Nursing in the nineties - Managing the uncertainty

Objective: This study examined qualitative data on nurses' work lives from 53 hospitals that participated in the National Institutes of Health (NIH)fu nded Outcomes Research in Nursing Administration Project (ORNA). Background: The ORNA project examines the impact of nursing unit organizati onal structure on outcomes. The information reported in this article am pli fies the quantitative data with qualitative data that enhances understandin g of nurses' work lives. Methods: Site coordinators at all participating hospitals were requested to send monthly journal entries for 6 months. Data were documented according to an agreed-on content outline that consisted of critical incidents and im plications. Data were collected from 53 of the 65 study site coordinators ( response rate 81.5%). Content analysis of all collected data was conducted by the research team. Results: Study site coordinators in 53 hospitals characterize the acute car e environment as turbulent and uncertain. Contributing factors include: 1) work load (fluctuating census, staff preparation, turnover); 2) loss of wor kplace identity (unit consolidation, hospital buy-outs, and system mergers) ; and 3) reengineering (skill mix, new equipment/system changes? new docume ntation systems, rumored changes). Conclusions: This study adds to the growing body of literature that portray s environmental uncertainty from the narrative perspective. Although there is an ongoing need for the employment of fiscally accountable, quality enha ncing organizational/management strategies, all initiatives are at risk unl ess personnel needs are attended to and seen as unique in each care setting . Some strategies are offered to meet this dual imperative.