Preventable adverse drug reactions account for 3.7% hospital admissions. Nurse-led medication monitoring may reduce drug-related harm. However, development of medication monitoring strategies is not reported elsewhere.

The profile was developed by: (1) cognitive interviews (n = 4), (2) the content validity index (n = 10) involving academics, clinicians and service users prescribed respiratory medicines, (3) inter-rater reliability (n = 48) and clinical gains in a nurse-led outpatient clinic.

Cognitive interviews prompted more profile changes than either the content validity index or inter-rater reliability testing. Cohen's κ for inter-rater reliability for each item ranged from 0.73–1.00 (good to complete agreement). The profile identified previously unsuspected problems in all participants, including muscular weakness, skin and mouth problems.

The West Wales Adverse Drug Reaction profile was valid and reliable, and helped to detect and ameliorate drug-related harm.

The West Wales Adverse Drug Reaction profile offers opportunities to improve care. Medication monitoring provides the structure to concurrently monitor known adverse drug reactions. Practice-based adverse drug reaction profiles benefit from cognitive, content validity and inter-rater reliability testing.

Leadership is important for the implementation of nursing practice. However, the empirical knowledge of positive leadership in processes enhancing person-centred culture of care in nursing homes is limited.

The study has a qualitative descriptive design. The DCM method was used in three nursing homes. Eighteen staff members and seven leaders participated in focus-group interviews centring on the role of leadership in facilitating the development process.

The different roles of leadership in the three nursing homes, characterized as ‘highly professional’, ‘market orientated’ or ‘traditional’, seemed to influence to what extent the DCM process led to successful implementation of PCC.

This study provided useful information about the influence of leadership in the implementation of person-centred care in nursing homes. Leaders should be active role models, expound a clear vision and include and empower all staff in the professional development process.

Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning.

Ninety-eight NPs at a conference completed the Interprofessional Team Functioning Survey (ITFS).

The survey items with the lowest mean scores were related to organisational systems. These items included workplace policies that support interprofessional teamwork, in particular, orientation to the interprofessional team. Items that generated lower mean scores were adequate time to work as a member of the interprofessional team, team dynamics, collaboration among team members and the sharing of responsibility.

Organisational and team relational issues can be addressed through organisational management strategies. Nurse managers have an important role in facilitating high functioning interprofessional teams.

Strategies for managers to support interprofessional team functioning emerged. These strategies include ensuring that there are appropriate policies, orientation of new members, allocation of time to support interprofessional teamwork, leadership to enhance team collaboration and clear delineation of responsibilities of each member.

Leadership programmes are effective ways to prepare nurse leaders for their complex roles. Relational competencies, such as leader empowering behaviours, are associated with improved leader, staff and practice environment outcomes.

A quasi-experimental, pre-test–post-test design was used to compare perceptions and self-reported behaviours of leaders who participated in a year-long leadership programme with those of similar leaders who did not attend the programme. Multiple regression analyses were used to evaluate a conceptual framework of leader empowerment.

The leadership programme was directly associated with leaders' perceptions of using more empowering behaviours. Leader empowering behaviours were also associated with feelings of being structurally empowered, mediated through feelings of being psychologically empowered, although the source of empowerment needs further investigation.

Leaders' use of empowering behaviours can be increased through focused training and through a workplace empowerment process.

Leader empowering behaviours have been shown to be associated with more engaged staff and healthier work environments. Based on study results, we suggest that these behaviours are teachable, and they should be emphasized in leadership development programmes.

Leadership in nursing is at the fore front of the policy agenda for shifting the balance of care from hospitals to the community setting and for improving the quality of healthcare services. Yet, little is known about the implementation of policy within the community setting.

A qualitative, interpretive analysis including semi-structured interviews with nurse leaders (n = 12) and community nurses (n = 27) and three focus groups (n = 13) with community nurses (Total N = 39) in three Health Boards in Scotland.

Policy implementation is not adequately integrated between primary and secondary care service at the point of care delivery. The ‘top down approach’ to policy implementation for shifting the balance of care is currently at odds with the grass roots service organisation and delivery in the community setting.

The aspirations of integrated, collaborative health and social care require more clinicians working at the frontline in both primary and secondary care to value more the work of colleagues in the different sectors.

The current ‘top down approach’ to policy implementation encourages resistance in the frontline community nurses rather than commitment. A more ‘bottom up’ integrated approach to policy implementation is therefore required.

Four scales were used to assess students' perceptions by collecting primary data while academic performance was measured by obtaining students' academic records. A questionnaire completed by 391 first-year nursing students was administered.

Differences were observed in the perceptions of climate and academic performance in different classroom contexts with trends, which did not always overlap; however, strong correlations were observed among self-esteem, well-being and climate, and schoolmate relationships.

Universities should not merely train competent professionals but also build learning communities that support the well-being of relationships and the development of well-being contexts.

The findings support the need for an educational intervention for improving the quality of life and well-being of the community and individual students. This type of intervention requires a ‘compliant’ organisational environment that puts studetns, teachers and professionals in the condition to practice their professional skills.

The first phase involved the use of the Delphi technique facilitating the experts to identify the major problems. The mean rank score was used for grading the problems. The second phase of the study involved getting direct feedback from the ward nurses. The sample size was 147 at a level of significance of 5%.

Consensus was reached among experts on four problems that should galvanize nursing administration vis-à-vis quality improvement. The responses of ward nurses in the second phase gave a better insight into these problems.

Identifying the existing problems and fostering a team spirit among all stakeholders hold the key in strategizing quality improvement in nursing care. Nursing administrators worldwide, after making suitable situation-specific customizations, may use this approach to realize both these objectives.

In spite of the fact that service users desire good spiritual care and that government guidelines recognize its importance, frontline staff in psychiatric settings often find current spiritual assessment tools hard to use and the concept of spirituality difficult to comprehend.

A database search was conducted, the grey literature analysed, spirituality assessment tools were explored, and an approach based on user experience was considered.

Each of these four perspectives resulted in different perceptions of care.

