The need to be more efficient: lessons learned from a department of nursing reorganization.

The Department of Nursing at General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri, recently reorganized to improve efficiency. Evening, night, and weekend supervisors were eliminated and a new "crisis nurse" role was established. Excess inpatient resources were shifted to outpatient clinics. The process of planning and implementing the reorganization is described. Evaluation was accomplished by reviewing objective criteria as well as outcomes of crisis nurse and middle management seminars and a comprehensive staff survey. The reorganization did not appear to adversely affect quality of patient care, but lessons were learned regarding staff morale, departmental communication patterns, clarification of newly established roles, and participation of middle managers in planning and decision making.