Hospice is undergoing change, not only in their RN staffing model, but also in their historical perspective of time = quality. Although the RNs are participating in the process and stretching their paradigms to their limit, there remains work to done in the rest of the organization. Adjusting the function of social and pastoral care services, for example, will create greater congruence with the RNs’ new performance expectations. Performance reviews will need to be revised to reinforce adherence to the 60-minute Home Visit Model and efficiency of resource management. Hospice, for the first time, is experiencing the pains of growth and resulting accountability. With the continued application of evidence-based models such as the Three Step Model and the Congruence Model of Change, Hospice has an excellent chance of achieving long-term change and financial sustainability.