The implementation of a prospective payment system has had a profound effect on health care delivery in the United States. Providing realistic nursing experiences for baccalaureate students has become a challenge in the new arena of increased patient acuity, decreased length of patient stay in acute care settings, and increased use of home care services. The purpose of this study was to describe changes in the health care system and projected changes in baccalaureate nursing education associated with prospective payment. The descriptive survey design used a mail questionnaire to which deans or their designees from 186 National League for Nursing (NLN) accredited baccalaureate nursing programs responded. Outcomes of the study indicated specific health care delivery changes in all geographic areas and all types of institutions. Projected changes in nursing education included curriculum, teaching methods, and clinical learning experiences.