The first study reviewed looked at the "effect of patient-focused redesign on mid level nurse managers' role responsibilities and perceptions of work environment (Ingersoll, 1999, p. 21). The study was chosen because patient-focused redesign models are becoming increasingly popular and little research has been conducted regarding the results of these models on nurse leaders / managers . A review of published studies of Patient-Focused Redesign (PFR) suggests that models differ across institutions and that findings are preliminary and measure short-term effect only. Management theory is notably absent from the reports, and the extent of implementation of PFR principles differs according to the needs of the organization, the scope of services provided, and the resources available (Ingersoll, 1999, p. 22).

The study occurred at two tertiary hospitals in the Midwest. They selected nine mid level nurse managers for the study. Between 9 and 12 months after completion of PDR the subjects were interviewed for 60-90 minutes each regarding their perceptions of the effect of redesign on their roles and responsibilities. In addition, they were asked about their challenges as an administrator. Feelings reported by the nurses managers included frustration and inadequacy.

They mentioned numerous role behavior changes. The primary role behavior changes mentioned were "the need to measure and manage outcomes; the need to better understand the financial situation of the organization and the external factors that influence it; the need for high-level team-building skills; and the ability to manage rapid and dramatic change" (Ingersoll, 1999, p. 23). Overall, role confusion appeared to be the major issue for these nurse managers. The findings of this study show that regardless of how prepared the nurse managers were they still struggled to keep up with the demands of changes such as this. The study stressed the importance of providing support for managers facing situations such as these.

It concluded that "early involvement in decision making and formal opportunities to develop their skills as managers will maximize the potential for successful role readjustment in this highly committed and absolutely essential member of the administrative team" (Ingersoll, 1999, p. 27). The results of this study could have a significant impact on leadership and management. It is made clear that the mid level nurse managers often feel role strain when involved in something that requires a major change throughout the organization, such as PFR. These kinds of changes can be seen in health care organizations everywhere. They often feel like they are being put in the middle between higher administrators and their nursing staff.

This can cause them to feel isolated. In addition, they felt that their roles were not clearly defined. All of these things strongly suggest that more clearly defined roles, readily available resources for the managers and support groups would make their position in changes such as these less stressful and that the transition would flow smoother. If these efforts were taken, nursing leadership and management could be strengthened.

The second study reviewed took place in Sweden and looked at the effect that a professional development course would have on the role of a nurse manager over time. The course selected for the study was a professional development course in advanced nursing at the masters-degree level. The course took 2 years of part-time study. A few of the topics covered in the course were leadership, ethics, and quality assurance. A total of 15 nurse managers, 14 women and 1 man, attended the course; 12 women and 1 man successfully completed it. They all served in managerial positions on various levels in public or private healthcare organizations and were recruited from all over the country.

Some of the nurse managers had attended various courses in management and administration previously, but not at degree level (Lindholm, 1999, p. 50). Conducting interviews with the nurse managers collected the data for this study. They were interviewed twice.

The first interview was done at the start of the course and the second interview was done one year after the course was completed. According to the results of the study, the nurse managers did not see the course as a requirement for nurse management positions; however, they did state that the course had many positive effects on them. Some of these were, a gained theoretical knowledge and an increased knowledge about nursing research. This knowledge gain increased their self-confidence. They felt that the course served to help them with the implementation of their current management skills as opposed to helping them problem solve specific management situations. A highly appreciated side effect of the course was the development of a network of course members; all nurse managers from all over the country.

This study demonstrated the value in gathering one professional group with similar professional demands and needs, and through increased knowledge, strengthening their managerial identity and creating opportunities for collegial support and common growth (Lindholm, 1999, p. 55). Overall, the study showed that the professional development course had a positive effect on their leadership and management. As discussed in the previous study, the development of a support group is noted in this study as having the most positive side effect on the subjects. More programs, such as the one discussed in this study, are being developed due to the increased demand for further professional development. The development and implementation of these courses could have a positive effect on leadership and management in nursing as a whole, by not only increasing their knowledge in this area, but also by creating more support networks for the managers.

The third study reviewed took place in Canada. Its purpose was to "test a model linking specific leader-empowering behaviors to staff nurse perceptions of workplace empowerment, occupational stress, and work effectiveness" (Laschinger, 1999, p. 28). The study was evaluating the importance and effect of a nurse manager's leadership behaviors on staff nurses during a time of change within the organization. "It was hypothesized that leader behaviors have an impact on the way employees experience empowerment in their work setting" (Laschinger, 1999, p.

32). It is thought that the more power employees have the less job tension they experience, consequently having a positive effect on their work effectiveness. The method of the study included a survey of 606 staff nurses. Out of the 606 subjects selected, 537 questionnaires were returned, of which 94% were from women. Most of the respondents were diploma prepared (83. 6%).

Graduates of baccalaureate programs accounted for 15. 2% of the respondents. The data from the questionnaires were analyzed using structural equation modeling techniques. The results of this study supported the hypothesis. "Staff nurses in this study clearly believed that their sense of workplace empowerment and job tension and judgments of their ability to get their work done was related to their managers' use of empowering behaviors" (Laschinger, 1999, p.

37). These findings suggest that staff members perceive themselves to be empowered when their leaders provide purpose and meaning to their work and help them understand the importance of their role in the organization, solicit their participation in decision-making processes, enhance their skills, provide the resources required for effective performance, show confidence in their ability to perform at a high level, and promote autonomous practice by removing "red tape" These findings highlight the importance of leadership behaviors in structuring work environment to empower employees (Laschinger, 1999, p. 37). In conclusion, this study reinforces how important a strong leader is in creating the optimal environmental conditions for work effectiveness. By showing the importance of a strong leader / manager this study can greatly impact nursing leadership and management.

It has been noted that managers often struggle with role strain and confusion. This study reinforces the importance of a strong leader / facilitator . These results could have a positive effect on the self-confidence of managers struggling with this. In addition, the results of this study back up the strong evidence of the importance and the value of support groups for nurse managers.

In order for them to be strong leaders they must have support and resources, in addition to their knowledge and this is one main function of support groups. In all, it appears that throughout all of these studies the importance of support groups for nurse leaders and managers has been stressed. With all of these finding we continue to see that common element among each one and the formulation of support groups of this nature could definitely have an impact on the future of nursing management and leadership. References Ingersoll, G. , Cook, J.

, Fogel, S. , Applegate, M. , Frank, B. (1999).

The Effect of Patient-Focused Redesign on Mid level Nurse Managers' Role Responsibilities and Work Environment. Journal of Nursing Administration, 29. 21-27. Laschinger, H.

, Wong, C. , McMahon, L. , Kaufmann, C. (1999). Leader Behavior Impact on Staff Nurse Empowerment, Job Tension, and Work Effectiveness. Journal of Nursing Administration, 29.

28-38. Lindholm, M. , Ude n, G. (1999).

Influence of Nursing Management Education on Management Direction and Role. Journal of Nursing Administration, 29. 49-55.