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Objective: To examine the scientific evidence about the nursing practice environment in Primary Health Care., Methods: Three-step scoping review. 1) An initial research on CINAHL and MEDLINE. 2) A broader search using the same keywords and search terms in the remaining EBSCOHost platform databases. 3) Search the bibliographical references of the selected articles. The studies selected were from 2007 to 2018., Results: 19 articles were included, most reported findings of the nursing practice environment and results for clients, nurses, nurse managers and the efficiency of organizations, in Primary Health Care., Conclusion: Improving the environment of nursing practice has consequences on the quality of nursing care, with increased results for clients, nursing and Primary Health Care.

Charge nurses often act as the eyes and ears of the unit. They are leaders, clinical experts, educators, policy enforcers, and patient advocates. They ensure patients and caregivers receive high-quality, safe, and evidence-based care. With the shift in health care from the in-patient to outpatient setting, patients are becoming more acute and complex for staff nurses. Charge nurses are pivotal in the successful care and management of these patients. Unfortunately, charge nurses often receive minimal training and are placed in this role with inadequate preparation and support. This can lead to feelings of anxiety, stress, and dissatisfaction with their job. Providing nurses with structured education about this role can create a safer and more positive work environment. This article discusses the development, implementation, and evaluation of a charge nurse orientation program in the outpatient infusion setting. [J Contin Educ Nurs. 2019;50(11):517-521.]., (Copyright 2019, SLACK Incorporated.)

In this month's Magnet Perspectives column, the director of the Magnet Recognition Program highlights the program staff and leadership at ANCC responsible for the Magnet Program.

Objective: This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units., Background: The relationship between nurses' participation in decision making and the different types of hospital units where they work is not well understood., Methods: Nurses' participation in decision making was explored using the Participation in Decision Activities Questionnaire. The final sample included 307 nurses in 24 nursing units in 6 hospitals., Results: Nurses overall participated more in clinical than administrative decisions, and there were significant differences based on unit type. Critical care nurses had the highest and general care units the lowest levels of participation in decision making., Conclusions: Nurses in critical care units participated in higher amounts and at higher levels of clinical decisions overall than either intermediate or general care units. Nurse leaders should determine barriers to decision making in general care units and explore mechanisms to increase participation by clinical nurses.

Aim: The present study aimed to determine conflict-resolution styles of nurse managers working in hospitals where organisational conflicts are common, and factors affecting their styles., Background: When conflicts and/or administrative problems are encountered at different levels of nursing services, nurse managers' communication skills and approaches play a key role in problem solving., Methods: This study was conducted in Sivas, a province in the eastern part of Turkey. The study sample involved 116 nurse managers working in inpatient institutions. Data were collected with the Sociodemographic Characteristics Questionnaire and the Rahim Organizational Conflict Inventory., Results: Of the conflict-management styles, the one preferred by the participating nurse managers was collaborating, followed by compromising, avoiding, competing, and accommodating. However, age, educational background, length of service, and managerial experience were effective in determining the style of conflict resolution., Conclusion: It was concluded that nurse managers preferred the collaborating style to manage conflicts because it is a positive and effective conflict-management style, and that a variety of variables played a role in their decision to adopt this style., Implications for Nursing Management: Conflicts have an adverse effect on the productivity, morale, and patient care of all the health care team, which might lead to a rapid turnover of employees or dissatisfaction. Using conflict-resolution strategies in the workplace will help maintain a healthy work environment., (© 2018 John Wiley & Sons Ltd.)

Nursing professional development practitioners are frequently asked about program return on investment. A pre-postprogram self-assessment was developed for a Nurse Manager Certificate Program using the American Nurses Credentialing Center Nurse Executive Certification blueprint. The results identified knowledge and skill gaps, defined program outcomes, and helped determine return on investment. The results revealed improvement of knowledge, skill, and evidence for return on investment. J Contin Educ Nurs. 2018;49(10):446-448., (Copyright 2018, SLACK Incorporated.)

