With nurses and unlicensed supportive personnel composing the greatest percentage of the workforce at any hospital, it is not surprising nursing leadership plays an increasing role in the attainment of financial goals. The nursing leadership team at one academic medical center reduced costs by more than $10 million over 4 years while outperforming national benchmarks on nurse-sensitive quality indicators. The most critical success factor in attaining exceptional financial performance is a personal and collective accountability to achieving outcomes. Whether it is financial improvement, advancing patient safety, or ensuring a highly engaged workforce, success will not be attained without thoughtful, focused leadership. The accountability model ensures there is a culture built around financial performance where nurses and leaders think and act, on a daily basis, in a manner necessary to understand opportunities, find answers, and overcome obstacles. While structures, processes, and tools may serve as the means to achieve a target, it is leadership's responsibility to set the right goal and motivate others.