The first study reviewed looked at the "effect of patient-focused redesign on midlevel nurse managers' role responsibilities and perceptions of work environment (Ingersoll, 1999, p. 21). The study was chosen because patient-focused redesign models are becoming increasingly popular and little research has been conducted regarding the results of these models on nurse leaders/managers. A review of published studies of Patient-Focused Redesign (PFR) suggests that models differ across institutions and that findings are preliminary and measure short-term effect only. Management theory is notably absent from the reports, and the extent of implementation of PFR principles differs according to the needs of the organization, the scope of services provided, and the resources available (Ingersoll, 1999, p. 22). The study occurred at two tertiary hospitals in the Midwest. They selected nine midlevel nurse managers for the study. Between 9 and 12 months after completion of PDR the subjects were interviewed for 60-90 minutes each regarding their perceptions of the effect of redesign on their roles and responsibilities. In addition, they were asked about their challenges as an administrator. Feelings reported by the nurses managers included frustration and inadequacy. They mentioned numerous role behavior changes. The primary role behavior changes mentioned were "the need to measure and manage outcomes; the need to better understand the financial situation of the organization and the external factors that influence it; the need for high-level team-building skills; and the ability to manage rapid and dramatic change" (Ingersoll, 1999, p. 23). Overall, role confusion appeared to be the major issue for these nurse managers.
The findings of this study show that regardless of how prepared the nurse managers were they still struggled to keep up with the demands of changes such as this. The study stressed the importance of providing support for managers facing situations such as these. It concluded that "early involvement in decision making and formal opportunities to develop their skills as managers will maximize the potential for successful role readjustment in this highly committed and absolutely essential member of the administrative team" (Ingersoll, 1999, p. 27).
The results of this study could have a significant impact on leadership and management. It is made clear that the midlevel nurse managers often feel role strain when involved in something that requires a major change throughout the organization, such as PFR. These kinds of changes can be seen in health care organizations everywhere. They often feel like they are being put in the middle between higher administrators and their nursing staff. This can cause them to feel isolated. In addition, they felt that their roles were not clearly defined. All of these things strongly suggest that more clearly defined roles, readily available resources for the managers and support groups would make their position in changes such as these less stressful and that the transition would flow smoother. If these efforts were taken, nursing leadership and management could be strengthened.
The second study reviewed took place in Sweden and looked at the effect that a professional development course would have on the role of a nurse manager over time. The course selected for the study was a professional development course in advanced nursing at the masters-degree level. The course took 2 years of part-time study. A few of the topics covered in the course were leadership, ethics, and quality assurance. A total of 15 nurse managers, 14 women and 1 man, attended the course; 12 women and 1 man successfully completed it. They all served in managerial positions on various levels in public or private healthcare organizations and were recruited from all over the country. Some of the nurse managers had attended various courses in management and administration previously, but not at degree level (Lindholm,...
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