OBJECTIVE: We describe the use of a measurement of nursing acuity in an ICU based on data from an integrated clinical and financial information system to shed light on the problem of a perceived change in the work of the unit. SETTING: A surgical-neurosurgical ICU in a teaching hospital with more than 800 beds. DESIGN: Changes in the work of nursing, defined by nursing acuity and by case mix and use of ancillary services in this unit for an 18-month period, were reviewed. RESULTS: The caseload was unpredictable. The lack of a systematic pattern of use of hospital resources burdened the nurses. CONCLUSION: For the first time at this institution, timely clinical and financial information has been brought together in an understandable format that can be used to explain trends and variances, to plan for the future, and to manage for cost and quality. The model for information management described here might serve other hospitals as well.