This qualitative study investigated transformational leadership in nursing. The study used a single case study design to explore the leadership of Florence Wald who brought hospice care to the United States in the 1970's. The purpose of this study was to examine Wald's contributions using the constructs of the transformational leadership model of Burns (1978). Nursing leaders face many challenges and opportunities in the complex world of health care delivery. By understanding and analyzing the story of Wald's leadership, this study provided deeper insights into how nursing leaders can design and direct meaningful changes in the delivery of health care during turbulent times. The following research questions guided the study. (1) What values did Florence Wald use to lead the founders group in starting the first hospice in the United States? (2) What evidence exists to show Florence Wald elevated the consciousness of her hospice team to direct meaningful change? (3) How did Florence Wald demonstrate a caring component in her leadership of the interdisciplinary team to encourage a high level of participation? (4) What leadership methods did Florence Wald use to assist the hospice team to transform the quality of end-of-life care? (5) How did Florence Wald build consensus on vision before executing purposeful change in palliative care in the United States? The literature review examined the history of end-of-life care in the United States and the hospice movement that changed the culture of care for the dying. The concepts of transformational leadership were explored in research studies related to this theory in general, and then in nursing service. This search exposed a gap in the literature related to case studies of transformational leaders in nursing service and the essence of their ability to significantly change the delivery of healthcare. The findings from both interviews and the Yale Archives showed that Florence Wald based her leadership on strong values and the importance of creating a shared vision. In order to direct meaningful change, Florence Wald elevated the consciousness of her hospice team by conducting research to ensure interventions were based on evidence. To encourage a high level of participation, Florence Wald demonstrated a caring component in her leadership. Wald worked to transform the quality of end-of-life care by assessing the readiness for change prior to acting, and by working to provide supports for success. Finally, The findings show that Florence Wald built consensus on vision before executing purposeful change by collaborating with the Founders and asking the hard questions. A conclusion of this study is that Florence Wald was successful in creating a culture of inquiry among the Founders which served to drive evidence based decision making to improve the quality of palliative care in the United States. A recommendation for nursing practice is when nursing leaders work to elevate the consciousness of their work groups to direct meaningful change by developing and sustaining cultures of inquire, decisions will more directly aligned with evidence and support successful outcomes. More studies are needed correlating transformational leadership with sustained transformational change in nursing.