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As the link between a healthy workforce and better patient outcomes is becoming more evident, creating healthy and safe workplaces for health care providers is now a concern for many employers. While a safe work environment includes being exempt from aggression, workplace aggression continues to be identified as a serious problem by health care professionals. Notwithstanding the importance and obligation of addressing all types of workplace aggression and all groups of perpetrators, dealing with instances of intra/inter professional aggression is essential since this type of aggression is often insidious and can be more disturbing to the victim than any other type of aggression. While nurse managers were identified as playing a central role in the management of workplace aggression, it is not clear how they deal with instances of intra/inter professional aggression given their current work environment and working conditions. The purpose of this study is to broaden the understanding of how nurse managers respond to intra/inter professional workplace aggression. Based on a theoretical framework developed from the work of Girard, Foucault and Weber, this study focuses on aspects of the social/cultural work environment influencing nurse managers' responses to intra/inter professional aggression as well as strategies deployed by nurse managers to deal with such aggression. Using principles from critical nursing ethnography, the research was conducted in both a university affiliated psychiatric hospital and a community hospital located in a large metropolitan city in Ontario. Data collection included 23 semi-structured interviews, collection of mute evidence and observations. The major study findings are that 1) aggression management is a non linear process involving managing perceptions, emotions and the actual aggressive act, which are all influenced by omnipresent and insidious power relations; 2) aggression management is not solely the responsibility of managers but must involve several actors including the aggressive individual, peers, human resources department and unions; and 3) each individual needs to play an active role in aggression management and be held responsible and accountable for his/her actions.

Background. Several theoretical models now suggest the need to promote an organizational approach to practice change for nursing. Objectives. To examine organizational factors that influence revisions and modifications to policies and procedures in health care agencies that participated in a pilot implementation and evaluation of six clinical practice guidelines developed by the Registered Nurses Association of Ontario. To describe the nature and extent of changes to policies and procedures from the perspective of nursing administrators, clinical resource nurses and nursing staff. Conclusion. Organizational support in the form of perceived support by top management, sufficient time and training to learn how to use the clinical guideline, adequate number of qualified staff and sufficient equipment and supplies to implement the clinical guideline is important and can influence nurses' awareness of evidence-based modification of policies and procedures. Further research is needed to compare nurses' actual practice with current policies and procedures. In addition, research is needed to determine whether organizations that modified or internalized their policies and procedures sustained the implementation of the clinical guidelines recommendations better over time. (Abstract shortened by UMI.)