In summary, increasingly accountability implies the acceptance of peer review as an integral part of nursing practice. Peer review in turn presents a variety of ethical and legal implications and, beyond the scope of this discussion, educational, organizational and psychological implications as well. We must proceed to identify the components necessary to a sound peer review approach, starting with ethical issue and the necessary data base to measure outcomes of care right through the mechanisms of process and structural arrangements. Then, of course, we must ensure the application of rigorous examination of results. Whether QAPs as a whole or peer review as a specific, results are not dependent solely on the provider and client. Environmental and organizational factors must also be considered. Outcomes of care and performance are a function of the interaction of a variety of factors. In essence, the onus for assuring that the profession will meet its public accountability rests largely with each and every one of us. Every professional practitioner in the context of peer review will be compelled to be involved in assessment of the many dimensions of patient care. If professional self-requlation is to be effective, all professional nurses must be involved. In sum, we are the ones who must determine the what and the how of accountability for the nursing profession.