Substitution among nurses: its impact on charge nurses' perceptions of quality of care.

The results of the study suggest that both independent variables influence the charge nurses' perceptions. The relationship between the independent and dependent variables provides an understanding of the decision-making process that a charge nurse follows in making substitution decisions. The management policy implications of the study are as follows. Allowing charge nurses the flexibility for nurse substitutions is helpful in dealing with problems associated with nurse shortages and varying patient needs. Charge nurses observe specific decision rules for substitutions among nurses to balance staff availability with patient need while preserving standards of quality of care. Finally, nurse substitutions have a potential for cost savings.