By engaging patient and staff experience, we begin to see spiritual care very differently. There may be rich opportunities for research into the lived experience of the support systems that service users create for each other on wards when they experience staff as inaccessible.

Deeper engagement with patients and staff and their concerns is likely to result in breakthroughs in both the understanding and the practice of spiritual care as well as potentially other areas of nursing care.

Cynicism is a significant predictor of intention to quit among nurses. Social supports are hypothesized to protect workers from becoming increasingly cynical.

Measures of cynicism, and trust and civility in both co-workers and supervisors were part of a survey completed by a sample of 323 Canadian nurses whose responses were matched across two time-points, 1 year apart.

Hierarchical multiple linear regression analyses revealed that co-worker civility enhanced the ability of our regression models to predict cynicism by explaining 1.1% of the variance in cynicism. The addition of co-worker trust, supervisor civility and supervisor trust did not enhance the ability of the models to predict cynicism.

The results indicated the importance of workgroup civility in diminishing workplace cynicism.

Efforts to reduce burnout may be improved by decreasing cynicism through interventions aimed at increasing workgroup civility.

While the 12-hour shift has been a widely accepted staffing solution in hospitals, the fatigue-recovery process in nurses working 12-hour shifts remains unclear.

A cross-sectional survey was completed by 130 full-time nurses working 12-hour dayshifts in three hospitals to assess the perceived levels of acute fatigue, chronic fatigue and inter-shift recovery, as well as their associations with selected organisational and individual factors.

Nurses experienced a moderate to high level of acute fatigue and moderate levels of chronic fatigue and inter-shift recovery. Fatigue and recovery levels differed by the interaction between hospital and unit after controlling for individual factors. Lack of regular exercise and older age were associated with higher acute fatigue.

An unhealthy fatigue-recovery process was found for nurses working a 12-hour shift during the day.

There appears to be a need to establish fatigue intervention programmes for 12-hour shift nurses in hospitals. Hospital administration, unit managers and staff nurses need to collaborate to achieve a healthy fatigue-recovery balance when implementing 12-hour shifts.

Health-care utilization and claims data from callers to the Nurse HealthLine were included. Adherent callers were those who followed the nurse recommendations, while those who did not were classified as non-adherent. Programme-related savings were estimated using differences in downstream health-care expenditures between adherent and non-adherent callers after using multivariate modelling to adjust for between-group differences.

Fifty-five per cent of callers were adherent. Nurses were over three times as likely (41% vs. 13%) to recommend seeking a higher level of care (e.g. emergency room vs. urgent care). Regression analyses showed that the impact of getting members to the appropriate place of care was associated with significant annual savings of $13.8 million (P < 0.05), attributable mostly to Medicare, generating a positive return on investment of $1.59.

This is the first known Nurse HealthLine triage programme exclusively for Medicare beneficiaries with supplemental coverage.

Nurse managers should consider promoting telephone-based triage programmes as complementary to clinical nursing, which has a direct impact on health-care utilization and costs.

The notion that nurses should identify and address patients' spiritual needs remains controversial, particularly in the UK where criticisms derived from secularization theory have appeared in the literature.

To respond to these criticisms and to develop rationales supportive of spiritual assessment, I draw upon scholarship from a variety of disciplines including social work, sociology, and medicine.

Five rationales are posited to support the concept of universal spiritual assessments: professional ethics, patient autonomy, knowledge of patients' worldviews, the identification of spiritual assets, and accrediting and governmental requirements. Criticisms based on secularization theory are discussed and analysed.

A two-stage spiritual assessment – consisting of a brief preliminary assessment followed, if necessary, by a comprehensive assessment – provides a mechanism to efficiently identify patients' spiritual needs.

As key members of the healthcare team, nurse managers are ideally situated to ensure that all patients receive a spiritual assessment as a routine component of care. In so doing, they help ensure the provision of ethical and effective care to the diverse spiritual groups that will continue to populate the UK for the foreseeable future.

Poor nurse–physician collaboration and low autonomy may limit intensive care unit nurses' ability to act on their moral decisions.

A cross-sectional correlational design with a sample of 566 Italian intensive care unit nurses.

The intensity of moral distress was 57.9 ± 15.6 (mean, standard deviation) (scale range: 0–84) and the frequency of occurrence was 28.4 ± 12.3 (scale range: 0–84). The mean score of the severity of moral distress was 88.0 ± 44 (scale range: 0–336). The severity of moral distress was associated with (1) nurse–physician collaboration and dissatisfaction on care decisions (r = −0.215, P < 0.001); and (2) intention to resign (r = 0.244, P < 0.0001). The frequency of occurrence of moral distress was associated with the intention of nurses to resign (r = −0. 209, P < 0.0001).

Moral distress seems to be associated with the intention to resign, whereas poor nurse–physician collaboration appears to be a pivotal factor accounting for nurses' moral distress.

Enhancement of nurse–physician collaboration and nurses' participation in end-of-life decisions seems to be a managerial task that could lead to the alleviation of nurses' moral distress and their retention in the profession.

Development strategies for experienced staff who wish to remain at the bedside are needed, especially in smaller health services with limited opportunities for horizontal or vertical mobility.

Face-to-face semistructured interviews were conducted with 54 senior staff nurses who participated in the career structure arrangements.

The policy enhanced the structure of opportunity in three ways: by increasing the number of senior staff nurse positions, the ladder steps were improved; undertaking strategic projects developed new skills; and the job enrichment approach facilitated time out from the immediate pressures of ward work and challenged nurses in a different way.

Through job enrichment, South Australia has found a novel way of providing meaningful career development opportunities for experienced nurses.

Methods of job enrichment need to be considered as part of career development policy, especially where movement between clinical facilities is limited and staff wish to remain at the bedside.

Healthcare institutions face a nursing shortage, and it is important to examine the factors that influence turnover intention among nurses. Excessive levels of work stress may lead to employee dissatisfaction and a significant inverse relationship between work stress and job satisfaction, including subsequent effects on turnover among nurses. However, little is known about the mediating role of job satisfaction on work stress and turnover intention among long-term care nurses.

