Head nurses as middle managers.

The relationship between head nurses and their staff nurses influences staff turnover rates and job satisfaction. In this article the author describes the measures taken by the management of Greater Southeast Community Hospital in response to an increasing turnover rate among staff RNs. In recognition of the head nurse role vis-d-vis attrition rates and job satisfaction, head nurses were upgraded to department head status and rigorous head nurse performance standards were developed. These standards required clinical expertise, managerial competence, and accountability. It is the author's contention that clinical practice and staff morale are directly related to a clearly defined head nurse role.