Some facilities are adopting a new organizational model to deliver rehabilitation services: the programmatic model. The premise of this model is the delivery of completely integrated services. The programmatic model differs from the traditional service model in many aspects, including philosophy, governance, clinical practice standards, and identification of patient care goals. There are five phases involved in moving from a pure service model to a programmatic model: commitment, enmeshment, product orientation, integration, and maintenance and growth. This article describes the clinical nurse specialist role and experiences in implementing a programmatic model in a rehabilitation hospital.