A cross-sectional survey and a correlation design were used. Multistage linear regression was used to test the mediation model.

This study showed that job satisfaction significantly mediated the relationship between work stress and turnover intention. Thirty-eight percent of the variance in turnover intention explained by work stress was accounted for by the mediation pathway.

The results of this study showed that higher job satisfaction significantly decreased work stress and turnover intention among long-term care nurses.

This study provides nursing administrators with a resource to build a supportive environment to increase nurses’ job satisfaction and to decrease their stress and turnover.

Ethical competence of nurses refers to ethical behaviour and action requiring ethical knowledge and reflection. Nurse leaders have a key role in supporting the ethical competence of nurses, but little is known about just how this should be done.

The data were collected using a structured questionnaire and analysed statistically. The target sample consisted of nurse leaders (n = 198) from two university hospitals in two healthcare districts in Finland.

Nurse leaders support the ethical competence of nurses more often during performance reviews than during recruitment. During recruitment, nurse leaders ensure the ethical behaviour and knowledge of nurses to varying degrees. During performance reviews, nurse leaders ensure that nurses meet the requirements for collegiality and comply with ethical guidelines and that they do so according to nursing values and principles.

There seems to be a need to examine and improve support for the ethical competence of nurses, both during recruitment and performance reviews. Future priorities should include a focus on supporting the ethical knowledge, reflection and behaviour of nurses.

An important aspect in terms of supporting the ethical competence of nurses has to do with the ethical knowledge and education of nurse leaders and organisational policies or recommendations for ethical support.

As the number of older people with chronic conditions needing health care continues to increase research is needed to optimize nurse retention.

Qualified nurses were surveyed with a set of items derived from four published nurse workforce questionnaires (Cronbach's alpha range 0.75–0.96). There were 3983 complete responses and 10 focus groups with 58 volunteer survey respondents.

In addition to reporting a number of workplace issues, nurses also reported reasonable levels of satisfaction. Intrinsic factors related to caregiving, work relations and colleague support. Extrinsic factors included professional opportunities and organisational support.

Altruism is a primary motivation for choosing to nurse older people and persons with dementia. Nurses are most positive when they feel valued and supported by their organisation and colleagues, through education, training, supervision, mentoring opportunities and appropriate remuneration.

Nursing managers need to take positive steps to address the organisational factors outlined in this paper that either inhibit or promote nurse retention.

There has been little cost-effectiveness research into nursing interventions in hospitals, resulting in an inability to explain the economic value of hospital nursing interventions.

The direct effects of nursing interventions on hospital direct costs and complication rates were analysed using path modelling, controlling for multiple factors (patient characteristics and nursing contexts) influencing nursing care. Then, cost-effectiveness ratios and the cost-effectiveness plane were used to identify cost-effective interventions.

Intramuscular (IM)/Subcutaneous (SC) Administration was the most cost-effective nursing intervention, followed by Orthotics Management.

The study findings can be used to promote nurses' knowledge and attitudes about the economic value of nursing and cost-effective care delivery. A sensitivity analysis with actual cost per nursing intervention and for specific complications will be necessary.

It is important for nurse administrators to support nurses' clear documentation in order to make nursing information available. Utilizing study methods and findings, nurse managers can compare the cost-effectiveness of new nursing interventions or manage dosages of nursing interventions to provide the most cost-effective nursing interventions.

The programme associated with this study is based on Practice Development concepts which aim to improve patient care and service delivery as well as empower practitioners to foster and support a transformational culture.

Mixed methods were used.

Evidence indicated participants' self-confidence improved leading to a ‘growing up’. This was demonstrated in a number of ways: taking more responsibility for individual clinical practice, undertaking quality and safety roles as well as postgraduate study. These findings can be constructed in terms of linking leadership training with the development of professional identity.

This study provides evidence that in-house leadership programmes can provide front-line nurses and midwives with opportunities to enhance their professional identity and expand their skills in a variety of ways.

Organisational investment in in-house programmes aimed at leadership skills have the potential to enhance patient care as well as improve the work environment for nurses and midwives. However, in-house programmes should be considered as augmenting rather than replacing tertiary education institutions' leadership courses and qualifications.

Nursing turnover is a challenge and may compromise patient care. Work dissatisfaction contributes to high turnover. Improving nurse satisfaction can contribute to better patient outcomes.

Eighty-eight nurses participated in a quantitative and qualitative survey focusing on nursing satisfaction, turnover and selected organisation characteristics.

Issues that may affect nurse satisfaction and turnover were identified using questions from the Nursing Work Index: pay, insufficient number of nurses, undervaluing of nurses by public and the medical team, limited advancement opportunities, lack of autonomy and inflexibility in schedule. Other themes identified from qualitative data are reported.

The top factor of decreased satisfaction was low pay as indicated by the Nursing Work Index. The qualitative results showed that low pay was the factor for nurse turnover. Additional factors related to nursing satisfaction can be addressed to improve nurse retention.

Along with increasing nursing pay, strategies to consider in decreasing turnover and increasing satisfaction included: providing opportunities for nursing advancement, promoting the value of nursing, creating clinical protocols and enhancing autonomy. This study adds to knowledge about nursing needs and satisfaction in South America.

Community health nursing is based on the notion that all activities should respond to frail people's needs in a coordinated way, together with other professionals. Relational coordination is therefore important for the effective health-care delivery by these nurses.

This cross-sectional study was performed among 167 professionals (n = 323, response rate 52%) who regularly worked with community health nurses.

The results showed a higher degree of relational coordination with community health nurses than with other primary care professionals. Multilevel analyses revealed that professionals' satisfaction with the care delivered by community health nurses was influenced positively by relational coordination.

Enhancing relational coordination between community health nurses and other primary care professionals in the neighborhood may improve the delivery of care to community-dwelling frail people.

Comprehensive care delivery to community-dwelling frail people requires strong connections between all health and social care professionals. Community health nurses may be an important factor in strengthening these connections.

