There was no relationship between demografpgic variables and responses concerning preparation of nurse managers for the entry

level management position.The only demographic characteristic significantly related to preparation for a mid-level position was number of years that the respondent was in a current position.The fewer the years in a current position,the more likely a masters degree in nursing was recommended as the appropriate preparation for a mid level management position.Respondents who were in their current position from 7 to 15 years were more likely to believe that experience was the most important qualifier to prepare for an intermediet level management position. Several demographic variables were significantly related to responses concerning the preparation for the nurse executive position.Both the highest level of edication attained by the respondents and the teaching status of their hospital were related to that dependent variable.in general,respondents were most likely to suggest that the best preparationfor the executive position should be the level of edication that they had received themselves :those with doctorates recommended a doctoral degree ,those with nonnursing masters degree suggested nonnursing masters degree, and those with a masters degree in nursing or dual degree was best.The exception to this trend was indicated by those who held a diploma or an undergraduate degree.Respondents who held a baccalaureate degree advised a masters degree in nursing for the best preparation.Participants with a diploma or an associate degree stated that the nonnursing masters degree provided the best preparation.Respondents employed by teaching institutions were more likely to select the bestacademic preparation for the nurse executive to be the masters degree in nursing or a dual degree.Whereas those employed by other types of fasilities were divided as to the best preparation ,indicating responses that were distributed equally among numerouse types of graduate program to prepare nurse executive. Three demographic variables were significantly related to type and amount of advanced clinical content indicated as being essential for the nursing administration position.On variable was related to the entry level and two were related to the executive level.Bed size of the employing organization was significantly related to advanced clinical countet needed for the respondents and their highest education level were related to advanced clinical countent for the nurse executive.Nurse executive employed in smaller hospitals were significantly more likely to state that advanced clinical content is not needed for the entry level position.Respondents froom small hospitals who indicated that it was necessary beleived that advanced clinical content should be obtained through certification.Respondents from hospitals with over 600 beds were significantly

more likely to state that the nurse execitive should have advanced clinical knowledge and that clinical experience should be the primary mothod for obtaining the content. The most frequen response by all age-groups was that no advanced clinical content was needed for the nurse executive.However ,respondents from age 45 to 49 were more likrly to indicate certification,and subjects over the age of 50 were more likely to suggest doctoral education as means to attain advanced clinical content.Those respondents with associate,baccalaureate ,or masters degree were significantly more likely to indicate that no advanced academic clinical content was needed for the nurse executive ,whereas subjects with a doctoral degree were more likely to state that the nurse executive needed significant clinical experience or doctoral level clinical content for an advanced clinical knowledge base. DICUSSION The result of this study offer direction for nurse educators to refine and develop further programs in nursing administration .Role theory suggests that expectations for varios aspects of the management role differ with different levels in nursing administration (biddle,1986).The needs for academic preparation vary just as roles differ .Respondents in this study believe the appropriation for an entry level management position is the baccalaureate degree in nursing.At the mid-level positions,the masters degree in nursing degree was recommended as the type of program that besy prepared nurses for the management role. The discipline of nursing administration was suggested more often as a major area for concentration than the clinical area. However ,this finding must be placed in the context of this study .Nurse executives with less than 7 years in their current position advised that approach ,while nurse executives with 7to 15 years experience in their current position were convinced that experience was more impirtant than academic preparation.The seasoned nurse executives responses may reflect signifcant understanding and apprecation for role operationalization and the difficulty that some masters prepared nurses have in assuming and establishing a management role. Overall these results are consistent with the model proposed by Clelad (1984). For the nurse executive most of the respondents posited that the best academic preparation was the masters degree in nursing with a major in nursing administration .This finding must be interpreted with caution ,as both the education of the respondents and the size of their employing institution were related to their response.However,the differences concerning the need for a masters program rather than differences concerning the need for a masters program.