Background: Nurse managers have a pivotal role in fostering unit climates supportive of implementing evidence-based practices (EBPs) in care delivery. EBP leadership behaviors and competencies of nurse managers and their impact on practice climates are widely overlooked in implementation science. The purpose of this study was to examine the contributions of nurse manager EBP leadership behaviors and nurse manager EBP competencies in explaining unit climates for EBP implementation in adult medical-surgical units., Methods: A multi-site, multi-unit cross-sectional research design was used to recruit the sample of 24 nurse managers and 553 randomly selected staff nurses from 24 adult medical-surgical units from 7 acute care hospitals in the Northeast and Midwestern USA. Staff nurse perceptions of nurse manager EBP leadership behaviors and unit climates for EBP implementation were measured using the Implementation Leadership Scale and Implementation Climate Scale, respectively. EBP competencies of nurse managers were measured using the Nurse Manager EBP Competency Scale. Participants were emailed a link to an electronic questionnaire and asked to respond within 1 month. The contributions of nurse manager EBP leadership behaviors and competencies in explaining unit climates for EBP implementation were estimated using mixed-effects models controlling for nurse education and years of experience on current unit and accounting for the variability across hospitals and units. Significance level was set at α < .05., Results: Two hundred sixty-four staff nurses and 22 nurse managers were included in the final sample, representing 22 units in 7 hospitals. Nurse manager EBP leadership behaviors (p < .001) and EBP competency (p = .008) explained 52.4% of marginal variance in unit climate for EBP implementation. Leadership behaviors uniquely explained 45.2% variance. The variance accounted for by the random intercepts for hospitals and units (p < .001) and years of nursing experience in current unit (p < .05) were significant but level of nursing education was not., Conclusion: Nurse managers are significantly related to unit climates for EBP implementation primarily through their leadership behaviors. Future implementation studies should consider the leadership of nurse managers in creating climates supportive of EBP implementation.

Objective: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®., Background: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources., Methods: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed., Results: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged., Conclusions: The journey to Magnet leads to improved nurse, patient, and organization outcomes.

Background: In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing., Objective: We aimed to describe experiences and factors related to SM implementation., Methods: We administered a Web-based survey to chief nurse executives to obtain their implementation experiences. Structural, process, and outcome factors and barriers associated with self-reported implementation success were identified., Results: Respondents representing 104 of 117 facilities participated. Almost all facilities (96%) had completed at least 1 cycle of SM, yet only half (52%) rated their implementation highly successful. Early implementation date, higher levels of leadership confidence in SM, and higher frequency in which nursing staff think in terms of hours per patient day were associated with higher SM implementation success. Time, staff training and educational needs, and engagement were common barriers., Discussion: Understanding factors that influence successful implementation of staffing policies is important to ensuring safe staffing.

Objective: This study provided insight into the level of engagement of nurse managers (NMs) and strategies used to achieve and sustain engagement in acute care settings., Background: Nurse managers have a significant role in staff satisfaction and unit outcomes and therefore need to be engaged in their work to influence others. Little is known about the level of individual NM engagement and strategies they use to remain engaged., Methods: A mixed methods approach was used to elicit information about NM engagement. This study used a sample of 47 NMs to measure their level of engagement, and for those achieving scores indicating high levels of engagement, interviews were conducted, and a content analysis was completed to identify themes., Results: Results showed that there were significantly higher levels of NM engagement among those managers who had been practicing as nurse leaders for a longer period and also those who had advanced degrees. Qualitative review revealed the themes of expert communication, autonomy, and influence as the key factors driving NM engagement., Conclusions: The role of the nurse executive in NM engagement is significant in supporting educational advancement and retention, both of which proved to have an impact on the level of engagement.

Background: The professional performance level of their alumni is one of the quality indicators of educational institutions. Nursing education institutions can use their alumni's performance analysis results to enhance their curricula, eliminate deficiencies, improve the quality of education and graduate more highly qualified nurses., Objective and Design: This is a descriptive, cross-sectional and comparative study, which aimed to determine the professional performances of nurses who graduated from the same nursing faculty., Methods: The study sample included alumni of Turkey's first nursing faculty, part of the nation's first public university in Istanbul, and their administrative supervisors. The study data were collected using the self-assessment forms of 314 alumni who worked as bedside nurses in 36 Istanbul hospitals, and 314 evaluations by the 195 nurse managers who supervised them. The study's response rate was 82.6%. To collect the study data, the researchers created a performance evaluation form based on the relevant literature. The same form was administered both to the nurse managers and the alumni. The researchers obtained ethical board approval and official permissions from the relevant hospitals to conduct the study. The study data were analyzed by a statistics expert., Results: According to the study results, the alumni's perceptions of themselves as well as the nurse managers' perceptions of the alumni were different from those of the other nurses with undergraduate degrees in terms of professional knowledge, expectations and ideals. The performance evaluation results showed that the alumni evaluated themselves more positively than their managers did. It was determined that there were highly significant differences (p=0.000) between the values provided by the five sub-dimensions of the scale and the total scale. In addition, the performance level was low in the sub-dimension focusing on research, and there was a significant difference in this sub-dimension (p=0.040)., Conclusions: The study found that the alumni mainly had better evaluations of their own performances than their nurse managers, and that the research skills of the alumni should be enhanced., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Chief nurse executives (CNEs) face challenges in providing high-quality, patient-centered care for diverse populations. Although the implementation of culturally and linguistically appropriate services (CLAS) may improve patient satisfaction, the cost of initiatives and education coupled with shortened episodes of care pose obstacles. The article describes themes from a qualitative study with CNEs, describes resources and best practices, and highlights nurse leader rounds as a vehicle for implementing CLAS.