Shared governance refers to systems and services aligned in partnership. The information gained by studying the lived experience of nurse managers and staff nurses in shared governance is valuable for providing knowledge of empowerment.

A qualitative design was used. Data were collected through a semi-structured interview using five questions with 11 Registered Nurses. Data were analysed through thematic analysis.

Four themes emerged from data analysis. Nurse managers identified the journey of patient satisfaction; journey of empowerment; journey of self-management and journey of wellness. Staff nurses identified the journey of development and implementation of best practice; journey to provide quality patient care, journey to a new culture of nursing; and journey of a variety of challenges.

This study supports the idea that collaboration between nurse managers and staff nurses develops a journey toward shared governance.

Nursing management can use findings to empower nurses to collaborate with nurse managers toward best practice. This adds to current knowledge that partnership of nurse managers and staff nurses, supports and encourages ownership in shared governance.

To identify initiatives that have strengthened the ward manager role.

A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies.

Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role.

The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position.

The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

The style of leadership in reducing the onset of mobbing risk in nurse working teams still remains a matter of discussion. Nurse working teams are particularly affected by mobbing and studies exploring individual and organisational inhibiting/modulating factors are needed.

An empirical study involving 175 nurses of various public hospital corporations in northern Italy. Data were collected via structured and anonymous questionnaires and analysed through a logistic regression.

Organisational, individual and participative leadership variables explained 33.5% (P < 0.01) of variance in the onset of mobbing. Two predictive factors emerged: a participative leadership enacted by nursing managers and the nursing shortage as perceived by clinical nurses. Results confirmed that the contribution made by a participative leadership style in attenuating the onset of mobbing risk in working teams was significant.

A participative leadership style adopted by the nurse manager allows for the reduction of tensions in nurse working teams. However, mobbing remains a multifaceted phenomenon that is difficult to capture in its entirety and the leadership style cannot be considered as a panacea for resolving this problem in nurse working teams.

The report ‘Death by indifference’ in 2007 highlighted inadequate care given to people with intellectual disabilities in hospital. This study sought to develop and test a competency assessment tool for adult trained nurses in the care of this patient group.

A review of the literature informed the topic guide for focus groups (n = 4) with experienced adult trained nurses, learning disability nurses and people with intellectual disabilities (n = 25). Expert interviews (n = 29) were conducted to identify emergent themes. A draft competency assessment tool was reviewed by an expert panel (n = 5) and tested within a convenience sample (n = 34; response rate 28%) at a local district general hospital across several clinical specialities.

The participants considered themselves to be either ‘novice’ or ‘competent’ across most items. The tool was then redrafted and minor amendments made. ‘Little or no knowledge’ or ‘novice’ was reported in areas such as consent, diagnostic overshadowing and management of self harm.

Use of the competency assessment tool will support assessment of current levels of knowledge and skills and inform educational provision of the workforce.

Use of the competency assessment tool will inform nursing management of skill levels and educational need.

The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada.

The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates.

Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate.

Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC.

Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover.

The National Department of Health recommended that all primary health care facilities in South Africa start to implement the Basic Antenatal Care programme by the end of 2008. In her work as coordinator of the Maternal Child and Women's Health programme for the eThekwini Municipality, the researcher observed the slow progress in implementation of the programme in the eThekwini district.

A descriptive qualitative design using questionnaires was used to assess the challenges being experienced by midwives during the implementation of the programme.

The challenges identified included: shortage of staff, lack of cooperation from referral hospitals, lack of in-service training, problems with transportation of specimens to laboratories, lack of material resources, unavailability of Basic Antenatal Care programme guidelines and lack of management support.

The challenges were the possible cause of the slow progress in the implementation of the programme.

The successful implementation of the new programme is dependent on support and guidance offered by the nurse manager to the staff at operational level. The manager should monitor and develop strategies to address and overcome challenges that hinder implementation of the Basic Antenatal Care programme.

Job dissatisfaction in the nursing work environment is the primary cause of nursing turnover. Job satisfaction has been linked to a high level of empowerment in nurses.

We reviewed 596 articles, written in English, that examined the relationship between structural empowerment, psychological empowerment and nurses' job satisfaction. Twelve articles were included in the final analysis.

A significant positive relation was found between empowerment and nurses' job satisfaction. Structural empowerment and psychological empowerment affect job satisfaction differently.

A satisfying work environment for nurses is related to structural and psychological empowerment in the workplace. Structural empowerment is an antecedent of psychological empowerment and this relationship culminates in positive retention outcomes such as job satisfaction.

This review could be useful for guiding leaders' strategies to develop and maintain an empowering work environment that enhances job satisfaction. This could lead to nurse retention and positive organisational and patient outcomes.

Fostering nurse leadership in rural health services may be informed by gaining insight into rural nurse leaders' perceptions of structural empowerment.

A sample of nurse executives (n = 45) from hospitals throughout rural Victoria, Australia completed the Conditions of Work Effectiveness Questionnaire II (CWEQ-II) aimed to measure structural empowerment.

Rural nurse leaders' perceive themselves to be moderately empowered.

The concept of structural empowerment may be useful to inform rural leadership practices.

Acknowledgement of structural empowerment by nurse leaders may assist in the process of formulating strategies to facilitate an open, honest and responsive culture of patient safety, removing silos, departmental turf issues, and professional territoriality in healthcare services.

In Italy, the incidence and prevalence of people in a vegetative state are increasing. The team members have a clear understanding of the meaning of being mortal and the value of human dignity.

A descriptive study design was used in an intensive care ward in Northern Italy. An anonymous list with negative factors must be drawn up.

Thirty-two team members participated in the study. A lack of time and specific knowledge regarding the care of patients in a vegetative state, involvement of the family and repetition in assistance delivery were the most frequent causes that hinder provision of care to patients in a vegetative state.

The provision of dignity for patients is not an issue related only to the staff in direct contact with patients/clients, but also concerns the entire health care facility (physical structure and organisation).

The nursing coordinator has an important role in the promotion of care based on the respect for the patient's dignity, in the active involvement of staff and in the delivery of quality services to users.

