Patient care scores of staff nurses in seven Veterans Administration hospitals who used a performance counseling protocol that required written goal setting, coupled with head nurse modeling and support to achieve goals (experimental), were compared with scores of nurses who continued with usual practice (control). Staff nurses chose their own goals. One goal was to improve patient care and the other was to improve staff nurse professional competence. After six months, experimental group scores were higher on five patient care scales, one significantly. After 12 months, scores shifted in favor of the control group, one significantly. Experimental group scores were higher on patient interview questions after six months and made additional gains after 12 months. Experimental nurses generally were more satisfied with their nursing careers and described working relationships more positively. Some progress the experimental nurses made after six months was lost after 12 months. Nurses who received high patient care scores from outside observers described the hospital working environment in more positive terms. Relationships of three instruments that measure quality of patient care are presented.