<p> The specific problem under study results from the growth of multinational workforces in U.S. hospitals and the gap in the literature explaining how the presence of these workforces impacts hospital leadership, decision-making, and financial performance. The purpose of this qualitative embedded multi-case study was to discover and describe hospital nursing leader&rsquo;s beliefs from their experiences about how having employees from multiple national cultures affects nursing leadership, decision-making, and departmental financial performance in the hospital. The challenge faced by many hospitals is that the U.S. workforce is becoming culturally diverse as the global workforce increases its geographical mobility. The current research was important because results revealed nurse leaders&rsquo; beliefs about a link between the cultural dimensions of a multinational workforce and the decision-making, financial performance, and patient care within a hospital nursing department. The sample included eight nursing leaders from seven hospitals where the workforces are multinational and culturally diverse. The cultural dimensions by Hofstede were used to study the impact of a multinational workforce on the organizational practices of a nursing department in a hospital setting. Results revealed nine core themes, expected from the literature, and two emerging themes provided answers to the research questions. The nine core themes were Hofstede&rsquo;s cultural dimensions, workforce values, nursing organization impact, immigration/migration, nursing leadership, nursing workforce, organization culture, change, and develop multicultural organization attributes. The two emerging themes were familismo (family loyalty influences multinational workforce decision making) and hospital refusal to hire multicultural nurses whose national culture conflict with the organization&rsquo;s culture.</p>

Existing research into leadership has relied on individualistic theories which do not provide a satisfactory understanding of the leadership process, particularly in organisations where focus has moved away from vertical, hierarchical leadership, towards more distributed or emergent models (Avery, 2004; Dess & Picken, 2000; Denis, Lamothe & Langley, 2001). It is assumed that individuals will emerge as leaders, and be viewed as effective, when they are rewarded as prototypical, or representative, of the group they are attempting to lead (Hogg, 2001b; Hogg & Terry, 2000), and when they exhibit stereotypical leadership behaviours (Lord, Brown, Harvey & Hall, 2001a; Offermann, Kennedy, & Wirtz, 1994). To date, research has assumed that the two identity concepts are compatible, with little consideration given to groups whose professional identity is dissonant with expected leadership stereotypes. The question therefore arises: how does professional identity influence ability of individuals to construct a leadership identity, when those identities are orthogonal? To address this research gap I focus on leadership in nursing, a profession who have traditionally been defined by their subordination to doctors (Abbott, 1988; Allen, 1997; Campbell-Heider & Pollock, 1987). Combining real-time participant observation of two leadership development programmes with over 60 hours of longitudinal semi-structured interviews from 32 participants, I provide new insights into the chronic identity conflicts encountered by subordinate professionals, and the identity work they use to overcome those conflicts. Drawing on my analysis I develop a typology of four resulting identity constructions, with differing levels of leadership influence and identity conflict. In doing so I illuminate the processes through which subordinate professionals mediate de-coupled identities, challenging the assumption that the existence of a group identity is always beneficial and complementary to leadership behaviours (Hogg, 2001a), and highlight an arena where it can actually be detrimental to the emergence of a leadership identity.

Declining resources are a global phenomenon. One of the consequences has been the reorganization of health care provision in different countries. Doctor shortages and scarcity of resources particularly in developing countries like Cameroon have resulted in nurses providing frontline care to patients and taking on roles traditionally performed by doctors in developed economies, such as diagnosing and prescribing. However, little is known about the exact role of nurses, the process of providing care, how key stakeholders influence the nurse’s role and the consequences of this role of nurses on the various parties concerned in the context of Cameroon. An empirical study was conducted with (n= 42) key stakeholders; (government representatives, doctors, nursing managers, nurses and patients). Semi-structured taped-recorded interviews were carried out on a one-to-one basis to explore the perceptions of multiple key stakeholders of the role of nurses in diagnosing and prescribing. Interviews were transcribed and data analysed using framework analysis. Nurses are the first point of contact for patients in Cameroon in all health care settings and most have a far greater role in diagnosing and prescribing than their counterparts in developed economies. However their involvement was found to vary significantly depending on a number of factors, including: the organisational context, the type of facility (whether public / private or mission owned), individual nurse characteristics, doctors’ attitudes and practices, resources and experience of nursing managers, level of income and characteristics of patients. Most patients (including women) prefer to consult with doctors and in their absence, male nurses rather than female nurses. Some nurses, patients and doctors felt that a preoccupation with diagnosing and prescribing left nurses with little time for compassion and caring. In addition, the key stakeholders felt that some nurses were overstepping their professional boundaries, or had inadequate knowledge and were acting in a manner detrimental to patient care. Extended roles for nurses have the potential to enhance accessibility to care, to enhance the status and job satisfaction of nursing staff and maximise the use of scarce resources. Despite the benefits, there is growing concern that nurses do not have the advanced level of training and behaviour necessary to take on this expanded role and that some are neglecting the traditional caring side of their profession in pursuit of a more medical oriented disease-focused approach.

