Socio-technical approaches, with their over-emphasis on situated and contextual differences, find it difficult if not impossible to account for ICT-supported standardization of healthcare work. Empirically, not all efforts of standardization fail. How can that be theoretically conceptualized, even when key tenets of a situated perspective are maintained? We discuss an interpretative case study where standardization of nursing work-to an interesting degree-has been achieved. We analyze the process of co-construction of the standards (i.e., standards in practice). Standards are partly imposed from the top, and partly enacted through the active involvement and ingenuity of users.