Nurse executives' responses to the transition in acute care

Date of Award




Degree Name

Doctor of Philosophy (Ph.D.)



First Committee Member

Doris Ugarriza - Committee Chair


This qualitative study is an exploration of the demands imposed upon nurse executives and a description of their responses to fundamental changes in the health care delivery system. The study, which employs an inductive approach, is exploratory and descriptive in nature to gain insight into the behavior of nurse executives faced with health care reform.A purposive sample was used to capture the richness of a wide variety of perspectives. The technique of snowball sampling was used to broaden the sample and to identify respondents who were outside of an acute care system at the time of the study. Seventeen nurse executives were interviewed using open-ended questions to facilitate learning from the respondent's perspective. The process of content analysis refined the data that were collapsed into seventeen categories from which four domains emerged.A tree diagram was designed displaying the themes, domains and categories that are descriptive of the data. The four domains are (1) Feelings, (2) Relationships, (3) Roles, and (4) Strategies. The categories of Feelings are: (a) anger, (b) comfort, (c) frustration, (d) loneliness, and (e) loss. The categories of Relationships are: (a) CEO, (b) directors, (c) physicians, (d) peers, and (e) subordinates. The categories of Roles are: (a) advocate, (b) facilitator, (c) listener, and (d) visionary. The categories of Strategies are: (a) managing change, (b) staying in business, and (c) staying employed.Two themes emerged that captured all categories: (a) maintaining support, and (b) ongoing commitment. The support role encompassed looking out for others as well as themselves. The key recipient of their "support" was the patient. The nurse executives' commitment to the profession of nursing appears to be a significant factor contributing to the responses to their changing world. In addition to the commitment expressed, some of the nurse executives believed they had a "calling" to serve others.The attitude of today's nurse executive is positive as regards the role of a clinician in a position of authority. Key relationships that affect the ability of nursing and patient concerns to be advocated effectively are identified. The findings suggest that a broader base of education, one that includes clinical, as well as, business education is important at this time. Strategies that nurse executives can employ for personal and professional success are recommended. Further research into the volatile role of leadership in a dynamic, even tumultuous, health care field is warranted.


Health Sciences, Nursing; Health Sciences, Health Care Management

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