On a daily basis vascular access nurses are presented with complex patient care issues involving intravenous therapy. The nursing process as an instrument to organize nursing care is valuable; however, is it enough to positively affect patient outcomes? Nursing beyond the fundamental process requires the intent to advocate and protect the patient from unnecessary risk or harm. A patient with impaired tissue integrity from epidermolysis bullosa required a nurse specialist whose practice included advocacy, collegiality and consultation in order to protect a PICC insertion site and prevent complications. The intervention included the use of a soft silicone contact layer (Mepitel®) and a transparent semi-permeable membrane dressing (Tegaderm®). A new clinical process was born from the collaboration of two nursing professionals and it positively impacted patient outcomes. This is a professional approach to nursing care that is under utilized.