Perceptions of first line nurse managers : managing within a climate of fiscal restraint

The purpose of this study was to examine the perceptions of first line nurse managers of managing within a climate of fiscal restraint. The literature indicates that the first line nurse manager's role continues to evolve; it is increasing in accountability and responsibility, particularly in the area of financial responsibility. As well, first line nurse managers strongly influence the quality of care that is delivered in Canadian hospitals. They have the responsibility of ensuring that patients receive high quality care delivered in a cost effective manner. This study is part of a larger study by Acorn and Crawford (1995) in which data were collected through a survey completed by 200 first line nurse managers in 38 acute care hospitals in British Columbia. In this study, a descriptive exploratory design was used to examine the perceptions of nurse managers. Focus groups were conducted to validate the data collected by the open-ended questions in the Acorn and Crawford study, as well as to further explore the perceptions of first line nurse managers of managing within a climate of fiscal restraint. These data were then analyzed using content analysis. Data were first coded, then organized under categories from which themes emerged. The major themes that emerged from the data were; enormity of change, impact of change, and the management of change. The enormity of change resulted from health care reform, decentralization of decision making, increase in accountability and responsibility of first line nurse managers, and changes to the delivery of patient care. The impact of change increased the workload of first line nurse managers, contributed to less effective communication in the facilities and resulted in uncertainty about their future role in health care. First line nurse managers used several strategies to control costs and obtain technological and administrative support. In summary, the health care industry in Canada is rapidly changing and increasing in complexity, creating major challenges for first line nurse managers in meeting the standards for quality patient care. The implications of the findings for administrative nursing practice, nursing education, nursing research, and hospital administrators are presented.Applied Science, Faculty ofNursing, School ofGraduat