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As health care funding gets more and more tenuous, leaders in all institutions are called upon to find innovative ways to reduce costs while maintaining quality. It is possible to realize undreamed-of savings by reengineering certain processes, but such an undertaking demands that wholesale changes in the corporate culture and substantial effort at all levels. This paper reports a long-term project at a large, urban, tertiary care institution, the redesign of discharge planning to improve patient care and reduce lengths of stay and related expenses.

Research is an important priority in nursing. Nurses attempting to carry out studies in health care today, however, face greater complexity, financial pressures and ethical dilemmas than in the past. To meet these challenges, nurses need a solid understanding of research standards underpinned by ethical principles. In this article, the author discusses recent controversies in research including informed consent and interpretation of research results, as well as an action plan for greater attention to ethics in nursing research.