The present study was undertaken to identify elements needed for nurses to become involved in various levels of decision making processes as members of an organization through analyzing the activities of nurses serving as the vice presidents of hospitals. The study involved 8 nurses serving as the vice presidents of hospitals who cooperated with our network sampling. Data on their activities in the decision-making processes of their hospitals were collected by semi-structured interview and were analyzed in a qualitative inductive manner. The study revealed 11 categories of vice president nurse activities in policy planning processes, including "collection of objective data to confirm the intentions of employees," "setting clear numerical goals and deadlines for realization of policies" and so on. During policy adopting processes, 5 categories of activities were extracted, including "promotion of understanding of the proposed policy by members of the decision making team through presentation of objective data", "presentation of the necessity of the policy during decision making meetings" and so on. Analysis of these activities allowed us to isolate the following elements necessary for nurses to become involved in decision making. The elements needed in the policy planning processes were "setting goals and deadlines on the basis of data", "devising concrete plans, incorporating proposals from employees", "adequate adjustment and coordination to reach consensus", "requesting cooperation of competent personnel in an appropriate way", "presentation of clear views and holding negotiations towards authorization of the second best plan" and "active exploration of related information." The elements indispensable for policy making processes were "persuading the conference members through explanation of the policy's usefulness", "determining the human resources to be involved in the policy" and "acquisition of roles and positions."

The purpose of this study was to clarify the actual situation of discharge planning observed by head nurses in acute-care hospitals.

The subjects of this study were 10 head nurses in a prefecture. Each of the hospitals where the nurses work has more than 300 beds and the ratio of 10:1 official patient to nurse. The individual subject had been given a semi-structured interview, and content analysis of data was done. The following results were indexed according to 12 categories. The structure consisting of the above 12 categories revealed the properties of discharge planning in acute-care hospitals., which involved taking account of "Bed control", making "A plan for early discharge at the time of patient admission", obtaining "The cooperation of all concerned persons", "Promoting decision making by the patient/family", and considering "The need for patient/family supports on discharge", "The opportunity to discharge" and "Risks after discharge". In addition, the head nurses who are "Dependable", while giving the feedback of "The achievement of discharge planning support"indicated some ongoing issues such as "Incomplete discharge planning", "Difficulty in delegating to the staff"and "The future education of the staff".

This paper suggests that a new system needs to start, the system in which every individual involved share, patient information timely and cooperate well in discharge planning to bring patient and family satisfaction.

The focus of this study is the development of a "Self-Assessment Inventory of Leadership role for staff nurses" (SAIL), and appreciation of a staff nurse's leadership practice by the statistical examination. Leadership role means a process whereby a person who is a nurse as advocator effects the actions of others (patient/ family, team members) at the direct care to provide patient-centered care.

Sixty-two questions were presented to 275 nurses, with responses given on a 5-point Likert scale. Of the 275 respondents, 82.9 % yielded valid responses. After an item analysis of responses, 51 items were selected, for further analysis using the maximum-likelihood method (with promax rotations). The result yielded five factors for 20 items. The first factor (=F) was labeled as "The sharing of a common goal with patients"; the second F as "Self-realization of the importance of relationship building with the patient"; the third F as "Providing flexible care services"; the fourth F as "Interdisciplinary collaboration"; and the fifth F as "Sense of professionalism and willingness to provide the best possible care." The accumulated contribution rate was 52.16%.

The reliability of the SAIL was confirmed from the split-half and subscales of 0.73- 0.83, as the Cronbach alpha coefficient showed 0.90 and the Spearman-Brown coefficient was 0.83. The construct validity was confirmed, as the relation between the five factors nearly matched the suppositional leadership categories. The criterion-related validity was also confirmed as the correlation coefficient between the SAIL and Johnson's Inventory of leadership practices showed a strong relation (r=0.81(p<0.01)). The content validity was confirmed by clinical nurse and nursing teacher views of the SAIL. The discriminate validity was confirmed as well, as the nursing performance abilities of nurses in the SAIL was distinctive.

