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)-funded Outcomes Research in Nursing Administration Project (ORNA). BACKGROUND: The ORNA project examines the impact of nursing unit organizational structure on outcomes. The information reported in this article amplifies the quantitative data with qualitative data that enhances understanding 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 implications. 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 care environment as turbulent and uncertain. Contributing factors include: 1) work load (fluctuating census, staff preparation, turnover); 2) loss of workplace identity (unit consolidation, hospital buy-outs, and system mergers); and 3) re-engineering (skill mix, new equipment/system changes, new documentation systems, rumored changes). CONCLUSIONS: This study adds to the growing body of literature that portrays environmental uncertainty from the narrative perspective. Although there is an ongoing need for the employment of fiscally accountable, quality enhancing organizational/management strategies, all initiatives are at risk unless personnel needs are attended to and seen as unique in each care setting. Some strategies are offered to meet this dual imperative.