Cleva, Joyce.

The purpose of this study was to describe the practice of nursing and the factors that influence nursing practice in one patient care setting where the Director is not a nurse. A qualitative design employing the methods of grounded theory was utilized. Reaching for Completeness was the core concept that emerged from the analysis. Reaching for Completeness describes the directionality of nursing practice in this setting. It includes: coming to Know the Client, Responding to the Immediate Needs of the Client, and Pulling it All Together. Factors that appeared to influence the practice of nursing in this setting were the management styles of the director and nurse manager, shared expectations of professionalism, and a shared sense of satisfaction in what the patients and staff accomplished together each day. The results of this study suggest that the main factor affecting the development of nursing practice in a patient care setting may not be whether the director is a nurse, but rather, whether nursing retains ownership of the practice of nursing.