| Environment is critical for the practice of nursing. Leadership in design and management of the work environment is core to the practice of nursing administration. This study describes changes in one hospital's work environment over a fourteen year period. The research design is an embedded single case study incorporating story as narrative and as a source of evidence. Specific aims of the research were to explain how organizational change came about, to identify the meaning of organizational change for nurses who have been employed in the hospital throughout this time period and to "create insights that resonate" (Morgan, 1992).;Interviews were conducted with twenty-one participants including nurse managers, advanced practice nurses, clinical staff nurses, physicians and community observers. Data were collected through taped interviews eliciting anecdotes and stories of personal experiences during the study period. The tape-recorded interviews were transcribed and analyzed to recreate the story of organizational change and to uncover thematic findings. Data analysis revealed an evolution of the organization which was told in a story written by the researcher. This story begins with revolution as nurses demanded input in the selection of their leader. The story ends with nurses actively participating in patient care decisions, and in hospital planning. Nurses were instrumental in shaping their work environment and are concerned with the uncertainty of the future and potential impact on this environment.;Thematic findings included environment, community, knowing, caring, autonomy, self-organization, values and future. An emerging conceptual framework based on thematic findings is presented: A work environment that promotes professional growth and development is characterized by a sense of community where nurses know and are recognized. The establishment of a professional nursing community is facilitated by the development of autonomy, caring, self-organization and consistent overriding values. This work environment is threatened by the uncertainty of the future and the current health care environment. |
