Central to health care reform is the emphasis on value based health delivery. Nurses comprise the largest clinical subgroup in hospitals; a common avenue for cost containment is to reduce nurse labor hours and their associated costs. This strategy is short-sighted, however, as appropriate safe nurse staffing and skill mix levels are essential to optimize quality of care. The determination of appropriate safe nurse staffing challenges the profession to create dynamic and innovative staffing solutions that are adaptable to the evolving nature of the populations cared for and healthcare environment. This work is essential to save lives, prevent harm, and demonstrate the "business case for nursing", or the return on investment (ROI).