Differences and the discrepancy between individuals' organisational values and those of their organisational culture are a potential source of adjustment difficulties. Organisational values are considered to be the bond of the individual to their organisation. In multicultural societies, such as Israel, the differences in perception of organisational values and organisational commitment may be reflected within workgroups.

Data were collected using a questionnaire among 106 hospital nurses. About 59.8% of the sample were Israeli-born.

A positive correlation was found between organisational values and organisational commitment. Significant differences were found in organisational values and organisational commitment between Israeli-born-, USSR-born- and Ethiopian-born nurses. The socio-demographic profile modified the effect of organisational values on organisational commitment: when the nurse was male, Muslim, religiously orthodox and without academic education, the effect of organisational values on organisational commitment was higher.

Findings confirm the role of culture and ethnicity in the perception of organisational values and the level of organisational commitment among nurses.

Assessing ethno-cultural differences in organisational values and organisational commitment provides a fuller understanding of nurses' ability to adjust to their work environment and helps nurse managers devise means to increase nurses' commitment.

To establish current level of job satisfaction among public health nurses and identify the main contributing variables/factors to job satisfaction among this population.

Quantitative descriptive design. A simple random sample of 1000 public health nurses was conducted yielding a response rate of 35.1% (n = 351). Data was collected using the Index of Work Satisfaction Questionnaire. Descriptive and inferential statistics were deployed.

Low levels of job satisfaction among public health nurses emerged. Professional status, interaction and autonomy contributed most to job satisfaction while pay and task-related activities contributed least. Age and tenure were the only biographic factors that correlated significantly with job satisfaction.

Public health nurse managers/leaders need to find creative ways of improving the factors that contribute to job satisfaction and address robustly those factors that result in low job satisfaction.

The critical issue for public health nurse managers is to determine how job satisfaction can be improved. Greater collaboration and consultation between managers and public health nurses can be regarded as a useful way to begin this process, especially if contemporary nursing is to embrace a responsive approach within the profession.

Female hospital workers with higher perceived stress tend to report greater WFC and worse mental health than others with less perceived stress. A better fit between a person and her environment may lead to lower perceived stress. As a result, she may experience less WFC and better mental health.

This study adopts a longitudinal design with 273 participants, all of whom are employed by hospitals in Taiwan. All hypotheses are tested using hierarchical regression analyses.

The results show that perceived stress is an effective predictor of WFC and mental health status, whereas the P-E fit can moderate these relationships.

Hospitals should pay more attention to the negative effects of perceived high stress on the WFC levels and mental health of their female employees. The P-E fit can buffer effectively the impact of perceived stress on both WFC and mental health.

If hospitals can adopt appropriate human resource management practices as well as monitor and manage the P-E fit continuously, they can better help their employees to fit into the overall hospital environment.

Burnout has been a major concern in the field of occupational health, and yet there has been little research exploring the factors related to burnout among Chinese nurses. Exploring the factors associated with burnout is important in improving nurses’ health and the quality of health care services in China.

The study population consisted of 1845 female hospital nurses in the Liaoning Province of China. Burnout was measured using the Chinese version of the Maslach Burnout Inventory – General Survey; occupational stress was measured using the Chinese versions of the Job Content Questionnaire and Effort–Reward Imbalance Questionnaire. A general linear regression model was applied to analyse the factors associated with burnout.

Mean scores (±SD) were 11.74 (7.14) for emotional exhaustion, 7.12 (5.67) for cynicism and 23.34 (9.60) for self-efficacy. Strong extrinsic effort was the most powerful predictor of emotional exhaustion and cynicism; strong psychological job demands were the most robust predictor of low self-efficacy.

The findings suggest that occupational stress was strongly related to burnout among female hospital nurses in China.

Occupational stress was identified as the most robust predictor of burnout among Chinese female hospital nurses. Reducing burnout among nurses working in China may require health education, health promotion and occupational training programmes aimed at improving work situations and reducing occupational stress.

Specialist and advanced practice roles are common world-wide and were introduced in Ireland in 2000. After experiencing these roles for a decade, the views of healthcare policy-makers were sought as part of a national evaluation.

A qualitative, descriptive design was used. Following ethical approval, 12 policy-makers were interviewed in 2010, using a six-part interview schedule.

Policy-makers believed that specialist and advanced practice roles resulted in better continuity of care, improved patient/client outcomes and a more holistic approach. These clinicians were also said to be leading guideline development, new initiatives in care, education of staff, audit and policy development. They lacked administrative support and research time. Budget cuts and a government-applied recruitment moratorium were said to hamper the development of specialist/advanced practice roles.

Healthcare policy-makers believe that specialists and advanced practitioners contribute to higher quality patient/client care, particularly at a strategic level.

These roles could make an important contribution to future health service developments, particularly in relation to chronic-disease management and community care, where more advanced practitioner posts are required.

In the past, few studies have been conducted to investigate job satisfaction among different groups of nursing personnel.

This was a cross-sectional study. Stamps and Piedmonte's Index of Work Satisfaction (IWS) Scale was used to measure the level of job satisfaction.

Six hundred and seventy-two nursing personnel from two large hospitals participated in this study. Discrepancies were found between the perceived importance and the actual satisfaction of job components among nursing personnel. The level of job satisfaction varied by position (F_3,668 = 28.83, P < 0.001). Tukey's post-hoc tests further indicated that RNs had the lowest job satisfaction. The IWS scores for ENs, RNs, SNs and NMs were 12.3, 11.2, 12.5 and 13, respectively. Each group shared and had its own unique factors associated with its job satisfaction.

The perceived importance and actual satisfaction with the six job components among nursing personnel varied by position.

Administrators should be aware that strategies to improve job satisfaction should be specific to job titles. No single strategy is appropriate for all nursing personnel.

Transitional care is a timely topic as hospital days of care decrease whereas patient needs grow more complex as a result of aging populations.

This review considers evidence-based research as well as reports, case studies and literature reviews related to transitional care. International articles are included.

