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AIM: To determine if nurse leaders' attendance at a leadership development programme based on an empowerment framework would increase staff perceptions of organisational support and organisational commitment. BACKGROUND: Leadership empowering behaviours are teachable relational competencies that have been associated with quality leader-staff relationships and positive staff outcomes. METHODS: A quasi-experimental, pre-test-post-test design was used to compare perceptions of staff whose leaders participated in a year-long leadership programme with staff of similar leaders who did not attend the programme. A series of multiple regression analyses were used to test the conceptual model of programme effects. RESULTS: Leaders' programme participation was directly associated with greater staff organisational commitment 1 year after the programme. Both programme attendance and leader-empowering behaviours were found to act as independent catalysts for staff empowerment, with structural empowerment partially mediating the effects of leader empowering behaviours on organisational commitment. CONCLUSIONS: Leader participation in a development programme based on an empowerment framework may be an important means of increasing staff organisational commitment, a key predictor of staff turnover. IMPLICATIONS FOR NURSE MANAGEMENT: Leadership development programmes should emphasize relational competencies, including leader empowering behaviours, given their potential for enhancing organisational commitment.

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AIM: To determine if a leadership development programme based on an empowerment framework significantly increased leaders' use of empowering behaviours. BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: Leaders' use of empowering behaviours can be increased through focused training and through a workplace empowerment process. IMPLICATIONS FOR NURSE MANAGEMENT: 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.

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Critical care nursing is an area of policy concern with respect to staffing projections, skill mix and educational preparation in both Canada and Australia. Despite many similarities between the health systems of these two countries, differences exist in both undergraduate and graduate specialty nursing education. In Australia, specialist education is primarily delivered via the tertiary sector as a formalised qualification, whereas the current Canadian model displays significant variation in duration, content, and mode of delivery. This paper provides a comparative perspective on the educational preparation of critical care nurses in these two countries. Consideration of alternative models of specialty nursing education may provide a method to improve recruitment and retention of staff while maintaining quality of care.

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Although this conceptual framework is easy to understand, the data requirements for the mathematical model that underpins the framework are complex and must be defined carefully. In our framework, simulations of the health system are used to provide needs-based estimates that are aimed at optimizing outcomes. This type of model builds on research conducted at the macro, meso, and micro levels in order to reflect the complexity of relationships in the health human resource process. The papers in this issue of the Journal provide insight into specific constructs of the model. At the macro level, Tomblin Murphy explores methodological challenges in HHRP research. She examines common assumptions and the validity of their use in modelling in all aspects of the proposed framework. Tourangeau and colleagues report on the impact of hospital nurse-staffing decisions on 30-day mortality rates. Their model adds to our knowledge of the relationships among the management, deployment, and utilization of nursing services and patient/population outcomes. Shamian and colleagues explore the relationship between hospital-level indicators of the work environment and aggregated indicators of health and well-being for registered nurses employed in acute-care hospitals in the province of Ontario. This paper contributes to our understanding of how management decisions regarding the work environment influence nurse outcomes. Manojlovich and Ketafian explore the conflict between the practice of nursing and the organizational structure of many hospitals. This study provides insight into the management aspects of how the work unit is organized and the process of care delivery. Zboril-Benson examines the reasons for nurse absenteeism in the province of Saskatchewan. Birch describes the need for the planning process to take into account demographic changes in both populations and provider groups. A major challenge in modelling health human resources is access to meaningful databases for planning purposes. Pringle describes a unique Ontario initiative currently underway to develop and validate a nurse-sensitive set of data that will be routinely collected and will enhance HHRP in that province. Since the science that underpins HHRP is complex and rapidly changing, few books have been written on the subject. Reflecting the dynamic nature of the science, Tomblin Murphy and Barrath provide an excellent review of "grey literature" and useful Web sites for those interested in HHRP.

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This article is a review of the approaches published between 1996 and 1999 that have been used to forecast human resource requirements for nursing. Much of the work to date generally does not consider the complex factors that influence health human resources (HHR). They also do not consider the effect of HHR decisions on population health, provider outcomes such as stress, and the cost of a decision made. Supply and demand approaches have dominated. Forecasting is limited, too, by the availability of reliable and valid data bases for examining supply and use of nursing personnel across sectors. Three models--needs based, utilization based, and effective demand based--provide substantially different estimates of future HHR need. The methods of analysis employed for forecasting range from descriptive to predictive and are borrowed from demography, epidemiology, economics, and industrial engineering. Simulation models offer the most promise for the future. The forecasting methods described have demonstrated their accuracy and usefulness for specific situations, but none has proven accurate for long-term forecasting or for estimating needs for large geographical areas or populations.

