Reimbursement, budget, and nurse availability constraints no longer support the quality-at-any-cost concept. However, clear definitions of clinical and satisfaction outcomes, nursing responsibilities that contribute to those outcomes, and reasonable time targets for staff contributions can help nurses at all levels analyze and prioritize work load to build new or update existing acuity systems. The author describes specific methods nurse executives and managers can use to involve and guide staff members in (1) determining realistic and compatible standards of care, performance, and resource productivity,(2) integrating quality-based time standards into acuity systems, and (3) using acuity information to manage delivery of a targeted, desired level of ongoing quality care.