A highly visible transition occurred earlier this year with the retirement of Pam Thompson, MS, RN, CENP, FAAN, from her role as CEO of the American Organization of Nurse Executives. Ms Thompson was always an advocate of promoting the voice of nursing. This month, the spotlight will shine on a team of nurse leaders who found their voice, got involved, and led the conversation. We will trace their journey as they analyzed their situation, applied the evidence, and used their seat at the table.

In the 2nd of a 3-part series on the value of patient and family advisory councils, an early adopter at a large, Magnet®-recognized healthcare system reveals ways in which an environment focused on strong partnerships, a culture of safety, and a commitment to transparency led to the creation of successful councils at multiple hospitals. The authors discuss nursing's integral role in championing and leading the councils, as well as the benefits of a strong patient-family voice in hospital operations and care processes.

In the fall of 2013, the American Nurses Association began the process of redesigning the scope and standards for the nurse administrator. This article provides a synthesis of the top 10 changes in the new Scope and Standards for Nurse Administrators that are being reviewed for approval. These changes reflect the continuing evolution of practice for nurses serving as leaders across the United States.

Successful transitions require leadership, focus, and tenacity. Substantive change rarely comes easily. Leaders are frequently challenged to determine when change is needed and how to best accomplish it. This month we will shine the spotlight on a statewide initiative in Wisconsin to transition the nurse staffing decision process, in every practice setting, from largely opinion based to evidence based. This leadership initiative capitalized on the leadership potential of a professional association and the power of consensus and a well-executed strategy.

The recent growth in hospital mergers and the resultant mergers of nursing service departments (NSDs) have produced a need for chief nursing officers (CNOs) to be aware of implications and anticipated dynamic changes. This article addresses the major issues raised by mergers for NSDs and presents an operational step-by-step checklist for CNOs.

Nurse executives (NEs) are operating in a volatile, uncertain, complex, and ambiguous world. NEs must create supportive environments that promote staff empowerment, resilience, and alignment, to ensure organizational success. In addition, NEs need to be transparent and create a culture of partnership with their staff. The ability of NEs to create and sustain this environment is vital in supporting teams to successfully navigate in today's healthcare environment.

Objective: The aim of this study was to acquire nurse managers' perspectives as to the scope of workplace bullying, which interventions were deemed as effective and ineffective, and what environmental characteristics cultivated a healthy, caring work environment., Background: Research has linked workplace bullying among RNs to medical errors, unsafe hospital environments, and negative patient outcomes. Limited research had been conducted with nurse managers to discern their perspectives., Methods: Six nurse managers from hospital settings participated in in-depth, semistructured interviews. Ray's theory of bureaucratic caring guided the study., Results: These themes emerged: (a) awareness, (b) scope of the problem, (c) quality of performance, and (d) healthy, caring environment. Findings indicated mandated antibullying programs were not as effective as individual manager interventions., Conclusions: Systems must be in place to hold individuals accountable for their behavior. Communication, collective support, and teamwork are essential to create environments that lead to the delivery of safe, optimum patient care.

