Retooling the nurse executive for 21st century practice: decision support systems.

Health care financing and care delivery systems are changing at almost warp speed. This requires new responses and new capabilities from contemporary nurse executives and calls for new approaches to the preparation of the next generation of nursing leaders. The premise of this article is that, in these highly unstable environments, the nurse executive faces the need to make high-impact decisions in relatively short time frames. A standardized process for objective decision making becomes essential. This article describes that process.

Forging today's practice-academic link: a new era for nursing leadership.

In rapidly evolving health care scenarios, it is more essential than ever to have nursing viewed as a profession that has its clinical practice and academic arms united. It is necessary to keep schools of nursing entwined with what is evolving clinically and to keep clinical nurses closely involved with trends and issues in contemporary nursing education. To address this need, top nursing leadership must point the way. This article details one such model that was developed at Johns Hopkins, linking the service and education activities through the Institute for Johns Hopkins Nursing, a vehicle created for this purpose. Both sides shared a vision, both sides contributed willingly, and both have realized positive returns.

Nursing leadership for the new millennium. Essential knowledge & skills.

The major plenary sessions at the NLN 24th Biennial Convention in Miami Beach, Florida, addressed the subject of leadership as an important component of the convention's theme--The Nursing Renaissance: New Ways of Being, Learning, and Leading. Dr. Maryann F. Fralic spoke to the essential knowledge and skills of nursing leaders.

Redesigned nursing practice: a case management model for critical care.

Changes within the health care system necessitate changes in nursing practice. Given the financial environment and the need to balance the cost/quality equation, case management will become increasingly important and has the potential to become the predominant care delivery system of the 1990s. This transition represents a tremendous opportunity for nursing. The CCM role offers many potential advantages and benefits for individual nurses and the profession as a whole. Nurses practicing as case managers have the opportunity to function in a highly professional, independent manner with a great deal of interdisciplinary collaboration. In addition to the challenges and satisfactions of the work itself, the nurse case manager may also enjoy a higher salary and more scheduling control and flexibility. The broader advantages of case management include its benefits to patients and institutions and its fit with current trends in the health care environment. Nurse case managers manage hospital systems to produce optimal clinical outcomes for patients in the shortest time using as few resources as possible. This approach to care delivery places nurses in a position to demonstrate the tremendous contribution they can make to achieving the institution's goal of delivering high-quality, cost-effective care. Thus, case management fits extremely well with current trends in health care financing and outcome measurement. The model described in this article illustrates one approach to implementing these important concepts in a critical care setting.

Nurse executive practice--into the next millennium: from limbo dancer to pole vaulter.

Nurse executives, administrators, and managers are constantly being challenged by the changes in healthcare. Although it sometimes seems there is really nothing new, proactive visionary nurse administrators can rediscover, redesign, and redirect their own and others' activities to achieve organizational effectiveness. Such approaches require periodic examination of all strategies and practices--past, present, and future--for their relevance, practicality, and success. The editors of "Executive Development" reflect on topics important to organizational life.

Nursing practice in the next decade: the impact on nursing and pharmacy systems.

Nursing practice in the year 2000 will occur within more regulated health care systems, with a much higher focus on the cost and the quality of the service that is delivered. Patients will have more complex illnesses and treatment regimens that will require that nurses have appropriate levels of education, experience, and clinical specialization. The nursing work force will change in its nature, cost, and composition. Nurses will operate in flatter organizations and within productive multiprofessional and technical work groups that operate as flexible, self-directed teams. New clinical practice models will be operational, and they will be adapted to the unique work and environment of each patient care unit. Practice will be restructured to incorporate clinical and nonclinical support. Work redesign and restructured practice environments will be essential to meeting the requirements for the future. Patients with complicated illnesses will continue to move through hospital systems at high speeds. Treatment regimens will be extremely complex. The requirement will be to emphasize high-quality and affordable care, while minimizing errors and complications. Technology will provide new challenges, new excitement, new dilemmas, and new demands. The ethical dimensions of care will become ever more challenging. The pharmacological aspects of treatment will gain in prominence. Mutual respect and mutual support will be the hallmarks of the nursing and pharmacy interface in the year 2000.