This paper helps district nurses to understand how and why existing quality measurement tools can be used as part of everyday practice to demonstrate clinical effectiveness. We consider how productivity has historically been used to crudely indicate district nurses' clinical effectiveness and why this is now being balanced alongside a range of more robust clinical effectiveness measurement tools. Evaluating clinical effectiveness and improving future care involves examining a number of indicators alongside each other. These include patient safety indicators, patient satisfaction, productivity measurement tools, and how effective clinicians are in supporting people to achieve their best clinical outcomes.