The findings regarding the best prepation are contrary to what is currently being considered by educators and practitioners.The current emphasis is that education for nursing administration should in clude a significant amount of content in business administration (Henry,1989).In spite of the excessive credit requirements,dual materss degrees-nursing and business administrationincreasingly are being considered for nurse executives .It would appear that the critical content and program most frequently advocate by the nurse executives in this study ,that is ,masters programs in nursing with a major area in nursing administration ,may effectively meet needs.The design and resources for such programs remain critical variables The findings concerming academic preparation suggest a great need for inclusion of management content in baccalaureate programs for nurses,to prepare them for entry level management positions.Clearly completion of a master's program in nursing is the appropriate academic preparation for amidlevel or executive management level position.Genereally thouse programs should have a major focus in nursing administration ;however ,the data do not clearly indicate this.For the mid-level manager.a clinical masters degree is very acceptable. The differentiation of management content for the varios positions suggests that there are diserete management roles in nursing administration.It apoears that preperetion for entry level management requires broad-based management knowledge.Decision making concernin budgets and personnel may be a prime facet of the mid-level management role.Significant authority and responsibility are inherent in the mid-level managerial role for many organization.The need was relistically identified for substantive content in the areas of finance and personnel management.However, the respondents total lack of mentioning leandership knowladge and shortterm planning ability, and minimal responses for problem-solving and desicion-making abilities for the mid-level management role should be of great concern.It is unkely that mid-level managers would obtain sufficient knowledge in those areas from broad-based content in a program to prepare entry level managers.Mid-level managers must fulfill major leadership role.Frequently they are the blendersamong staff nurses,entry level management ,and executive management in the corporate structure.Exceptional academic preparation for the role is vital. The role of the nurse executive is very different from other management roles in nursing administration.The role focus is specialized at the executive level.Extensive knowledge is required in content areas that nurses seldom have had the opportunity to access or acquire. Therein frequently lies the argument that nurse may be best prepared for that rule totallyin programs aside from the discipline of nursing. However,the data from this study do not support that belief. Indeed the findings suggest that the most effective nurse executive mmay be one who appropriately integrates

advanced nursing and management content within the confines of a nursing graduate program. The liaison and unification of nursing and management appear to be in demand and essential for optimum provision of quality care and success for departments of nursing administration. The findings concerning a liberal arts base were very unexpected. These findings are contrary to what is incresingly and commonly being advocated for baccaleureate nursing programs by educators. It is further dinconcerting that the nurse executives in this study cited no need of a liberal arts background for mid-level and executive management . It appears that these nurse executives place little value on a liberal arts education and they appear to place a higher value as indicated by the data on tasks and technical competence (see Table 57-2).Given nursings humanistic orientation, this finding is puzzling. The question should be addressed as to how nurse executives conceptualize or understand the benefits of a liberal arts education. The nurse executives in this study did not perceive advanced clinical content an essential for persons in entry level management positions.Because of increasing acuity of patients and complexity in needs for care ,this finding also was unexpected.However ,professional nurse who are in entry level management positions may be viewed as having extensive current clinical knowlwdge , either by virtue of being recent graduates from basic programs or because of ongoing experience in providing direct patient care. Experience is a variable that should have significant implications for and within graduate programs. IMPLICATIONS The type of management content to include in graduate programs for nursing administration has been a continuing concern to nurse educators. The findings of this study concerning the identification of critical content were similar to the results of other studies (Duffy &Gold.1980:Wgner et al..1988). A relevant aspeet of this study was that not only were content areas identified ,but a ranking of thir importance for diffferent nursing management levels was obtained. The findings do not support the idea that specific management content, such as leandership indicated for one management level of management ,Rather,it is assumed that programs should build one content for higher position levels that were first identified for a lower level management position.Furthermore the point is that each management level requires specific substantive knowledge to be focused on as content in an academic program. The content primarily addressed should be that deemed most critical and essential to a particular position. Consequently graduate programs for nursing administration wisely may elect to develop content focused for a specefic management role in nursig aadministration.