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Restructuring, particularly redeployment and job change, had a dramatic impact on the working conditions and practices of nursing personnel. This study was conducted to determine whether nurses (RNs and RPNs) who experienced job change perceived their work-lives differently than those who did not undergo job change and, whether nurses who experienced different types of job change (new role, new unit, or new hospital) varied in their perceptions. A questionnaire exploring themes relevant to redeployment was administered to all nurses (N = 3,408) in two large teaching hospitals that had undergone restructuring. The response rate was 50.7% (n = 1,728). Of the responses, 1,662 were used in the analysis. T-tests and ANOVAs were used to compare groups of nurses. Nurses who changed their jobs perceived their commitment to the organization, their work environment and quality of care differently than those who did not change jobs. Nurses with different types of job change differed in their organizational commitment, perceptions of work-related injuries, attitudes towards job change, need for orientation and new knowledge, and feelings about the health care team. Results will assist managers to address the specific needs of nurses with different experiences of job change in the restructured workplace.

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The authors present a highly statistically oriented argument for examining work attitudes and activities among three groups of caregivers [RNs, RPNs, and HCAs] working in long-term care. The investigators used both work sampling, written surveys, and interviews with a sample of 46 caregivers in a large university-affiliated LTC facility in Toronto, Canada. While RNs stated their strong affinity for direct patient care activities, they perform the lowest percentage of direct care, chiefly due to their accountability for planning and coordinating the care provided by others. The HCAs who provided the bulk of direct patient care "valued it the least," apparently finding little gratification with this aspect of their role. This study suggests that there is a need to examine and clarify work roles and perceptions for all caregivers as part of any work redesign process. A higher level of RN involvement in direct patient care activities, along with "attention to enhancing the importance" of these activities for staff employed in the HCA role, could be beneficial.

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The reliability, validity, and sensitivity of the Medical Outcome Study Short Form (SF-36) and the Quality of Life Profile: Senior Version (QOLPSV) for measuring outcomes of home care nursing were evaluated. Data were collected from 50 clients receiving home care nursing services. Twenty-two registered nurses and six registered practical nurses collected client and nursing data on each home visit. Client baseline and outcome measures were collected by two independent evaluators at admission and discharge from the home care service. Internal consistency reliability ranged from.76 to.94 for the eight subscales of the SF-36. Internal consistency reliability ranged from.47 to.82 for the nine subscales of the QOLPSV. The subscales of both instruments had minimal problems with missing responses. The SF-36 was found to be more sensitive than the QOLPSV to change over time. In addition, the subscales of the SF-36 were found to be more sensitive than the subscales of the QOLPSV to several of the nursing variables, such as intensity of the client's nursing condition and skill mix.

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This study was undertaken to examine the practice pattern of nurse practitioners employed in Ontario acute care settings. A descriptive design, incorporating quantitative and qualitative methods for data collection, was used. The acute care nurse practitioners' practice pattern varied in terms of scope of practice, model guiding practice, reporting relations, and extent of role implementation. Role implementation encompassed activities representing the four role components: clinical practice, education, administration or management, and research. The acute care nurse practitioners engaged most frequently in the clinical component of the role. They performed medical and advanced nursing functions. They emphasized that they do not work in isolation and that they do not replace physicians or residents.

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The purpose of this study was to explore the influence of organizational factors on the Acute Care Nurse Practitioner (ACNP) role implementation. A descriptive correlational design, incorporating quantitative and qualitative methods for data collection was used. The sample of convenience consisted of 57 ACNPs assigned to various medical and surgical programs within acute care hospitals. Ten ACNPs participated in the unstructured qualitative interviews. In addition to the interviews, data pertinent to various organizational factors, including role formalization, receptivity of the role by others, perceived autonomy, role strain, and additional factors that may interfere with role implementation, were collected through a self-report structured questionnaire. A four-diary day was completed to gather data on role implementation. Descriptive and correlational statistics were used to analyze the quantitative data. The qualitative data were content analyzed. The ACNPs engaged most frequently in activities reflective of the clinical practice component of the role and less frequently in the non-clinical components (i.e., education, administration, and research). Results of the quantitative and qualitative analyses indicated that lack of formal clear job description, conflicting demands and expectations, lack of receptivity of the role by others, lack of autonomy, and increased workload were negatively correlated with the ACNP role implementation. The ACNP role implementation varies across practice settings. This variability should be accounted for when examining outcomes of ACNP care.