The authors explore transitional care through the lens of wicked problems; problems that appear seemingly intractable and are characterized by inter-related dilemmas, contradictory agendas, and multi-layered societal, economic and political influences. Outcome measures of success, barriers to achieving successful transitional care and effectiveness of interventions are investigated.

While the literature offers specific strategies that positively affect transitional care, there are few strategies that do not negatively affect an alternate agenda. Conscientious leaders should consider transitional care in the context of its wicked nature in order to achieve optimal patient care.

Stakeholders include: hospital administrators, nurse leaders, direct-care nurses, acute care and primary care clinicians, patients, caregivers, community agencies, health sciences educators and insurers.

Teams are essential to the health-care industry. However, the perception of injustice may lead to a high level of nurse turnover.

Data was collected from 187 nurses distributed in eight units in a mid-western hospital in the USA. Hierarchical linear modeling was used to analyze the cross-level interaction of leader-member exchange variability and task interdependence on individual-level perceptions of justice.

Leader–member exchange variability was significantly related to distributive justice and interactional justice but not significantly related to procedural justice. The interaction term was significantly related to interpersonal justice, but not to procedural justice or distributive justice.

This study showed that if leaders demonstrated a variation in treatment of different subordinates, nurses could perceive this as unfair regarding distribution and interaction; when the group was highly task interdependent, this kind of perception of ‘unfairness,’ particularly regarding interpersonal treatment, became even more salient.

Preferential and inconsistent treatment by them within the work group could introduce nurses' perceptions of unfair treatment. It is of crucial importance to provide training for supervisors on how to display relatively consistent behaviour towards nurses, particularly when the teams are highly task interdependent.

Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses.

This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units.

Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction.

Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff.

Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career.

Resilience is the ability to bounce back or cope successfully despite adverse circumstances. Nurses deal with modern-day problems that affect their abilities to remain resilient. Nursing administrators/managers need to look for solutions not only to recruit nurses, but to become knowledgeable about how to support and retain nurses.

A comprehensive search was undertaken for nursing research conducted between 1990 and 2011. Key search terms were nurse, resilience, resiliency and resilient. Whittemore and Knafl's integrative approach was used to conduct the methodological review.

Challenging workplaces, psychological emptiness, diminishing inner balance and a sense of dissonance are contributing factors for resilience. Examples of intrapersonal characteristics include hope, self-efficacy and coping. Cognitive reframing, toughening up, grounding connections, work-life balance and reconciliation are resilience building strategies.

This review provides information about the concept of resilience. Becoming aware of contributing factors to the need for resilience and successful strategies to build resilience can help in recruiting and retaining nurses.

Understanding the concept of resilience can assist in providing support and developing programmes to help nurses become and stay resilient.

Studies have been carried out to determine gender role stereotypes and requisite managerial characteristics across a number of industries and among student samples. No study has been carried out within the nursing and midwifery profession.

In order to allow for direct comparisons with previous research Schein's Descriptive Index (SDI) was used. A total 239 undergraduate and 171 postexperience responses were collected.

Female nurses and midwives did not gender type the managerial role, whereas males gender typed the managerial role in favour of men. Student nurses and midwives recorded a stronger correlation between women and management than their qualified counterparts.

Males gender typed the managerial role in favour of men. With an increase in numbers of men joining the profession and increased representation of males at the Clinical Nurse Manager (CMN) level there is a possibility that the profession will become two tiered. Health care organisations should pay careful consideration to career development and implement career structures which ensure equal access to managerial roles for both genders.

Difficult situations are a part of clinical nursing. Nurses are repeatedly exposed to situations that may cause them suffering and reduce their ability to serve the patients.

Data collection was based on a sample of semi-structured face-to-face deep interviews with eight nurses who were encouraged to narrate their lived experiences of difficult situations in clinical nursing.

Nurses want to discuss issues connected to nursing and caring science that emerge in clinical nursing with their nurse leaders. Painful memories and thoughts are often related to patients struggling between life and death, the despair of families and friends, and their hovering between hope and hopelessness. The results do not support the notion that nurses would request other kinds of support or debriefing.

The mission of nursing is to serve, console and alleviate human suffering. Nurse leaders carry a responsibility to create such evidence-based caring cultures that support the mission of nursing. Nurse leaders' understanding, sympathetic attitude, ethical value basis, personality and ability to discuss are important aspects for nurses. Through the support from nurse leaders, it seems possible to alleviate the nurse's suffering in clinical nursing. Implications for Nursing Management Nurse leaders' support creates a foundation for the nurses' professional development.

To enable the provision of 24-hour patient care, nurses need to work various shifts. Long-term shift work significantly affects nurses' overall physical and mental health.

Nurses from four Chiayi County district hospitals in Taiwan (n = 266) participated in this cross-sectional study from August to September 2010. Demographics, work schedule forms, a stress checklist, a sleep-quality measure and a health-status measure were used to collect data. Independent t-test, one-way anova, Pearson's r, and hierarchical regression were applied for analysis.

The results showed that regardless of the amount of shift work they performed, nurses reported moderate job stress, poor sleep quality and moderate self-perceived health. The following significant relationships were observed: job stress was inversely related to sleep quality, which was directly related to self-perceived health status.

Hospital managers need to ensure more healthy shift work scheduling in order to improve nurses' clinical performance and personal health status, thereby also improving the quality of patient care.

Collaboration is increasingly promoted as a means of solving shared problems and achieving common goals; however, collaboration creates its own opportunities and challenges. Evidence about the collaboration process, its outcomes and critical success factors is lacking.

A literature review and content analysis of data collected from six participants (from five European countries) members of the European Academy of Nursing Science Scholar Collaborative Workforce Workgroup, using a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis template.

Two major factors affecting scholarly collaboration were identified: Facilitators, which incorporated personal attributes and enabling contexts/mechanisms, including individual commitment, responsibility and teamwork, facilitative supportive structures and processes. The second, Barriers, incorporated unmet needs for funding; time; communication and impeding contexts/mechanisms, including workload and insufficient support/mentorship.

