The current and future climates in health care require increased accountability of health care organizations for the quality of the care they provide. Never before in the history of health care in America has this focus on quality been so critical. The imperative to measure nursing's impact without fully developed and tested monitoring systems is a critical issue for nurse executives and managers alike. This article describes a project to measure nursing structure, process, and outcomes in the military health system, the Military Nursing Outcomes Database project. Here we review the effectiveness of this project in monitoring changes over time, in satisfying expectations of nurse leaders in participating hospitals, and evaluate the potential budgetary impacts of such a system. We conclude that the Military Nursing Outcomes Database did meet the needs of a monitoring system that is sensitive to changes over time in outcomes, provides interpretable data for nurse leaders, and could result in cost benefits and patient care improvements in organizations. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams &Wilkins.