1. Kleinman, Carol S. PhD, RN, CNAA


Although they are responsible for the operation of business units, nurse managers are often less well prepared to manage the business activities than the clinical activities. Perceptions of nurse managers and nurse executives regarding competencies required for nursing management roles and the educational preparation required to attain them were examined. Results indicate the groups are in basic agreement about required competencies, though nurse managers appear less clear about nurse executive role responsibilities. Nurse executives value the acquisition of a master's degree as essential for nurse manager performance, while fewer nurse managers agree. Strategies nurse executives may employ to develop nurse manager business knowledge include traditional undergraduate and graduate degree programs, online programs, certificate programs, continuing education, inservice education offerings, seminars, and mentoring activities.


As healthcare has entered the new millennium, major changes have continued to influence the industry. Structural changes have moved from horizontal to vertical and even to virtual integration. Reimbursement changes have led to risk-based fixed-price financing and concerns about their effects on access, quality, and consumer satisfaction. Service delivery has shifted to population-based health and disease management across the continuum of care, made more effective and efficient by outcomes research. Advances in information systems and information technology have been dramatic. Future advances will occur to accommodate changing government regulations, changing vendor and supplier relations, e-health and Internet data transport, and the acquisition and integration of new business lines. Meanwhile, government's increasing role in health policy and regulation is competing with market-based reform efforts, adding to industry volatility.


The nursing profession has experienced tremendous changes since the mid-19th century. The domain of nursing knowledge has exploded, scope of practice has increased dramatically, and nursing roles exist that were unimaginable 50 years ago. The roles of the nurse manager and nurse executive have evolved significantly in response to changes in the healthcare industry in the last 20 years and, increasingly, characteristics for success in the marketplace are based on competencies that require sophisticated business knowledge and skills.