The literature review identified a low level of evidence on collaboration processes, outcomes, opportunities and challenges. The SWOT analysis identified critical success factors, planning strategies and resources of effective international collaboration.

Collaboration is an important concept for management. Evidence-based knowledge of the critical success factors facilitating and impeding collaboration could help managers make collaboration more effective.

Nurse residency programmes are an evolving strategy to foster transition to practice for new nurses. However, there are limited data available for programme outcomes particularly for rural nurses.

A longitudinal design sampled 382 urban and 86 rural newly licensed hospital nurses during a 12-month nurse residency programme. Data were collected at the start of the programme, at 6 months and the end of the programme.

At the end of the programme, rural nurses had significantly higher job satisfaction and lower job stress compared with urban nurses. Across all time-periods rural nurses had significantly lower levels of stress caused by the physical work environment and at the end of the programme had less stress related to staffing compared with urban nurses. Perceptions of their organisational commitment and competency to make decisions and perform role elements were similar.

Differences in these outcomes may be result from unique characteristics of rural vs. urban nursing practice that need further exploration.

Providing a nurse residency programme in rural and urban hospitals can be a useful recruitment and retention strategy.

Previous findings showed that fewer nurses than physicians and pharmacists report adverse drug reactions. This is not attributed to any lack of ability in identifying adverse drug reactions.

Adverse drug reactions received by the Central Portugal Regional Pharmacovigilance Unit, between 2001 and 2011, were studied. Certain and probable adverse drug reactions were included to test differences between professional groups for serious and non-serious adverse drug reactions.

The Central Portugal Regional Pharmacovigilance Unit received 1014 adverse drug reactions. Fifty-four nurses reported 66 adverse drug reactions, whereas 232 physicians and 145 pharmacists reported 589 and 357 adverse drug reactions, respectively. Considering the number of practising professionals, it was estimated that 0.55% of nurses, 3.96% of physicians and 7.08% of pharmacists have reported an adverse drug reaction. Of the 633 adverse drug reactions assessed as certain or probable, 46 (21 serious), 387 (192 serious) and 198 (77 serious) were reported from nurses, physicians and pharmacists, respectively. There were no differences in the reporting of serious adverse drug reactions among nurses, physicians or pharmacists.

Nurses are able to identify serious adverse drug reactions although they report less than other professionals.

Nurses need to increase their involvement in spontaneous reporting schemes by undertaking responsibility in routinely reporting suspected adverse drug reactions.

The aims of this study were to identify the attitudes and perceptions of nurses towards family-paid caregivers, to examine the roles of caregivers in hospital bedside nursing care and to describe the supervision of family-paid caregivers by nurses.

The inadequacy of nurse staffing and the Chinese tradition emphasising family responsibility have established family-paid caregivers as an important workforce for inpatient bedside nursing care in China.

This was a descriptive study combining qualitative interviews with a quantitative cross-sectional questionnaire survey.

Six nurses were interviewed and 209 family-paid caregivers were surveyed.

According to the respondents, patients relied on the caregivers to receive assistance and care during hospitalization and family-paid caregivers were involved in most of the bedside nursing care.

The heavy workload of nurses and staffing inadequacy have led to a severe need for caregivers to provide bedside nursing care within hospitals in China. The roles of family-paid caregivers need to be defined and closely monitored.

Proper management of the caregivers should be strengthened and the hospital nursing workforce encouraged to take over bedside nursing care as essential strategies for improving nursing care quality and the patients' satisfaction with the hospitals.

The role of the senior charge nurse in providing clinical leadership is evolving. However, recent evidence suggests that research is needed to inform the development of leadership and quality improvement and to connect them.

Data were collected using an electronic survey to all senior charge nurses in one locality and semi-structured interviews with a subsample of respondents. Fifty (54%) senior charge nurses responded to the survey and nine were interviewed.

Senior charge nurses reported mainly positive perceptions of clinical leadership, clinical team performance and improvement of care delivery for patients following the leadership programme implementation. Themes related to confidence, quality improvement and team performance were generated.

‘Leading Better Care’ was reported to enhance senior charge nurse clinical leadership, with some development needed to link the details of change management with the wider strategic direction.

Nurse managers may wish to ensure that their clinical leaders have clarity of role in order to inspire confidence. Some challenges were noted in achieving improvement in quality and it is possible that if improvement in quality is the cornerstone of patient-centred care then it needs to be placed centrally in workload considerations.

Health reform efforts in many countries are redefining the role of health professionals in public health. Little is known about the role of nurses working in public health contexts in Latin America.

Fourteen focus groups were conducted in Mexico and Peru with 82 nurses working in government-sponsored community health centres. Data were analysed using a content analysis technique.

Themes identified were: nurses' job descriptions in public health settings; organisational factors influencing the nurses' work, and influence of academic and social image factors.

Management barriers and limited training influences the role and working conditions of public health nurses in Mexico and Peru.

The professional role of nurses working in public health in Latin America is not well defined because of the health-care system infrastructure and the lack of a clear public health nurse job description. Further research is needed to better understand the role of public health nurses and strengthen their training, particularly in relation to nursing management encompassing abilities for decision-making processes and public health program planning and evaluation.

Previous studies have shown that relational coordination is positively associated with the delivery of acute, emergency and trauma care. The effect of relational coordination in integrated care delivery to hospitalized older patients remains unknown.

This cross-sectional study was part of an examination of integrated care delivery to hospitalized older patients. Data were collected using questionnaires distributed to hospital professionals (192 respondents; 44% response rate).

After controlling for demographic variables, regression analyses showed that relational coordination was positively related to integrated care delivery (β = 0.20; P ≤ 0.05). Relational coordination was lower among professionals in the same discipline, and higher between nurses and others than between medical specialists and others. Relational coordination and integrated care delivery were significantly higher in geriatrics than in other units (both P ≤ 0.001).

The enhancement of relational coordination among healthcare professionals is positively associated with integrated care delivery to older patients.

Relational coordination should be improved between medical specialists and others and higher levels of relational coordination and integrated care delivery should be achieved in all hospital units.

