Abstract
Within the context of neoliberal restructuring, accountability is primarily linked to efficiency, determined through standardized, numerically based technologies and focused on lengths of stay, utilization indicators, and the like. Disappearing from view in this approach is what is actually happening at the point of care for registered nurses. Grounded in semistructured interviews, this article casts a critical light on the tensions and contradictions experienced by nurses, arguing that instead of a more accountable, effective, or efficient system, this path is jeopardizing nurses' ability to provide needed care within healthy, supportive work environments, setting into motion a fundamental transformation of nursing practice.