The score of the SAIL indicates that leadership role of the nurse is not sufficient for the patient/ family and improvement is required in a clinical situation. It seems, therefore, that future investigation should focus on training and strategy for leadership role of the nurse.

Aim

To clarify the competency of nursing administrators who demonstrate as action required in the medical institution which introduced the Private Financial Initiative (PFI) and accomplished business environment change.

Methods

The duration of research was October 2006~March 2007. Data was collected for one director of hospital, secretary general, and eight nurse administrators (top-level: one director of nursing, two subdirector of nursing, middle-level: three nurse managers, lower-level: two chief managers) from a hospital demonstrated by Private Financial Initiative (PFI) in Japan through the semi-structured interviews which referring to the Spencer's behavior event interview method.

The results of interviews regarding behavior to overcome the business environment change such as PFI were analyzed in order to classify the categories and develop the competency dictionary. After that nursing administrator's competency model was check in group discussion in order to confirm the result.

Result

1)The common essential competency of nursing administrators was same as Spencer's competency. "flexibility and situation adaptation" and "negotiation power and explanation capability" are not only included in the Spencer's competency, but also important competency to deal with the business environment change such as PFI

2)Each nursing administrators' level has different essential competency as PFI was introducing. The top level requests the "gathering information" and "conceptual thinking". The middle level needs "achievement", "analytical thinking", and "flexibility and situation adaptation". The lower level emphasized the essential competency as "achievement", "human development", "gathering information", and "flexibility and situation adaptation".

Conclusion

The essential nursing administrators' competency in order to overcome the business environment change such as PFI was identified. Furthermore, each level of nursing administrators' competency has different important competency. This result may put to practical use for the hospitals which are going to introducing the PFI through electing the nursing administrators possessing of competency we clarified and human development.

The purpose of this study is to clarify the factors which influence the desire of new graduates to continue nursing, and examine the support resources available to them. New graduates were interviewed, and the interviews transcribed, seven months after having started working. The interviews were then examined in order to understand the factors which influence the desire of them to continue in the field, and the support resources available to them.

As a result, the factors which influence the desire of them to continue nursing were as follows: ① A distrust of the reality and the future, ② A interplay between resignation and continue nursing, ③ The ability to make growing power as a result of ascertaining the reality. The available support resources were that the senior nurses accepted the puzzle of them concerning lack of the practice ability and feeling a mental factor, and urged to convert them into advanced power. From their relations, new graduates acquired materials to advance to their own painful experiences, and found the meaning of the process and the obtained value newly.

The purpose of this study was to examine the possibility of reducing the burnout of nurse managers by assertiveness training.

The nurse managers in university hospitals were asked to fill in a questionnaire just before and three months after the assertiveness training. The questionnaire included questions about demographic attributes, workplace satisfaction, transfer preference, stress coping, thoughts on their work, assertiveness (Japanese version of the Rathus Assertiveness Schedule:J-RAS), and burnout (Maslach Burnout Inventory:MBI).

A total of 77 respondents (15 head nurses, 62 sub-head nurses) provided valid data for analysis. The pre-intervention averages of age, J-RAS, and MBI were 40.9, -5.0, and 10.8, respectively. For total data, t-tests detected a tendency of increase for J-RAS and a significant decrease for MBI. The stratified examinations showed that J-RAS increased significantly, or tended to increase, and MBI reduced significantly among those who had low pre-intervention J-RAS and those who intended to keep assertiveness after the training. The same tendencies, partly with statistical significance, were observed among those who were unsatisfied with their workplace or own care and those who could not consult with fellow workers, the boss, or any other persons in their workplace.

The results showed that the assertiveness training could reduce burnout of nurse managers. The reduction was apparent among persons who intended to keep assertiveness after the training, and those with low pre-intervention J-RAS. The reduction of burnout was also observed among those who lacked social support.

The purpose of this study was to examine how factors involved in the structure (time spent for training and budgets) and process (evaluation of practical nursing skills and goal management) of hospital education affect the achievements (recruitment and turnover rates, self-efficacy, and autonomy of nurses).

