Increasing nurse first-line leader (manager) positions to improve nurse retention and quality of patient care

Nurses' job action during the spring and summer 2001 taught us much in British Columbia. Post job action de-briefing with non-contract staff confirmed for the Capital Health Region in Victoria that the workload of patient care managers, along with their scope of responsibility was contributing to dissatisfaction, both on the part of patient care managers as well as nursing staff who they are intended to serve. Further, it was becoming increasingly apparent that the success of most of the organizational initiatives depended greatly on the presence, availability and support of patient care managers. Supported by the senior leadership team, the Chief Nursing Officer for the Capital Health Region agreed to have a look at unit based leadership--see what was being discussed across the country and in the literature and draw on her own experience in three provinces. The result would be a discussion paper that would circulate broadly throughout the organization and would provide the organization with broad input to help it decide collectively "What do we need to do? Where do we need to go from here? And how will we get there?" This article is an adaptation of that discussion paper.