions who have collaborated designed to elevate the care of pediatric patients requiring intensive care by the elimination of duplicated services, by providing additional education to each subset of pediatric nurses, and by sharing nursing staff and management. This highlights how the interest of each institution was promoted and addressed while focusing on the ultimate goal of excellent pediatric patient care in the intensive care setting.