Introduction: In a developing country like Iran, wasting economic resources has a number of negative consequences. Therefore, it is crucial that problems of introducing new electronic systems be identified and addressed early to avoid failure of the programs. The purpose of this study was to evaluate head nurses' and supervisors' perceptions about the efficiency of the electronic patient record (EPR) system and its impact on nursing management tasks in order to provide useful recommendations., Methods: This descriptive study was performed in teaching hospitals affiliated to Semnan University of Medical Sciences, Iran. An anonymous self-administered questionnaire was developed. Head nurses and supervisors were included in this study., Results: It was found that the EPR system was immature and was not proportionate to the operational level. Moreover, few head nurses and supervisors agreed on the benefits of the EPR system on the performance of their duties such as planning, organizing, budgeting, and coordinating., Conclusion: It is concluded that in addition to the technical improvements, the social and cultural factors should be considered to improve the acceptability of electronic systems through social marketing in the different aspects of nursing management. It is essential that health information technology managers emphasize on training head nurses and supervisors to design technology corresponding to their needs rather than to accept poorly designed technology., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Purpose: Nurse manager behaviors and job satisfaction are commonly addressed in the literature; however, registered nurse (RN) perceptions of nurse manager behaviors provide a unique perspective that may inform future strategies designed to enhance RN job satisfaction. In this paper, the perceptions of RNs were explored through focus groups to learn the behaviors of nurse managers that most influence RNs' job satisfaction., Methods: Five focus groups were conducted through semi-structured interviews of a total of 28 RNs to provide data that were coded through qualitative content analysis for themes., Findings: The findings provide nurse managers with data related to the perceptions of RNs and the behaviors of managers that influence job satisfaction. The findings identified two conceptual categories of RN perceptions of nurse manager behaviors: manager behaviors supportive of RNs (communication, respect, and feeling cared for) plus the RNs' perceived disconnect of work issues from the manager's role., Conclusion: Findings support past research in relation to the perceptions of RNs wanting to be respected, included in communication, and the need to feel cared for by nurse managers to have higher levels of job satisfaction., (© 2014 Wiley Periodicals, Inc.)

Objective: This study sought to identify significant differences in nursing leadership strengths by position title., Background: Recent reports show aspects of transformational leadership (TL) related to position, age, and educational level. This study focuses on differentiating the strength of leadership practices across the range of nursing management positions., Methods: The Leadership Practices Inventory-Self-assessment survey, and a variety of demographic questions, were used to anonymously poll voluntary members of the Association of California Nurse Leaders., Results: Nursing positions of director level and above were strongest in leadership practices. Those at manager and below were identified as needing additional leadership development. LPI-S subscales Enable Others to Act and Model the Way were strongest., Conclusion: Those at the manager level and below will benefit most from additional education and training. Even upper levels of management would gain from enhancing the LPI practices of Challenge the Process and Inspire a Shared Vision.

Deborah Zimmermann, DNP, RN, Chair of the Commission on Magnet® Recognition, provides reflections regarding her 8 years on the Commission. Dr Zimmermann discusses how the standards have changed and how they have positively impacted nursing practice and patient outcomes.

Background: Nurses play a crucial role in pain management and must be highly knowledgeable to ensure their practices are of a high standard., Aim: The purpose of this study was to determine the baseline level of knowledge and attitudes regarding pain of nurses working in three teaching hospitals in Dublin., Methods: This descriptive study explored the knowledge and attitudes of nurses regarding pain management. A modified version of the 'Knowledge and Attitudes Survey Regarding Pain' tool was used to collect data. The sample comprised a convenience sample of 94 nurses working in the acute surgical wards of three hospitals., Findings: Three per cent of respondents achieved a passing score of 80% or greater. Results revealed that the mean percentage score overall was 65.7%. Widespread knowledge deficits were noted in this study, particularly in the domain of pharmacological management of pain. Further analysis revealed respondents had an inaccurate self-evaluation of their pain management knowledge., Conclusion: The results of this study support the concern of inadequate knowledge and attitudes of nurses regarding pain. Educational and quality improvement initiatives in pain management should be used, which could foster and enhance nurses' knowledge base in the area of pain and possibly improve practices.

Aims: To evaluate the advancement of knowledge on the impact of an empowering leadership style on the risk of mobbing behaviour among nurse working teams. The secondary aim was to evaluate, along with leadership style, the contribution of other organisational- and individual-related mobbing predictors., Background: 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., Methods: 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., Results: 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., Conclusions and Implications for Nursing Management: 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., (© 2013 John Wiley & Sons Ltd.)

Background: A healthy work environment can improve patient outcomes and registered nurse (RN) turnover. Creating cultures of retention and fostering healthy work environments are 2 major challenges facing nurse leaders today., Specific Aims: Examine the effects of the healthy work environment (communication, collaboration, and leadership) on RN turnover from data collected from a research study., Methods: Descriptive, cross-sectional, correlational design. Pediatric critical care RNs from 10 pediatric intensive care units (PICU) completed the Practice Environment Scale of the Nursing Work Index Revised and a subscale of the Intensive Care Unit Nurse-Physician Communication Questionnaire. These staff nurses were asked whether they intend to leave their current job in the next 6 months. Statistical analysis included correlations, multiple linear regression, t tests (2-tailed), and 1-way analysis of variance., Results: A total of 415 RNs completed the survey. There was a statistically significant relationship between leadership and the intent to leave (P < .05). There was also an inverse relationship between years of experience and intent to leave. None of the communication variables between RNs and among RNs and MDs or collaboration were significantly associated with PICU nurses' intention to leave., Conclusion: Effective leadership in the PICU is important to PICU RNs and significantly influences their decisions about staying in their current job.