The literature on stress lacks studies examining whether control, either as a personality trait or job characteristic, would overtake coping efforts.

A three-way interaction effect (workload × LOC × job level) was applied to test the moderation model. Participants were hospital staff nurses and nurse managers (n = 934) in Finnish hospitals. They responded to an electronic-questionnaire that sought their work loads, coping behaviours and LOC.

The results provided support for the moderation model. Staff nurses with external LOC exerted more coping behaviours when experiencing a high workload. Job level significantly altered the moderating effect of LOC; staff nurses with an internal LOC and nurse managers with an external LOC disregarded coping efforts.

Extrinsic control inherent in higher job levels appeared to undertake the lacking disposition of control among externals diminishing coping efforts.

Job level interacts with LOC on the perception of control in hospitals. Staff nurses with internal LOC and nurse managers with external LOC could make a greater balance between personal and job resources effectively to deal with role overload.

RNs may act as patients' advocates in the care of older patients. NMs should support patient advocacy in order to make the best care available to patients.

A modified Attitudes towards Patient Advocacy Scale was used to collect data from 207 RNs and 23 NMs in the Swedish community care of older patients. The response rate was 52%. Descriptive and inferential statistics were used.

Both RNs and NMs showed positive attitudes towards patient advocacy. They were more positive towards patient advocacy for patients unable to help themselves than for competent patients.

This study showed that RNs and NMs did not differ in their attitudes towards patient advocacy. This result is consistent with the idea of giving the neediest and vulnerable patients greater care.

It is important for NMs to clarify their own and RNs attitudes towards patient advocacy as disparities may affect cooperation between the groups. Any effects on cooperation may, by extension, affect the quality of care.

Many Western countries have difficulties in recruiting healthcare staff to provide care for an ageing population. Knowledge on the causes of turnover among healthcare staff is therefore important.

In a prospective cohort study (n = 7025) baseline characteristics were compared for employees who respectively quit, retired and worked in eldercare at follow-up. Additionally, a survey was conducted among those employees who left their jobs during follow-up.

Employees who quit their jobs (n = 461) primarily stated that psychosocial work conditions caused them to quit, whereas retirees (n = 265) primarily stated reasons related to health and physical job demands. Improvements in the time available for the contact with the elderly, increased skill discretion and improved social relations could prompt employees to reconsider quitting or retiring.

Work in eldercare has some ‘core’ aspects that appear desirable to employees who quit or retired. Building on those aspects offers a strategy for enhanced recruitment potential.

To reduce turnover managers should improve psychosocial work conditions in eldercare and ensure that physical demands do not exceed the capacities of employees.

Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services.

A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing.

Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors.

Parents highlighted the importance of the parent–health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM.

Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service.

Supervision is an important ability and part of a nurse's leadership role. Student nurses need to learn competence in clinical practice.

A descriptive-correlational study comparing three groups of student nurses (n = 151) who attended process-oriented group supervision during their education.

The effects of process-oriented group supervision were increased awareness of interpersonal, professional and communication skills. There was a moderate relation between the three factors. The strongest correlation was found between the factors professional and communication skills (r = 0.81). The correlations between the factors in group 3, the mandatory group, were identical.

By correlating the factors, we concluded that the student nurses' perceptions of the effects of process-oriented group supervision strengthened their professional identity, which may have a bearing on patient safety, nursing leadership and collaboration with the patient, her/his family members and other professionals.

There is potential for improving the links between nursing leadership, supervision and patient safety.

The nursing profession is seen as a stressful and emotionally demanding profession, which makes nurses susceptible to burnout.

A cross-sectional survey design with a stratified random sample (n = 818) was used. The MBI-HSS and a biographical questionnaire were administered.

Exploratory factor analysis resulted in a three-factor structure of burnout, consisting of emotional exhaustion, depersonalization and personal accomplishment. Construct equivalence and reliability of the three factors were confirmed. Significant differences were found in burnout levels with regard to language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

The MBI-HSS showed acceptable validity and reliability for South African nurses. Burnout is associated with specific factors, including language, age, rank, job satisfaction, reciprocity, full-time employment and specialised training.

The use of the MBI-HSS is recommended to assess burnout of nurses in South Africa. Organisations employing nurses should intervene to prevent and/or manage burnout.

Nurses commonly experience high levels of occupational stress, with negative consequences for their physical and psychological health, health-care organisations and community. There is minimal research on reducing occupational stress.

Six focus groups were conducted with 38 registered nurses using a qualitative exploratory approach. Participants were asked to identify sources of occupational stress and possible workplace initiatives to reduce stress.

Sources of occupational stress were: high workloads, unavailability of doctors, unsupportive management, human resource issues, interpersonal issues, patients’ relatives, shift work, car parking, handover procedures, no common area for nurses, not progressing at work and patient mental health. Suggestions for reduction included: workload modification, non-ward-based initiatives, changing shift hours, forwarding suggestions for change, music, special events, organisational development, ensuring nurses get breaks, massage therapists, acknowledgement from management and leadership within wards.

The findings highlight the need to understand local perspectives and the importance of involving nurses in identifying initiatives to reduce occupational stress.

Health-care environments can be enhanced through local understanding of the occupational stressors and productively engaging nurses in developing stress reduction initiatives. Nurse managers must facilitate such processes.

The evidence-based management practice process was used to identify the major impediment to Getting Work Done–assignment to multiple patients with simultaneous complex needs. Best management practice consisted of class presentation of a clinical-management problem scenario to 144 residents in nine Magnet hospitals, a private action commitment, class discussion and terminal action commitments.

Responses indicated that this ‘best management practice’ was effective in helping newly licensed registered nurses manage and handle multiple patients with simultaneous complex needs. A major avenue of resolution was perception of professional practice responsibilities as a series of complex, interrelated, adaptive systems.

Perception and use of the principles of complexity science assists newly licensed registered nurses in mastering management dilemmas that inhibit professional practice. In many participating hospitals, plans are underway to expand this best practice to include input and perception exchange among experienced nurses, managers and physicians.