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In her paper, MacAdam refers to future challenges in health human resources for the home-care sector. This paper builds on her comments and discusses conceptual and practical approaches to future planning of health human resources. Necessary national data requirements are identified for this type of planning. The authors point out the limitations of traditional supply-side modelling and describe a new framework linking population health needs to outcomes that builds upon earlier conceptual work in needs-based, utilization-based and effective demand-based models.

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BACKGROUND: The authors used a nursing task inventory system to assess nursing resources for patients with and without adverse postoperative events in the postanesthesia care unit (PACU). METHODS: Over 3 months, 2,031 patients were observed, and each task/activity related to direct patient care was recorded and assigned points according to the Project Research in Nursing (PRN) workload system. PRN values for each patient were merged with data from an anesthesia database containing demographics, anesthesia technique, and postoperative adverse events. Mean and median PRN points were determined by age, sex, duration of procedure, and mode of anesthesia for patients with and without adverse events in the PACU. Three theoretical models were developed to determine the effect of differing rates of adverse events on the requirements for nurses in the PACU. RESULTS: The median workload (PRN points) per patient was 31.0 (25th-75th percentile, 25-46). Median workload was 26 points for patients with no postoperative events and 155 for > or = six adverse events. Workload varied by type of postoperative event (e.g., unanticipated admission to the intensive care unit, median workload = 95; critical respiratory event = 54; and nausea/vomiting = 33). Monitored anesthesia care or general anesthesia with spontaneous ventilation used less resources compared with general anesthesia with mechanical ventilation. Modeling various scenarios (controlling for types of patients) showed that adverse events increased the number of nursing personnel required in the PACU. CONCLUSIONS: Nursing care documentation based on requirements for individual patients demonstrates that the rate of postoperative adverse events affects the amount of nursing resources needed in the PACU.

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The World Health Assembly approved resolution WHA45.5 in 1992. This paper reports the findings of an evaluation of the implementation of this resolution using a survey technique. A total of 150 WHO Member States responded, for a 79% response rate. Findings suggest that the greatest strides worldwide have been made in education. While the data show that progress has been made at the country level, far more action is needed to strengthen nursing and midwifery if these cost-effective resources are to play a decisive role in improving the extent and quality of services, especially as delivered to people in the greatest need.

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In the midst of downsizing, restructuring, layoffs, hospital closures, mergers, and the beginning cycle of shortages in specialty units, nursing administrators must extend their understanding of the factors influencing job satisfaction and the implications these findings may have for nursing practice, in order to enhance the quality of worklife for nurses in a hospital setting and create competitive work environments. The Causal Model of Job Satisfaction for Nurses (Blegen & Mueller, 1987), including Leatt and Schneck's (1981) technology variable, was the conceptual framework used to look at the effect of the 14 variables (opportunity, routinization, autonomy, job communication, social integration, distributive justice, promotional opportunity, motivation, pay, workload, general training, kinship responsibility, unit size, technology) on job satisfaction. This study demonstrated a statistically significant positive correlation between autonomy, motivation and job satisfaction and a statistically significant negative correlation between routinization and job satisfaction.

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The authors present a new multifactorial intensity and complexity of care model and meta-paradigm that is designed to examine costs, nursing work, and the variability in resource use across patients and environments. Relationships were observed among four key variables which included patient-nursing condition, medical condition, caregiver characteristics and the environment. Patient-nursing complexity and medical complexity are commonly measured by nursing diagnosis and DRG or Canadian case mix groupings (CMG) respectively. The complexities associated with the work environment had been the least previously studied factors. Environmental complexity factors include both supply and demand dimensions: scheduling and coordination of procedures, multiple and long procedures, and characteristics and composition of the caregiver team.

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In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.

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In Part One, an overview of the theory related to validity and reliability of workload measurement systems (WMSs) was reviewed. In this article, the MEDICUS WMS is used to provide a concrete example of the type of comprehensive validity and reliability programs that can be established, in an inpatient setting, on the basis of this theory. Practical strategies for monitoring validity and reliability are identified. Administrators can adapt the approaches specified to fit the methodology underpinning other WMSs.

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Nursing workload measurement systems (WMSs) are used in inpatient and outpatient settings for staffing, scheduling, and budgeting. The nurse administrator can use WMS data to make wise decisions in these key areas providing the data are reliable and valid. Unfortunately, in most institutions, attention to issues of reliability and validity occurs only at system implementation and then the systems are left unattended. This article provides an overview of validity and reliability as it relates to WMSs. Part Two of this article will demonstrate how validity and reliability theory can be operationalized in an ongoing program for maintaining WMS reliability and validity.

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