In summary , finance and communucation should be emphasized for all management levels, but in different depth. Clinical competenciec are particularly important for the entry and the midmanagement levels. While content that addreesses leadership, problem solving, and short-term planning are important primarily for the entry level position. Personnel management and public relations knoeledge and skill are needed predominantly at the mid-level positions.Long-range planning skills are critical for both mid-level and executive level management positions. Finally a broad health economics,regulation and reimbursement,and political acumen are highly desired for the nurse executive. The type and degree of advanced clinical content should vary according to the management positon. For both the entry and executive levels the normmay be that clinical content beyond the basic nursing edication is not needed. However, that norm should be adjusted for entry level management in certaint clinical areas such as intensive care. Advanced experience, masters degree content, or certification for clinical practice are recommended for the mid-management level.As for the other recommendation concerning academic preparation, the findings pertaining to advanceed clinical content for the nurse executive must be considered with cation. There were intervening variables that could not be controlled in this study. The preceding findings and discussion provide salient information about the content for nursing administrstion programs. However.the education process still needs to be further explored and developed. Adult learning theory (knowles,1980)postulates ideas concerning teaching and learning methodologies that may be applicable for graduate programs to prepare nurse managers and executives. This study did not generate a clear direction regarding processee for synthesizing nursing and management content. The suggestions of program flexibility,extensive practicum experiences, and personalized advisement are consistent with Knowlesstheory. Gifen the differences in academic and clinical content recommended by the nurse executives,preperetion for the varios nursing positions in nursing administrstion and proper counsel ,based on individual career goals and experience,would seemto be essential. Further study is warranted regarding the issues . Strategic assessment ,planning ,emplementation,and evalution concerning content critical in the practice of nursing administration and for programs educating nurse administrators must be an on going process. The challenge remains constant to explicate the academic clinical nursing and management knowledge and practice experience needed to prepare an effective nurse administrstor.

REFERENCES American Nurses Association (ana).(1978).Roles,responsibilities,and qualifications for nurse administrators.Kansas City,MO:Author. American Nurses Association (ANA).(1988).Standards for organized nursing services and responsibilities of nurse administrators across all settings.Kansas City, MO:Author Biddle,B.j (1979).Role theory :Expectations,identities,and behaviors.New York:AcademicnPress. Biddle,B.J(1986).Recent developments in role theory.In R.H. Turner&J.F.Short,Jr.(EDS.).Annual Review of Sociology,Vol.12 (pp.67-92).Palo Alto,CA: Annual Reviews Inc. Biddle,Bj,.&Thomas, E.j.(Eds.).(1979).Role the ory:Concepts and research.Hunington,NY:Robert E. Krieger Publishing Co. Blair,F.(1976).Needed:Nursing administration leaders.Nursing Outlook.24.550-554. Christman.L(1987).A view of the future .Nursing Outlook,35 .216-218. Cleland.V.(1984).An articuated model for preparing nursing administrators.Jurnal Of Nursing Administration.14(10),23-31 Conway.M.E.(1988).Theoritical apporoaches to the study of rules (2nd ed.),in M. Hardy &M.E.Conway (Eds)Role theory:Perspectives for health professinals (pp.63-72).St.louis:AppletonLange. Damewood.D.M.(1988).Targeting student learning at the critical skills of the middle manager .Journal Of Nursing Administration,18(3).6.38. Duffy,M.E.,&Gold,N.E(1980).Education for nursing administration:What invesment yieldest highest returns?Journal of Nursing Administration,17(7,8),35-38

EDITORS QUESTIONS FOR DISCUSSION Critique the study design,methodology,data analysis, and interpretation of the findings.How valid and reliable are the findings?What alternative explanations could be offered for the

findings?What are the strengths and limitations of the study ?What are critical issues where telephone interviews are the means of collecting data? What relationship exists between content suggested in this study and the preparation of nurses for the new manager and clinical roles in future delivery models as proposed by PorterOGrady (Chapter 51)?Design a curriculum for the preparation of nurse managers and executives based on findings of the Chaska and Alexanders study in this chapter and that conducted by Sides (Chapter 56).What strategis might be used to synthesize effectively nursing and management content in one curriculum for nurse administrators?Discuss the pros and cons of offering different programs for nursing administration. How might resources for nursing administration programs be more effectively ased or shared between universities?