Orientational research into dismissed managers in health care.

The importance of the competence of managers is illustrated by findings of provisional research conducted on the failure of managers in health care (15 case studies of dismissed managers in hospitals, nursing homes, and convalescent homes). The first guarded conclusion that may be drawn from the preliminary study is that, as a rule, the dismissal is based on the attitude and competence of the manager ("software") and not on business expertise or technical skill ("hardware"). It could be said that the manager in health care is judged more on the process than the results.

Coping strategies of enrolled nurses in nursing homes: shifting between organizational imperatives and residents' needs.

In today's nursing homes, which can be considered modern versions of "total institutions", enrolled nurses expend much energy coping with problems which arise from the day-to-day care of seriously impaired patients. The problems they encounter include the burden of never ending work, having to cope with deviant and problematic behaviour, handling emotional disturbance and, on a more abstract level, balancing self-interest and power with love and affection. The grounded theory approach was used to discover the coping strategies employed by enrolled nurses. On the criterium of favouring either organizational imperatives or residents' needs, six strategies were differentiated, and placed into one of two categories. The discovery during research of two distinct nursing teams, each inclining towards the strategies available within one of these two categories, not only has important theoretical implications, but also practical consequences for the training of student nurses, the labour market and the quality of care.

Communication climate and patient care: causes and effects of nurses' attitudes to patients.

This article deals with the effects to be expected from improvements in the communication among nurses on the ward. It is often assumed that both nurses and patients would profit from these improvements. The patients would experience fewer problems during their stay on the ward. However, the empirical data from a study in Dutch hospitals indicates that there is little reason to be optimistic about the effects on patients. Research findings show that hardly any link was found between the communication climate on the ward and the nurses' attitudes to patients. A clear link was found, however, between the extent to which the nurses experienced problems with the physicians and the hospital management, and the extent to which they had a negative attitude to the patients (problem shifting). In the last section, some consequences of the findings for the improvement of patient care are discussed.