Objective: The aim of this study was to examine the effect of patient turnover and acuity on worked hours per patient day (WHPPD)., Background: An examination of staffing plans publically posted by Massachusetts hospitals with more than 300 beds revealed that less than 40% were within 5% of their planned versus actual WHPPD., Methods: Three years of WHPPD data collected from 14 adult acute care units were correlated with patient turnover and acuity data. A weight factor was retrospectively added to 8 paired units' planned WHPPD where correlations were identified., Results: Twelve units (86%) showed significant correlations between WHPPD and patient turnover. Correlations between patient acuity and WHPPD were significant only at the aggregate level. After weighting WHPPD, the 8 paired units demonstrated a decreased variance between planned and actual WHPPD., Conclusion: Using a weight factor added to WHPPD to right size acute care medical-surgical units may be useful for accurate staff planning and budgeting.

Objective: This study compared the perspectives of internationally educated nurses (IENs) and registered nurses (RNs) educated in the United States regarding participation in hospital governance structures and professional advancement., Background: Nurses' participation in hospital governance is reported to contribute to empowerment. No research has examined how IENs' perceptions about participation in governance compared with those of U.S. RNs., Methods: Semistructured interviews were held with 82 nurses in 2 urban hospitals. Forty nurses were reinterviewed to follow up on themes., Results: Internationally educated nurses and US RNs shared similar perspectives. Nurses in both samples did not value participation in governance, lacked guidance about how to advance, and preferred to at the bedside., Conclusions: Strategies to encourage nurses to participate in and value governance and professional advancement opportunities should be explored and adopted.

Healthy workplace practice environments are essential to keeping patients safe. The American Organization of Nurse Executives (AONE) identifies the creation and maintenance of healthful practice environments as an essential role for nurse leaders. In this article, we profile exemplars of nurse leaders who have integrated elements of the AONE Principles and Elements of a Healthful Practice Work Environment in their executive practices.

Magnet designation has become a highly sought-after credential for hospitals across the United States and internationally who want to distinguish themselves for clinical excellence and employee engagement. This article chronicles how Emory Healthcare, the largest, comprehensive academic healthcare system in Georgia, developed the Magnet Readiness Index™ to assess the status of nursing compared with the standards prior to submission of an application.

Staffing problems can arise because of poor delegation skills or a failure by leaders to respond appropriately to economic factors and patient demographics. Training dilemmas, meanwhile, can arise because of managers' confusion about what constitutes 'training' and what constitutes 'education', and where responsibility of provision lies, with the consequence that they neglect these activities. This article uses Kouzes and Posner's (2009) transformational leadership model to show how managers can respond. Leaders who challenge budgets, consider new ways of working and engage effectively with the workforce can improve productivity and care, while those who invest in appropriate learning will have a highly trained workforce. The author explains how integration of leadership roles and management functions can lead to innovative problem solving.

This month, the director of the Magnet Recognition Program® provides an in-depth look at the Magnet® Model component exemplary professional practice, what it takes to establish such a practice, and how it can help organizations achieve extraordinary results.

An aging workforce and high-stress environments have led to more nurses working with their own health problems, which in turn affects productivity. To assess this issue, the authors conducted focus groups with nurses and nurse managers. The authors discuss their findings and their implications for more proactively addressing issues that relate to health problems in nurses and the workplace changes that are needed to support nurses with health problems to ensure patient safety and quality care.

Enhancing the critical thinking skills of frontline nurses has been a longstanding concern for hospital nursing leaders, but increased complexity of care now lends renewed urgency to this challenge. Rising patient acuity and decreasing length of stay contribute to an environment that challenges even tenured nurses long recognized as strong critical thinkers. To ensure safe patient care in a fast-paced care environment, nurse leaders must invest in more individualized development of key critical-thinking competencies. As part of a broader research initiative on elevating frontline critical thinking, the Nursing Executive Center has developed a diagnostic tool for assessing individual performance on 25 critical thinking skills. The authors discuss the tool's development, methodology, and potential applications.