This thesis describes an action research study that took place in the context of increasing intervention by UK central government in the shaping and delivery of health services, and broadening expectations about who could deliver services. The study was aimed at exploring the issues arising from the development of the interprofessional care co-ordinator (IPCC) role in an acute in-patient setting. The role was new, introduced with an inherent flexibility that enabled IPCCs to speed patients through their in-patient stays as fast as clinically possible. None of the four IPCCs appointed held a registrable qualification in health or social care. A review of the literature identified that very little is known about care co-ordinator roles in practice, particularly those held by non-registered workers. The study reported in this thesis began two years after the IPCCs took up post. The study’s objectives were to describe the characteristics, impact, issues and influences on the role. A wide range of qualitative and quantitative data were gathered and analysed between October 1998 and July 2000 within the framework of an action research approach. The findings identified that the IPCC role had informally shifted over time to take up the complex discharge planning work previously carried out by nurses. This shift was not reflected in Trust policy and had not been accompanied by a review of training, regulation or supervision. This had led to situations of risk for some patients. The findings threw light on contextual factors that enabled the role shift and disrupted the reflective leadership and long-term overview needed to monitor and respond to the shift. These factors included nursing staff shortages and a turbulent environment for managers characterised by multiple pressures, top-down targets particularly for acute efficiency, and high managerial turnover. In addition, nurses did not perceive that they had an influence on the ongoing development of the IPCC role. The findings support Abbott’s (1988) theory that an occupational group can take up the discarded work of a higher status occupational group, but challenge the theory that the work discarded is always more routine than the work retained. They support theories of a growing challenge to the primacy of professional knowledge and the existence of an organisational culture in the NHS in which there are broader expectations of who can deliver which health services. They also indicate that role substitution can lead to the routinisation and marginalisation of aspects of patient care. The findings also illustrate how an innovation can continue to be re-invented following its establishment into routine practice, and how the journey of an innovation can be influenced by its context. The findings throw light on a role in practice that is a cameo of current policy on new roles and have a number of implications for practice, policy, education and research.

It is argued that healthcare governance should play an important role in the overall functioning and effective performance of hospitals. However, the literature is devoid of how healthcare governance influences the performance of hospitals in Africa and other developing countries. This study examines the effects of hospital boards and ownership structure on the performance of hospitals in Ghana. The study specifically examines the characteristics of hospital boards, ascertains whether the presence of a hospital board and ownership structure affect hospital performance, evaluates the effects of hospital board characteristics and ownership structure on hospital performance, and also investigates the interaction effects of hospital board characteristics and ownership on performance. Based on a sample of 132 hospitals, the study produces a number of results. First, the study indicates that 69% of the hospitals have a board in place. The results also show that all the mission hospitals have a board in place. Half of the public hospitals and 80% of the private hospitals also have a board. The hospitals with a board exhibit varying board characteristics. Using regression models, the results show that hospitals with a board demonstrate lower occupancy, higher discharge and deliver better quality healthcare. In terms of the effect of board characteristics on performance, smaller boards are associated with better health service quality and lower occupancy. Hospitals with greater proportion of outside board members assist management to be cost efficient and improve on their operations leading to higher discharge. The results also show that hospitals with greater representation of medical staff on the board perform better in terms of occupancy but are less cost efficient. Hospitals with CEO duality perform better in terms of efficiency. However, hospitals with separate positions for the CEO and chair perform better in terms of discharge and service quality. Additionally, the evidence suggests that boards with higher female representation deliver better quality of healthcare, resulting in higher discharge rate. Also, frequency of board meetings is associated with lower occupancy, higher discharge and improved health service quality. The results also show that mission-based and private hospitals perform better than public hospitals. Further, the results of the interaction effects suggest that mission-based and private hospitals with effective board governance exhibit better performance than public hospitals. This study makes a number of new and meaningful contributions to the extant literature and the findings support managerialism, stakeholder and resource dependency theories. The findings also have important implications for effective and efficient governance and management of hospitals.

