ABSTRACT
Skills and spirit must be blended in nursing, and much evidence indicates that today’s challenges threaten to overwhelm coping competencies and resources. Can efficiency be increased, and can care-giving costs be stabilized or decreased in a patient-centered mode, without diminishing the quality of nursing services and also without rubbing nurses emotionally raw? This chapter justifies optimism about an affirmative working answer to this question by responding to ubiquitous role problems in nursing, while reducing costs and enhancing the quality of nursing performance as perceived by major stakeholders-patients, their families, nurses, and physicians.* The major interventions are well known in Organization Development, or OD; large-scale surveys; actionplanning with a design group; developing supportive norms and interpersonal processes; and redesigning the structure and policies/procedures as well as interaction in a specific worksite. Such emphases qualify the interventions as broadly socio-technical. The positive results are especially attractive because they derive from a setting that was initially in decent shape before interventions began.