We obtained consent from 33 hospitals in Prefecture A, and conducted a questionnaire survey, including 653 new nurses and 794 in their fourth or fifth year.

1. Correlations were observed between the recruitment rate and total amount of time for hospital education or educational costs per person.

2. We performed a multiple regression analysis, with turnover and recruitment rates as dependent variables, and the factors associated with the structure and process of hospital education as independent variables. The educational costs per person and implementation of goal management and nursing skill time markedly influenced turnover rates.

3. Nurses in their first year cited commuting convenience and established hospital education as the reason for their choice of the hospital. Nurses who were provided with orientation training by teachers specialized in hospital education showed a higher level of satisfaction.

4. We performed a logistic regression analysis to examine the relationship between the group of nurses with four to five years of experience who were satisfied with hospital education, those not satisfied with it, and its structure and process. Goal management, one of the factors, was associated with their levels of satisfaction with hospital education.

5. No association was found between nurses' autonomy or their sense of self-efficacy and the structure and process of hospital education.

The results demonstrated that improvement in the structure and process of hospital education contributes to ensuring a sufficient number of nurses and their desire to remain working.

The present study investigated the relationship between staff nurses' perceptions of leadership behaviors including transformational leadership performed by nurse managers and motivation for working of staff nurses. Data on the perceptions about leadership behaviors performed by nurse managers and motivation for working of 273 staff nurses working at one hospital were collected using questionnaire. The reliability of the scales of leadership behaviors was maintained with Cronbach' s alphas above 0.8. The internal consistency of the scales of motivation for working was examined using factor analysis, and the reliability of the scales was measured (Cronbach's alphas ranging from 0.747 to 0.942). Significant correlation was observed between the perceptions of leadership behaviors and those of motivation for working. Particularly, "individualized consideration" of transformational leadership had relatively strong positive correlation with all items of motivation for working. The results imply that the transformational leadership behaviors performed by nurse managers are effective in nursing.

The purpose of this study was to clarify the characteristic of nurses in mid-career and to understand the present circumstances of their professional development in Japan.

A literature review for the period of 1995 to 2005 was performed using electronic database (Ichushi), using the following key phrase: mid-career nurse/s. Thirty-two research articles , thirty-three practical reports and two journals were reviewed.

Results indicated there was no standardized definition of nurses in mid-career. Many researchers described it using years of clinical experience or positions. However, five years of clinical experience was included in most definitions.

The characteristic of nurses in mid-career were summarized by three aspects: their ability, problems, and factors which foster their development. It appears that nurses in mid-career have higher nursing abilities compared to younger nurses and degree of their ability development varied. Also they have many conflicts.

A variety of professional development programs for mid-career nurses including human resource management programs were reported. Many programs included two components; experiential learning and reflection about self and work place.

The author considered professional development programs for mid-career nurses should aim to foster abilities to perform expected roles such as leadership, to develop their career on their own initiative, and to overcome conflicts. In addition, the programs should include opportunities for mid-career nurses to receive recognitions from others.

When the roles of nurses are discussed, it is essential to consider perspectives of patients, who take health care while participate in and form it. Therefore it is important for those who engage in nursing to know the expectations patients have for health care and nurses. This literature review was conducted to identify a trend and the findings of previous studies about expectations of patients for nurses and nursing at a hospital in Japan.

Ichushi-Web was searched for studies which investigated on patients' expectations and published between 1983 and 2008, so that 43 articles turned up. Most of them were issues of recent years. Thirtyone articles described specific expectations for nurses or nursing such as a specific care, behavior and patients. Several studies used Likert scale, but any did not identify which item had relative importance.

Studies which investigated expectations for whole of nurses' practice were chosen and contents of patients' expectations were examined mainly on four studies that matched criteria for minute examination. As a result, elements concerned with technical components and with interpersonal relationships emerged. However there were few arguments over what technical elements meant. It is necessary for nursing education and career development to look into that more concretely. In addition, both nurses' practices as a team performance and function in health care were hardly mentioned in patients' expectations. Other research approaches to the expectations are required to grasp them about such roles and functions.