A nursing research is an integral part of the nursing. An implementation of research activities in this field makes a basis for an improving of the nursing care and a development of the discipline itself. For nurses working in a clinical department who should carry out research investigations, there is important a knowledge how to conduct investigations and a support from the hospital management. Without this support they could not put the research results into practice which is currently based more on standard procedures. A theoretical part of the thesis deals with the nursing research, research concepts and its historical development. Then it also discusses ethical principles of the nursing research, nurses´ fundamental roles, evidence-based activities, opportunities of the research funding in the Czech Republic and an evaluation of a scientific work. An aim of the thesis was to establish the awareness, participation and interest of the primary and secondary level management in the nursing research. We have identified four hypotheses which we verified by a quantitative survey. H1: More general nurses with a higher education participate in the nursing research than the nurses who are graduates of the secondary medical school. H 2: General nurses-managers who completed a university education are better prepared for an implementation of the nursing research than nurses-managers with the secondary education. H3: The primary and secondary level nursing management of Hospital in České Budějovice participate in the nursing research more than the management from other hospitals in the South Bohemian Region. H 4: The nursing management which is involved in the nursing research apply the research results into practice. The quantitative survey was made by a questionnaire technique. The research sample consisted of nurses working on the positions of the secondary and primary level managers in the inpatients departments of hospitals in the South Bohemian Region. The investigation was conducted in eight hospitals in the South Bohemian Region. It is possible to say, that the awareness of the nursing research is on a good level, nearly half of the nurses monitor and apply the information and the research results in their clinical practice as well as most nurses are ready to implement either a simple research survey or to participate in the research under a guidance or to prepare and implement an independent research project. We believe that the nurses should be interested in the nursing research, but not as a part of their normal duties which they have in their workplace. For a development in the nursing field it is necessary to increase a further awareness of the nursing research and to encourage the nurses so that they should be interested to conduct this research. Results of the survey will be sent to the primary nurses/directors of the nursing in all of the addressed medical facilities. They may also serve as a basis for further research investigations. The lecture on the topic: ?The importance of the nursing research in the nurse´s work? will serve to raise the awareness of the nursing research.

No description available.

The National Health Service (NHS) continues to go through a period of considerable transition as health services change to meet the needs of a 21st century population. Staff are acknowledged as key to such processes. Staff well-being is a key concept in organisational change literature. For example, levels of staff well-being can be used to measure the success of organisational change. Existing literature has established that a number of different features of change are associated with staff well-being such as levels of control and demand, and social support. The study presented here extends these relationships to focus on how and why staff well-being is influenced during organisational transition. An ethnographic approach was used to observe two surgical units, both of which were undertaking transitions by relocating to new purpose-built facilities. Findings are arranged around three different themes and within each theme a number of aspects of the change were found to be driving effects on well-being: 1) information and communication during transition: the extent to which change-related communications were consultative/participatory, well-scheduled, transparent and incorporated job-related technical information; 2) the nature of the transition: working with ‘unsuitable’ patients, working in restrictive and disconnected work spaces and the fast-paced nature of work; 3) the impact of the transition on social relationships: the presence of support structures and changes to team dynamics. This investigation contributes to improving understanding of what affects staff well-being during change. A number recommendations for best practice are subsequently formulated.

Thesis (Ph. D.) -- University of Western Sydney, Hawkesbury, 2000. / Includes bibliographical references (leaves 211-238).

No description available.