Abstract
Global economic changes, managed care and insurance issues, media forces, and new career choices for women have impacted the profession of nursing. A loss of trust underscores decreased loyalty to hospital organizations and disillusionment with nursing practice. Nursing shortages have ensued. This article reports data from a grounded theory study of nursing in hospital organizations. Strategies of respecting, communicating, maintaining visibility, and engaging in participative decision making are the transformative processes leading to relational self-organization-a shared, creative response to a continuously changing and interconnected work environment. Organizations that foster ethical choices, respect, and co-creativity rather than focusing only on fiscal and material assets become the successful organizations of the future.