Clinical teaching has long enjoyed a well deserved reputation as a difficult teaching challenge. Recent pressures, particularly those for accountability in health care, have accentuated the difficulties for clinical teaching. These pressures arise from public sensitivity to rising costs and the increasing complexity and sophistication of hospital systems (raising patient fears of technologies too complex to be understood). More than ever, patients insist on high quality care from all health profession workers. Thus, the increased frequency over the past 2 decades of articles on aspects of nursing quality is not surprising. How have these pressures affected the nursing instructor?