The performance appraisal process is a key component of professional nursing practice. The peer review process is referred to frequently in Magnet Nursing Standards as a key element in professional nursing. The peer review process allows professionals from common practice areas to systematically assess, monitor, make judgments, and provide feedback to peers by comparing actual practice to established standards. Peer review can engage a multigenerational workforce and lead to more satisfied, engaged employees. As a component of the annual performance appraisal, peer review can create positive relationships, foster a better work environment, and allow peers to increase individual and group accountability. Peer review has many common elements that can be individualized to fit any type of unit or work culture. This article describes how to design, implement, and evaluate a unit-based peer review program. The content and steps outlined are intended to support nurse managers in implementing unit-specific peer review programs by focusing on existing expertise and best practices. The implementation steps are divided into 5 phases describing the introduction of concepts and getting nurses engaged, implementation guidelines, piloting the process, staff education, and ongoing evaluation. Staff involvement is the key to a successful unit-based peer review process.

Aim: The purpose of this study was to evaluate how an executive nursing team, within an acute hospital trust in the south of England, developed their leadership characteristics through the use of a professional development programme., Background: This paper offers an insight into how this team worked together to clarify their views of their new role and how the role would be enacted., Method: A questionnaire using quantitative and qualitative measures was used to explore the group's leadership style and evaluate the professional development programme., Findings: The findings show how the development programme worked and what clarity it afforded the group in terms of their leadership style. Group work, building on the findings, helped them define their particular characteristics, skills and leadership ability and what further work was needed to demonstrate this., Conclusions: The issues raised, such as team-working, mutual purpose and personal development, are discussed in terms of their function within an integrated executive team with vision and goals., Implications for Nursing Management: In ensuring that the nursing service has positive purpose, direction and goals, there needs to be a strategic approach to corporate development; otherwise, nursing will struggle to lead itself within a fast changing health care system.

For most patients and the general public, their most significant interface within the hospital setting occurs at the ward level. Here, the professional abilities of the Ward Sister/Charge Nurse--as well as the ward environment--will have a major impact on the experience and outcome of the patient's stay in hospital. It will also strongly influence the opinion of relatives and friends about the standards of care being delivered in that hospital. Ward managers are expected to demonstrate not only clinical leadership, but also be competent at dealing with the plethora of organisational issues which arise on their ward on a daily basis. As part of a professional response to the public's concerns around the environment of care within our hospitals and the perception that nursing leadership is not what it was, Welsh Assembly Government have launched a new strategy to re-empower Ward Sisters/Charge Nurses and develop and support the nurse managers/leaders of the future.

The evaluation of employees by their superiors is standard managerial practice but the value of the evaluation of superiors by their employees is much less recognized. This study describes a project where for 3 years (2000-02), in an Israeli mental health center, the Director of Nursing, clinical supervisors, ward head nurses and their deputies were evaluated by nurses and nursing aides. Feedback was gathered through anonymous questionnaires under conditions of confidentiality. Based on the findings, steps were taken to improve managers' performance. Evaluators were also requested to evaluate the project's contribution to themselves and the hospital in a second, open questionnaire. All parties, evaluators and evaluated, expressed satisfaction and recommended that the project continue on a regular basis. Nurses felt empowered and respected and that manager-subordinate relations were improved. Other results and recommendations are discussed.

Background: Several studies have described the work environment of nurses from magnet and nonmagnet hospitals, but there have been no studies of nurses from hospitals in the magnet application process., Objectives: To compare the differences between characteristics of hospitals and nurses from three hospital types: magnet hospitals, hospitals in the process of applying for magnet certification, and nonmagnet hospitals, and how nurses from these hospitals perceive their work environment., Methods: In a national, cross-sectional survey of critical care nurses, the Perceived Nursing Work Environment (PNWE) instrument was administered to measure nurses' perceptions of their work environment., Results: Data were available from 2,092 nurse surveys. Over a third of the respondents were from in-process hospitals and almost half were from nonmagnet hospitals. The majority of nurses were female and from large hospitals in the Atlantic region. The mean age of nurses was 39.5 years and the mean years of work experience in the intensive care unit (ICU) was 10.2 years. Higher nurse scores were significantly associated with magnet certification on one subscale of the PNWE, nursing competence., Discussion: Nurses from magnet hospitals had a positive perception of nursing competence in their work environment. Further research is necessary to examine the nurse work environment and to determine if the characteristics of magnet hospitals have changed.