The purpose of this study was to determine the usefulness of an instrument developed to assess the practice of 14 experienced nurses providing case management within a decentralized, nurse-based case-management system. The instrument was based on nursing process concepts. The nurses designed complex care plans for chronically ill children and coordinated the many services necessary to assure appropriate, home-based implementation of therapeutic regimens. Findings were that in 91 percent of the practice encounters, the purpose of the visit and subsequent plans for care were consistent with the needs of the child and family. Assessment areas identified as needing improvement were psychosocial, developmental, and nutritional. Reliability of the instrument was 0.91 using Cronbach's alpha. In addition, the instrument proved to be an acceptable method for supervisors to assess the practice of experienced nurses.