The nurse manager's work in the hospital environment during the 1990s and 2000s: responsibility, accountability and expertise in nursing leadership

AIM: The aim of the study was to describe and compare the characteristics of the nurse manager's work in different hospital environments and at different times. BACKGROUND: Business values and pressures for cost efficiency have become a reality in health care. METHOD: The data comprised the diaries of 155 nurse managers working in one Finnish health district's hospitals in the 1990s and 2000s. In addition, focus group interviews were used as a data source. The data were subjected to qualitative and quantitative content analysis. RESULTS: The nurse manager's work comprises responsibility activities, accountability activities, and traditional bedside nursing. They also described the recognition of the underlying premises of their work and outcome orientation. Their descriptions of work varied between university and rural hospitals, between psychiatric and somatic nursing and between different wards. The work changed in the 2000s as the nurse manager's role changed from nurse to nurse leader. CONCLUSION: It appears that nurse managers have succeeded in integrating different leadership models into their daily work pattern. IMPLICATIONS FOR NURSING MANAGEMENT: A new leadership model was devised based on an emerging nursing framework. Nurse leaders should assess who can assume leadership positions in health care and on what grounds.